{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:38Z","timestamp":1787022158774,"version":"build-2736575974"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T00:00:00Z","timestamp":1730332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple sclerosis (MS) and cancer present substantial global health challenges. Understanding cancer patterns among people with MS (PwMS) is crucial due to potential variations across demographics and geographic regions. Isfahan province in Iran, known for its high MS incidence ratio, offers a significant population for comprehensive studies on MS. In this study, we aim to investigate the association between risk of cancer and MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Data on PwMS were collected utilizing the National Multiple Sclerosis Registry System of Iran (NMSRI), with diagnoses confirmed using McDonald criteria by neurologists specialized in MS. Cancer incidence was investigated using the Iranian National Population-Based Cancer Registry (INPCR) data, collected following international protocols. Descriptive statistics and regression analyses were employed to assess factors associated with cancer and mortality risks among PwMS. Survival analysis was conducted using Kaplan-Meier curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 10,049 PwMS, 123 were diagnosed with cancer, with an mean age at the time of cancer diagnosis being 40.41 years and a mean MS duration of 6.76 years. The majority had relapsing-remitting MS (81.2%), and Interferon-\u03b2 was the most common disease-modifying therapy (DMT) (42.4%). Cancer incidence was 125.6 per 100,000 person-years, peaking at ages 60\u201364 (677.9 per 100,000 person-years). Receiving monoclonal antibody medications and older age were significantly associated with higher cancer risk (OR:1.542 (1.009\u20132.357), OR:1.033 (1.015\u20131.051), respectively). Female breast cancer had the highest incidence ratio among PwMS (40.17 per 100,000 person-years), followed by thyroid (18.38 per 100,000\n                      <jats:italic>person-years<\/jats:italic>\n                      ) and digestive system cancers (17.36 per 100,000\n                      <jats:italic>person-years<\/jats:italic>\n                      ). Breast cancer was the predominant cancer in women, while digestive system cancers were most common among men. Being male and having longer MS duration were linked to higher cancer mortality risk (HR: 2.683, 1.087, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cancer incidence among 10,049 people with multiple sclerosis was significant, especially in older individuals, with breast cancer being the most common. Male gender and longer MS duration were linked to higher cancer mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0312707","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T13:37:46Z","timestamp":1730381866000},"page":"e0312707","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cancer and mortality risks among people with multiple sclerosis: A population-based study in Isfahan, Iran"],"prefix":"10.1371","volume":"19","author":[{"given":"Amirhossein","family":"Nafari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Vaheb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Afshari-Safavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Ravankhah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fotooheh","family":"Teimouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6960-1265","authenticated-orcid":true,"given":"Vahid","family":"Shaygannejad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Mirmosayyeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,31]]},"reference":[{"key":"pone.0312707.ref001","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/ene.13819","article-title":"Multiple sclerosis\u2013a review","volume":"26","author":"R Dobson","year":"2019","journal-title":"European journal of neurology"},{"key":"pone.0312707.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12883-018-1026-3","article-title":"Pediatric multiple sclerosis: a review.","volume":"18","author":"R Alroughani","year":"2018","journal-title":"BMC neurology"},{"key":"pone.0312707.ref003","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS.","volume":"26","author":"C Walton","year":"2020","journal-title":"Multiple Sclerosis Journal"},{"key":"pone.0312707.ref004","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/j.1600-0404.1996.tb00019.x","article-title":"Multiple sclerosis and cancer in Norway A retrospective cohort study","volume":"93","author":"R Midgard","year":"1996","journal-title":"Acta neurologica scandinavica"},{"key":"pone.0312707.ref005","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s00415-020-10170-5","article-title":"Increasing cancer risk over calendar year in people with multiple sclerosis: a case\u2013control study","volume":"268","author":"C Zecca","year":"2021","journal-title":"Journal of neurology"},{"key":"pone.0312707.ref006","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s40263-018-0564-y","article-title":"Cancer risk in patients with multiple sclerosis: potential impact of disease-modifying drugs.","volume":"32","author":"C Lebrun","year":"2018","journal-title":"CNS drugs"},{"key":"pone.0312707.ref007","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1177\/1352458507083625","article-title":"Cancer risk and impact of disease-modifying treatments in patients with multiple sclerosis","volume":"14","author":"C Lebrun","year":"2008","journal-title":"Multiple Sclerosis Journal"},{"key":"pone.0312707.ref008","doi-asserted-by":"crossref","first-page":"2954","DOI":"10.3389\/fimmu.2019.02954","article-title":"Multiple sclerosis and cancer: the ying-yang effect of disease modifying therapies.","author":"E Melamed","year":"2020","journal-title":"Frontiers