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To the Editor:
Bahmanyar et al.1 report that patients with multiple sclerosis (MS) have a decreased overall cancer risk but an increased risk for brain cancer. No altered risk was detected in first-degree relatives of patients with MS.
This is unexpected because the incidence of gliomas has been considered inversely correlated with altered immune responsiveness and specifically allergies.2 The distribution of histologic diagnoses of the 131 patients with brain tumors was not provided.1
We treated 6 patients with MS and glial brain tumors in the last 6 years (table 1). Patients 1 and 4 had a family history of MS. Bahmanyar et al. argue that the chronic inflammation in the brain associated with MS may promote tumorigenesis.1 They also propose that the neuroimaging monitoring of patients with MS renders the early diagnosis of brain tumors more likely, as illustrated by our patient 4.
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Table 1 Clinical characteristics of MS patients with brain tumors*
While the authors acknowledge that immunosuppressive treatment might promote cancerogenesis, they also contend that this would not explain the differential risk alterations with a decreased overall cancer risk and enhanced risks only for cancers of brain and genitourinary tract.1 However, states of immunosuppression are strongly related to the development of brain lymphomas, and there is also controversial evidence for an increased incidence of …
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