Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 106, Issue 12, Pages 3487-3496Publisher
ENDOCRINE SOC
DOI: 10.1210/clinem/dgab560
Keywords
Acromegaly; cancer risk; benign tumors; colorectal cancer; kidney cancer; thyroid cancer
Categories
Funding
- Swedish government under the ALF agreement [ALFGBG-719531]
- Pfizer
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The risk of malignancies is slightly increased in acromegaly patients, especially for colorectal and anal cancer, and renal and ureteral cancer. Meanwhile, the incidence of benign tumors has more than doubled in this population.
Context: Whether cancer risk in acromegaly is increased remains controversial, and the risk of benign tumors has been little studied. Objective: To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study. Methods: Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% CIs were calculated using the Swedish general population as reference. Results: The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared with 144 expected in the general population (SIR 1.3; 95% CI 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only 3 cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI 2.1-2.7). Conclusion: Patients with acromegaly had an increased risk of both benign and malignant tumors, including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.
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