Possible link

[Pieater67]

Have read 70 percent of patients diagnosed with PMR go on to get diagnosed with Ca with in 6 months of PMR first being diagnosed.

[Hidden]

Where have you read this?

[DorsetLady PMRGCAuk volunteer]

Think that's a very high percentage, as Mrs Nails asked - what source?

[PMRpro Ambassador in reply to DorsetLady]

Someone mentioned this somewhere recently as having read it in Kate Gilbert's book. The denouement is below.

[PMRpro Ambassador]

That is in Kate Gilbert's book isn't it? I have to say - I have no idea what she means because I'm pretty sure it isn't true!

PMR is not the disease, it is the name given to a set of symptoms which is due to an underlying illness. In the case of the PMR we discuss on the forum it is an autoimmune disorder but it can also be due to other illnesses including some cancers. These should be screened for when any patient goes to the doctor with the symptoms. Only once these have been excluded should the diagnosis of PMR as we mean it be suggested.

In this paper in the BMJ (which I assume is the source to which Kate may have been referring):

Is cancer associated with polymyalgia rheumatica?

A cohort study in the General Practice Research Database

by Sara Muller, Samantha L Hider, John Belcher, Toby Helliwell, Christian D Mallen

they looked at the numbers and this is the abstract:

"Objective: To investigate the incidence of new cancer

diagnoses in a community sample of patients with polymyalgia rheumatica (PMR).

Methods: All incident cases of PMR in the UK General

Practice Research Database (GPRD) (1987–99), without pre-existing cancer or vascular disease and treated with corticosteroids (n=2877) were matched with up to five age, sex and GP practice patients without PMR (n=9942). Participants were followed up until first

cancer diagnosis, death, transfer out of the database or end of available records.

Results: The mean age of the sample was 71.6 years

(SD 9.0), 73% were female. Median follow-up time was 7.8 years (IQR 3.4, 12.3). 667 (23.2%) people with a PMR diagnosis developed cancer compared with 1938 (19.5%) of those without PMR. There was an interaction between PMR status and time. In the first 6 months after diagnosis, those with a PMR diagnosis were significantly more likely to receive a cancer diagnosis (adjusted HR (95% CI): 1.69 (1.18 to 2.42)). The number of events was small, but occurrences of prostate, blood, lymph nodes, female reproductive and nervous system cancers may be more common in those with PMR in the first 6 months after PMR diagnosis.

Conclusions: An increase in the rate of cancer diagnoses was noted in the first 6 months of observation, but we were unable to determine whether the cancer incidence in PMR was different from controls, beyond this time point. Clinicians should ensure they fully exclude cancer as a cause of PMR-like symptoms and monitor patients for possible malignancies."

This doesn't mean that PMR causes cancer - it means that certain cancers may start with PMR like symptoms and the initial assumption that it is "just" PMR was wrong in a small number of patients. In the discussion it says there is "a 69% increased risk of a cancer diagnosis

within the first 6 months after a PMR diagnosis." That doesn't mean that about 70% of patients go on to develop cancer. It is an increase of relative risk not in absolute numbers.

Over the period of the study (7.8 years), it meant that in a group of 100 patients without PMR they would have found 20 with cancer. In a corresponding group of patients WITH PMR, in the same period they would have found 23 patients with cancer. But the most likely time to detect the cancer was In the first 6 months after presentation with PMR and that is where the 70% figure comes in. In that period of 6 months 1.69 times as many patients with PMR were found to have cancer as patients without PMR.

The actual numbers were similar over the entire period of the study, only 3% more overall developed cancer in that time. They go on to say that another larger scale study showed that patients with GCA do not have any increased risk of developing cancer over years:

"the largest study, comparing 36 918 people in Sweden hospitalised with PMR or GCA with population controls and, as in our study, found no increased risk of cancer in the long term, but an excess of cancer diagnoses within the first year."

So it isn't a case of PMR causes cancer - it is that people with cancer often go to the doctor complaining of polymyalgia type symptoms and it is important that the GP doesn't jump to conclusions about the cause of the symptoms.

This is the link for the paper if you want to see where I took the figures and information from:

ard.bmj.com/content/early/2...

