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Bisphosphonate use does not raise cancer risk

Oral bisphosphonates do not increase the risk of oesophageal or gastric cancer

Louise Prime

Thursday, 12 August 2010

Oral bisphosphonate use is not a risk factor for oesophageal or gastric cancer, a large UK study has shown. Earlier reports had raised suspicion that this class of osteoporosis drugs, which it’s known can cause oesophagitis, could also be a causal factor in oesophageal cancer.

Researchers from the Centre for Public Health at Queen’s University, Belfast, conducted a large study of general practice data to investigate the possibility of a causal link; their findings are published in this week’s JAMA. “Oesophagitis is a known adverse effect of bisphosphonate use, and recent reports suggest a link between bisphosphonate use and oesophageal cancer, but this has not been robustly investigated,” they say.

“Large studies with appropriate comparison groups, adequate follow-up, robust characterisation of bisphosphonate exposure, and information on relevant confounders are required to determine whether bisphosphonates increase oesophageal cancer risk.”

Chris Cardwell and others analysed data from the General Practice Research Database, on the incidence of oesophageal and gastric cancer in more than 83,000 patients; half of them were taking a bisphosphonate, and the others – controls – were not. Most patients (81 per cent) were women, with an average age of 70 years. Mean follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively.

The risk of oesophageal and gastric cancer was similar in each cohort. A combined total of 116 cases of oesophageal and gastric cancer occurred in the bisphosphonate group, and 115 in the control group. For oesophageal cancer alone, there were 79 cases in the bisphosphonate group and 72 in the control group. Risk of oesophageal or gastric cancer did not vary by duration of bisphosphonate intake.

“In the UK GPRD patient population we found no evidence for a substantially increased risk of oesophageal (or gastric) cancer in persons using oral bisphosphonates. These drugs should not be withheld, on the basis of possible oesophageal cancer risk, from patients with a genuine clinical indication for their use,” the authors conclude.

JAMA. 2010;304[6]:657-663

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