OC29 - THE RISK OF OESOPHAGEAL AND GASTRIC CANCER INCIDENCE AND MORTALITY IN ALENDRONATE USERS: NATIONAL COHORT STUDY
B. Abrahamsen1,*, M. Pazianas2, P. Eiken3, R. G. Russell2, R. Eastell4
1 Dept of Medicine F, GENTOFTE HOSPITAL, Hellerup, Denmark, 2 The Botnar Research Centre, OXFORD UNIVERSITY, Oxford, United Kingdom, 3 Endocrinology & Cardiology, HILLERØD HOSPITAL, Hillerød, Denmark, 4 Academic Unit of Bone Metabolism, UNIVERSITY OF SHEFFIELD, Sheffield, United Kingdom
Abstract: Background: Two recent studies from the GPRD database have reached conflicting conclusions regarding the risk of oesophageal cancer in alendronate users. While interesting, these studies did not proceed to examine the influence on cancer deaths and they did not address endoscopy rates, which could be higher in alendronate users and lead to more upper GI cancers being diagnosed at a stage where they still can be classified as of esophageal origin.
Methods: We retrospectively examined upper endoscopy frequency, cancer incidence and cancer mortality in a large, register-based national cohort of 30,606 alendronate users (female, age 50+) and 122,424 matched controls. For cancer incidence, the median follow-up time was 3.5 y (1-11) and for cancer mortality 5.5y (3-13). Cox models and logistic regressions were used.
Results: Endoscopy had been done in 1.7% of controls but 4.1% of alendronate users (p<0.001) in the year before treatment. After beginning alendronate, the HR for oesophageal cancer was 0.73 (0.44-1.20) and for gastric cancer 0.62 (0.39-0.98), adjusted for comorbidity (Charlson) and baseline endoscopy (0/1). At 3y, the risk of oesophageal cancer death was HR 0.47 (0.23-0.96) and gastric cancer death HR 0.49 (0.26-0.92). Based on a smaller subgroup with long term data (N=25,820) the 9 y risk of oesophageal cancer death was HR 0.98 (0.51-1.80) and the risk of gastric cancer death HR 0.43 (0.19-1.03, p=0.057).
Conclusion: The current study confirms our previous findings (N Engl J Med 2009;360:1789) but now the sample is 4 times bigger and the duration longer. We find no excess in oesophageal cancer deaths nor in oesophageal cancer incidence. The early decrease might relate to the 2.5 times greater use of endoscopy prior to starting alendronate. Reassuringly, long term observations (9 y mortality) also indicated no excess risk of oesophageal cancer death and possibly a decreased risk of gastric cancer death, though power was lower in this subanalysis.
Disclosure of Interest: B. Abrahamsen Grant / Research Support from Roche, Novartis, Amgen, Advisory Board Membership of Nycomed, Amgen, Speaker Fees from Servier, MSD, Eli Lilly, M. Pazianas Consulting fees from Warner Chilcott Pharm, P. Eiken Advisory Board Membership of Nycomed, Amgen, Speaker Fees from Novartis, Eli Lilly, R. Russell Grant / Research Support from Warner Chilcott Pharm, Consulting fees from Amgen, GSK, Novartis, Lilly, Warner Chilcott Pharma, Speaker Fees from Amgen, GSK, Novartis, Lilly, Warner Chilcott Pharma, R. Eastell Grant / Research Support from AstraZeneca, Unilever, Amgen, Procter and Gamble, Unipath, Pfizer, Eli Lilly, Novartis Osteologix, Crescent Diagnostics, Nittoboseki, Nestle Foundation, Sanofi Aventis, Advisory Board Membership of Procter & Gamble and the MRC , Consulting fees from Amgen, AstraZeneca, GlaxoSmithKline, Medtronics, Nastech, Nestle, Fonterra Brands, Novartis, Ono Pharma, Osteologix, Pfizer, Lilly, Sanofi-Aventis, Tethys, Unilever, Unipath, Inverness Medical, Lecture Fees from Takeda, Lilly, Amgen, Procter & Gamble, and GlaxoSmith-Kline Nutrition
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