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Introduction: The use of anti-tumour necrosis factor (anti-TNF) therapy is increasing in the treatment of rheumatoid arthritis (RA), spondyloarthropathy, psoriasis and inflammatory bowel disease. It is being debated whether treatment of patients with rheumatic diseases with anti-TNF therapy is associated with an increased cancer incidence., Material and Methods: A descriptive study of cancer cases among 3,688 patients with rheumatic diseases who received anti-TNF therapy was performed. The patients were identified in the nationwide database DANBIO and had a total number of treatment years of 6,092 years. All cancer cases were identified and the cancer diagnoses were subsequently confirmed by medical record review., Results: A total of 30 cancers in 28 of 3,688 patients were registered in the DANBIO after initiation of anti-TNF therapy in the period from October 2000 to June 2007. Among these six men and 20 women had RA, and two men had Morbus Becterew. The following cancer types were observed: malignant lymphoma 2 (7%), lung 4 (13%), plicae vocalis 2 (7%), breast 4 (13%), pancreatic 3 (10%), colorectal 2 (7%), prostate 1 (3%), malignant melanoma 3 (10%) and non-melanoma skin cancer 9 (30%)., Conclusion: In our descriptive study from the nationwide database DANBIO, a total of 30 cancers were observed in 3,688 patients with rheumatic diseases within a cumulated period of treatment with anti-TNF of 6,092 years. Follow-up for anti-rheumatic and adverse effects in patients in the DANBIO database will continue. Future studies must reveal whether anti-TNF therapy is associated with an increased cancer risk. Planned Danish studies will include relevant control groups and adjustment for confounders.

We report a nationwide study based on a cohort of patients with a thromboembolic event (TE) defined as deep venous thrombosis and/or pulmonary embolism identified from the Danish National Registry of Patients from 1977 to 1993. Cancer occurrence in the cohort was determined by linkage to the Danish Cancer Registry. Expected number of cancer cases was estimated from age, sex and site-specific incidence rates. A total of 26,653 TE-cases were identified. We observed 1737 cases of cancer versus 1371 expected (SIR 1.3; 95% CI, 1.21 to 1.33). The risk was particularly high during the first months of follow-up, but declined rapidly hereafter to a constant level slightly above 1.0 one year after the TE. Forty percent of patients diagnosed with cancer within one year from the hospitalization for TE had distant metastases at the time of cancer diagnosis. The observed risk pattern provides evidence that most often a preclinical cancer gives rise to a subsequent TE. An aggressive search for hidden cancer in patients with TE is not warranted.

In the current study we linked data from the Danish Hospital Discharge Register and the Danish Cancer Registry to estimate cancer occurrence among more than 20,000 patients hospitalized at least once with rheumatoid arthritis during 1977-1987. During a follow-up interval of up to 15 years, we found increased risks of non-Hodgkin's lymphoma, Hodgkin's disease and lung cancer, while the risk of colorectal cancer was decreased. These findings were all in agreement with the results of previous studies from two other Nordic countries, which were based on a similar type of data. We also found an excess of non-melanoma skin cancer and a deficit of female breast cancer, of which only the breast cancer observation had been seen in an earlier study.

In a nationwide cohort of gallstone patients we evaluated the hypothesis that gall stones are associated with an increased risk of cancer of the colon. In the Danish Hospital Discharge Register we identified 42,098 patients with gallstones diagnosed in 1977-1989. These patients were linked to the Danish Cancer Registry in order to assess their risks of colorectal and other cancers during follow-up to the end of 1992. The analysis showed a modest increase in the number of cancers at all sites combined (N = 3940; RR = 1.07; 95% CI = 1.0-1.1). A weak association was found for cancer of the colon (N = 360; RR = 1.09; 95% CI = 1.0-1.2), which remained unchanged when analysed by sex, anatomical subsite and duration of follow-up. Multivariate analysis with adjustment for cholecystectomy and clinically defined obesity did not change these estimates to any significant extent. A nonsignificantly increased risk of breast cancer was seen in women five years after initial discharge for gallstones.

Removal of the spleen may possibly affect functions of the immune system. Cancer risk following splenectomy was evaluated by performing a linked register study in Denmark from 1977-89. From the Hospital Discharge Register we identified 1103 patients splenectomized after traumatic rupture of the spleen and 5212 patients splenectomized for various malignant or non-malignant disorders and both groups were followed for cancer occurrence in the Danish Cancer Registry. No increased risk for cancer was observed among patients who underwent splenectomy due to trauma. In contrast, there were excesses of a number of specific cancers among patients who underwent splenectomy for non-traumatic reasons, but to a large extent this could be explained by factors related to the underlying disease and/or treatment of the disease.