Laura Macfarlane wrote this article for an Australian oncology newsletter, Oncology Update, this week:
No link between bisphosphonates and gastric cancers
UK researchers have found no
increased risk of oesophageal and
gastric cancer in people taking
oral bisphosphonates and say
the drugs should not be withheld
on that basis from those with a
clinical indication for their use.
Writing in JAMA, the researchers
noted the lack of evidence
on whether bisphosphonate
related oesophagitis can increase
oesophageal cancer risk but that
cases of oesophageal cancer in
users have been reported by the
US FDA and in Europe and Japan.
Extracting data from the UK
General Practice Research Database
to compare the incidence of
oesophageal and gastric cancer,
the present study authors matched
46,036 oral bisphosphonate users
with 46,036 controls all over the
age of 40 years, men age of 70.
Mean follow up was around
4.5 years for both groups and
over 80% were women.
They found 116 oesophageal
or gastric cancers (79 oesophageal)
in the bisphosphonate group
compared to 115 (72 oesophageal)
in the control cohort.
There was no difference in risk
of oesophageal and gastric cancer
combined between the cohorts for
any bisphosphonate use (adjusted
HR 0.96), and no difference in risk
by duration of bisphosphonate use.
The authors noted that the
association between gastrooesophageal
reflux disease (GORD)
and incidence of oesophageal
and gastric cancer combined, or
oesophageal cancer alone, did
not differ between the bisphosphonate
and control cohorts
(p=0.74 and 0.99 respectively).
They also noted that GORD
diagnosis was associated with
an almost 50% increase in the
incidence of oesophageal and
gastric cancer combined.
“Data from preclinical studies
indicate that bisphosphonates may
affect tumour proliferation, invasion
and angiogenesis, potentially
reducing cancer risk,” they wrote.
On the basis of their findings of
no substantial increased risk of
oesophageal cancer in persons
using oral bisphosphonates the
researchers concluded “these
drugs should not be withheld.”
JAMA 2010: 304(6); 657-663
More evidence not to fear bisphosphonates.
Feel good and keep smiling! Pat