in immunology"},{"key":"pone.0312707.ref009","doi-asserted-by":"crossref","first-page":"103679","DOI":"10.1016\/j.msard.2022.103679","article-title":"Incidence of malignant neoplasms and mortality in people affected by multiple sclerosis in the epoch of disease-modifying treatments: A population-based study on Tuscan residents.","volume":"60","author":"A Mariottini","year":"2022","journal-title":"Multiple Sclerosis and Related Disorders"},{"key":"pone.0312707.ref010","doi-asserted-by":"crossref","first-page":"104417","DOI":"10.1016\/j.msard.2022.104417","article-title":"Cancer related mortality in multiple sclerosis. A population based cohort study","volume":"69","author":"N Grytten","year":"2023","journal-title":"Multiple Sclerosis and Related Disorders"},{"key":"pone.0312707.ref011","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/1352458514564489","article-title":"A systematic review of the incidence and prevalence of cancer in multiple sclerosis","volume":"21","author":"RA Marrie","year":"2015","journal-title":"Multiple Sclerosis Journal"},{"key":"pone.0312707.ref012","doi-asserted-by":"crossref","first-page":"105479","DOI":"10.1016\/j.msard.2024.105479","article-title":"Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study.","volume":"84","author":"M Barzegar","journal-title":"Multiple Sclerosis and Related Disorders 2024"},{"key":"pone.0312707.ref013","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jneuroim.2018.02.019","article-title":"An 8-year study of people with multiple sclerosis in Isfahan, Iran: Association between environmental air pollutants and severity of disease","volume":"319","author":"F Ashtari","year":"2018","journal-title":"Journal of neuroimmunology"},{"key":"pone.0312707.ref014","article-title":"Statistical Centre of Iran","volume":"2016","author":"S. Iran","year":"2016","journal-title":"Iran Population and Housing Census"},{"key":"pone.0312707.ref015","doi-asserted-by":"crossref","first-page":"6580","DOI":"10.1038\/s41598-023-33660-8","article-title":"Climate change impacts on optimal habitat of Stachys inflata medicinal plant in central Iran.","volume":"13","author":"M Shaban","year":"2023","journal-title":"Scientific Reports"},{"key":"pone.0312707.ref016","doi-asserted-by":"crossref","first-page":"104610","DOI":"10.1016\/j.msard.2023.104610","article-title":"The national multiple sclerosis registry system of Iran (NMSRI): Aspects and methodological dimensions.","volume":"72","author":"S Ayoubi","year":"2023","journal-title":"Multiple Sclerosis and Related Disorders"},{"key":"pone.0312707.ref017","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"AJ 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sclerosis: results of an international survey","volume":"46","author":"FD Lublin","year":"1996","journal-title":"Neurology"},{"key":"pone.0312707.ref022","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","author":"JF ME","year":"2024"},{"key":"pone.0312707.ref023","doi-asserted-by":"crossref","first-page":"49","DOI":"10.7224\/1537-2073-13.2.49","article-title":"Barriers and facilitators related to breast cancer screening: A qualitative study of women with multiple sclerosis.","volume":"13","author":"A Todd","year":"2011","journal-title":"International journal of MS care"},{"key":"pone.0312707.ref024","article-title":"Association between multiple sclerosis and cancer risk: An extensive review\/meta and Mendelian randomization analyses.","volume":"104798","author":"Q Liu","year":"2023","journal-title":"Multiple Sclerosis and Related 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Evans","year":"2020","journal-title":"Medicine"},{"key":"pone.0312707.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15280\/jlm.2021.11.1.1","article-title":"Impact of lifestyle behaviors on cancer risk and prevention","volume":"11","author":"J-W Choi","year":"2021","journal-title":"Journal of Lifestyle Medicine"},{"key":"pone.0312707.ref035","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1136\/jnnp-2016-315238","article-title":"Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study","volume":"88","author":"HMB Lunde","year":"2017","journal-title":"Journal of NeurologyNeurosurgery & Psychiatry"},{"key":"pone.0312707.ref036","doi-asserted-by":"crossref","first-page":"1073278","DOI":"10.3389\/fpubh.2023.1073278","article-title":"Global, regional, and national burden of multiple sclerosis from 1990 to 2019: findings of global burden of disease study 2019.","volume":"11","author":"Z Qian","year":"2023","journal-title":"Frontiers in public health"},{"key":"pone.0312707.ref037","doi-asserted-by":"crossref","first-page":"e1798","DOI":"10.1212\/WNL.0000000000200163","article-title":"Multiple sclerosis and the cancer diagnosis: diagnostic route, cancer stage, and the diagnostic interval in breast and colorectal cancer","volume":"98","author":"PA Groome","year":"2022","journal-title":"Neurology"},{"key":"pone.0312707.ref038","first-page":"737","volume-title":"Cancer Screening in Patients With Multiple Sclerosis: Are We Doing Enough?:","author":"JH Yang","year":"2022"},{"key":"pone.0312707.ref039","first-page":"13524585231223880","article-title":"Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society.","author":"N Collongues","year":"2024","journal-title":"Multiple Sclerosis Journal"},{"key":"pone.0312707.ref040","article-title":"Concurrent glioma and multiple sclerosis: A systematic review of case 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Frahm","year":"2020","journal-title":"Therapeutic Advances in Neurological Disorders"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T13:38:00Z","timestamp":1730381880000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312707"}},"subtitle":[],"editor":[{"given":"Mohammad 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