The effect of medications which cause inflammation of the gastro-oesophageal tract on cancer risk

a nested case-control study of routine Scottish data

John Busby, Peter Murchie, Liam Murray, Lisa Iversen, Amanda J. Lee, Andrew Spence, Margaret C. Watson, Chris R. Cardwell

Research output: Contribution to journalArticle

2 Citations (Scopus)
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Abstract

Bisphosphonate, tetracycline and spironolactone use has been shown to increase gastro-oesophageal inflammation, an accepted risk factor for cancer. However, evidence of the effect of these medications on gastro-oesophageal cancer risk are mixed or missing entirely. Therefore, we conducted a nested case–control study using the Primary Care Clinical Information Unit Research (PCCIUR) database from Scotland. Cases with oesophageal or gastric cancer between 1999 and 2011 were matched to up to five controls based on age, gender, year of diagnosis and general practice. Medication use was ascertained using electronic prescribing records. Conditional logistic regression was used to calculate odds ratios (ORs) for the association between medication use and cancer risk after adjustment for comorbidities and other medication use. A similar proportion of gastro-oesophageal cancer cases received bisphosphonates (3.9% vs. 3.5%), tetracycline (6.0% vs. 6.0%) and spironolactone (1.4% vs. 1.1%) compared with the controls. The adjusted ORs for the association between gastro-oesophageal cancer and bisphosphonates, tetracycline and spironolactone were 1.05 (95% CI: 0.85, 1.31), 0.99 (95% CI: 0.84, 1.17) and 1.04 (95% CI: 0.73, 1.49). Further analysis revealed bisphosphonates were associated with increased oesophageal cancer risk (1.34, 95% CI: 1.03, 1.74) but reduced gastric cancer risk (0.71, 95% CI: 0.49, 1.03), although there was no obvious dose–response relationship. Overall, there is little evidence that the use of bisphosphonate, tetracycline or spironolactone is associated with increased risk of gastro-oesophageal cancer. Our findings should reassure GPs and patients that these widely-used medications are safe with respect to gastro-oesophageal cancer risk.
Original languageEnglish
Pages (from-to)1828-1835
Number of pages8
JournalInternational Journal of Cancer
Volume140
Issue number8
Early online date6 Feb 2017
DOIs
Publication statusPublished - 23 Feb 2017

Fingerprint

Esophageal Neoplasms
Case-Control Studies
Diphosphonates
Spironolactone
Inflammation
Tetracycline
Neoplasms
Stomach Neoplasms
Electronic Prescribing
Odds Ratio
Risk Adjustment
Scotland
General Practice
Comorbidity
Primary Health Care
Logistic Models
Databases
Research

Keywords

  • risk factors
  • esophageal cancer
  • gastric cancer
  • case-control studies
  • inflammation

Cite this

Busby, John ; Murchie, Peter ; Murray, Liam ; Iversen, Lisa ; Lee, Amanda J. ; Spence, Andrew ; Watson, Margaret C. ; Cardwell, Chris R. / The effect of medications which cause inflammation of the gastro-oesophageal tract on cancer risk : a nested case-control study of routine Scottish data. In: International Journal of Cancer. 2017 ; Vol. 140, No. 8. pp. 1828-1835.
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abstract = "Bisphosphonate, tetracycline and spironolactone use has been shown to increase gastro-oesophageal inflammation, an accepted risk factor for cancer. However, evidence of the effect of these medications on gastro-oesophageal cancer risk are mixed or missing entirely. Therefore, we conducted a nested case–control study using the Primary Care Clinical Information Unit Research (PCCIUR) database from Scotland. Cases with oesophageal or gastric cancer between 1999 and 2011 were matched to up to five controls based on age, gender, year of diagnosis and general practice. Medication use was ascertained using electronic prescribing records. Conditional logistic regression was used to calculate odds ratios (ORs) for the association between medication use and cancer risk after adjustment for comorbidities and other medication use. A similar proportion of gastro-oesophageal cancer cases received bisphosphonates (3.9{\%} vs. 3.5{\%}), tetracycline (6.0{\%} vs. 6.0{\%}) and spironolactone (1.4{\%} vs. 1.1{\%}) compared with the controls. The adjusted ORs for the association between gastro-oesophageal cancer and bisphosphonates, tetracycline and spironolactone were 1.05 (95{\%} CI: 0.85, 1.31), 0.99 (95{\%} CI: 0.84, 1.17) and 1.04 (95{\%} CI: 0.73, 1.49). Further analysis revealed bisphosphonates were associated with increased oesophageal cancer risk (1.34, 95{\%} CI: 1.03, 1.74) but reduced gastric cancer risk (0.71, 95{\%} CI: 0.49, 1.03), although there was no obvious dose–response relationship. Overall, there is little evidence that the use of bisphosphonate, tetracycline or spironolactone is associated with increased risk of gastro-oesophageal cancer. Our findings should reassure GPs and patients that these widely-used medications are safe with respect to gastro-oesophageal cancer risk.",
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The effect of medications which cause inflammation of the gastro-oesophageal tract on cancer risk : a nested case-control study of routine Scottish data. / Busby, John; Murchie, Peter; Murray, Liam; Iversen, Lisa; Lee, Amanda J.; Spence, Andrew; Watson, Margaret C.; Cardwell, Chris R.

In: International Journal of Cancer, Vol. 140, No. 8, 23.02.2017, p. 1828-1835.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of medications which cause inflammation of the gastro-oesophageal tract on cancer risk

T2 - a nested case-control study of routine Scottish data

AU - Busby, John

AU - Murchie, Peter

AU - Murray, Liam

AU - Iversen, Lisa

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AU - Cardwell, Chris R.

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AB - Bisphosphonate, tetracycline and spironolactone use has been shown to increase gastro-oesophageal inflammation, an accepted risk factor for cancer. However, evidence of the effect of these medications on gastro-oesophageal cancer risk are mixed or missing entirely. Therefore, we conducted a nested case–control study using the Primary Care Clinical Information Unit Research (PCCIUR) database from Scotland. Cases with oesophageal or gastric cancer between 1999 and 2011 were matched to up to five controls based on age, gender, year of diagnosis and general practice. Medication use was ascertained using electronic prescribing records. Conditional logistic regression was used to calculate odds ratios (ORs) for the association between medication use and cancer risk after adjustment for comorbidities and other medication use. A similar proportion of gastro-oesophageal cancer cases received bisphosphonates (3.9% vs. 3.5%), tetracycline (6.0% vs. 6.0%) and spironolactone (1.4% vs. 1.1%) compared with the controls. The adjusted ORs for the association between gastro-oesophageal cancer and bisphosphonates, tetracycline and spironolactone were 1.05 (95% CI: 0.85, 1.31), 0.99 (95% CI: 0.84, 1.17) and 1.04 (95% CI: 0.73, 1.49). Further analysis revealed bisphosphonates were associated with increased oesophageal cancer risk (1.34, 95% CI: 1.03, 1.74) but reduced gastric cancer risk (0.71, 95% CI: 0.49, 1.03), although there was no obvious dose–response relationship. Overall, there is little evidence that the use of bisphosphonate, tetracycline or spironolactone is associated with increased risk of gastro-oesophageal cancer. Our findings should reassure GPs and patients that these widely-used medications are safe with respect to gastro-oesophageal cancer risk.

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KW - esophageal cancer

KW - gastric cancer

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