[markbenjamin57 in reply to PMRpro]

Dear PMRpro

Many thanks for your critical analysis of the facts and published data in response to speculation about the causes and implications of PMR. As a medical research specialist (as you have suggested somewhere here in the past ?), it's obvious that you know your stuff and are a steadying 'anchor' factually for those of us relative innocents for whom PMR is a mysterious and often scary illness to deal with.

Also, thanks for taking the time and trouble to explain all of this in layman's (or should I say women's!) terms.

Keep up your great work on this forum!

MB

[PMRpro Ambassador in reply to markbenjamin57]

Believe me Mark, my brain hurt by the time I'd found the paper and worked out how to say it in plain language - I hope it makes sense! It is far easier to understand what is meant than to explain it! Its the same as the scare stuff you see in the gutter press about something doubling your risk of whatever - if 1 in a million develop a particular cancer and because of eating grilled bacon and sausages 2 in a million would develop that cancer, that is a doubling in risk. But the actual figure is still vanishingly small...

No, really wouldn't describe myself as a medical research specialist! I'm involved in it - but I leave the statistics to the others, I just advise on patient stuff. Even OH who was far more involved than me kept the statistics low key,

[Hidden]

Everyone wants to hang their hat on PMR as the source of all ills!

I've had aggressive Breast Cancer since I was diagnosed with PMR & none of my Specialist have ever mentioned a connection or have l ever considered one! The only time it was ever mentioned was the vain hope the Chemotherapy might eliminate the PMR but sadly no, it's still kicking around!

As a side note I actually think this could be upsetting to anyone newly diagnosed.....

Mrs N 💅🏼

[PMRpro Ambassador in reply to Hidden]

So do I - that was the feeling I had from the very short post starting the thread. I hope that isn't what was said in the book. I don't have a copy of the 2nd edition - and I have no intention of buying one!

[Hidden in reply to PMRpro]

Thanks PMRpro my copy is 1st edition too, but as you say it's surprising what a short post can trigger!

It upset me really but I've never connected the two.

Best Wishes

Mrs N

[PMRpro Ambassador in reply to Hidden]

Out of interest - what does it actually say in the book?

[Hidden in reply to PMRpro]

PMRpro

I've just been through my copy & no mention of this anywhere?

My book version is 2014, l had it originally on Kindle.

And I'm sure it would have rung a bell when I was diagnosed with BC

Mrs N

[PMRpro Ambassador in reply to Hidden]

It may just be in the 2nd edition (hence my comment) because I don't remember seeing it or I'd have shouted loudly sooner. Someone on another thread/forum even mentioned it a couple of months ago and they had the 2nd edition.

[annie_marie]

Just wanted to add my thanks to pmr/pro for clarifying this original post. It seems obvious to me, a non medical person, that as soon as we start having many visits to the GP and other specialists that different diseases are going to be found, and that the majority of us are over a "certain age" then cancer will be flagged up.

[HeronNS in reply to annie_marie]

Unless, annie-marie, you have a doctor like mine who does not want to consider the possibility that I might ever have anything else wrong with me. High Vitamin D "you can't have the test again too soon" Low bone mass in DXA scan I asked for "be careful what you wish for" Erratic heartbeat "what do you want me to do about that" But that's ok, we've all got to die sometime.

[AnneP01 in reply to HeronNS]

It sounds like a change of doctor is in order. This one sounds dreadful.

[HeronNS in reply to AnneP01]

I only have her because of my desperate state when undiagnosed with PMR and she's been a dream for that. No family doctors around here taking new patients, my old doctor retired about three years ago. But I'm getting kind of concerned about this heart thing, especially as a cousin, who has RA, recently added AF to her resume. I hadn't really grasped how flippant she is until I listed those items.

[Hidden in reply to HeronNS]

Heron you made me laugh ....

[Admiral06]

Pieater67,

In a paper entitled "The Burden of Polymyalgia Rheumatica", Dr. Bhaskar Dasgupta wrote the following: "Life expectancy in patients with polymyalgia rheumatica is equivalent to that of the general population."

[PMRpro Ambassador in reply to Admiral06]

Quite.