Increased cancer risk in acromegaly patients – the never ending controversy

H. Duskin-Bitan*a (Dr), A. Perezb (Dr), D. Netzerb (Dr), AD. Cohenb (Prof), D. Comaneshterb (Dr), S. Yaronb (Dr), T. Beckensteinb (Mrs), H. Masri-Iraqia (Dr), I. Shimona (Prof)

a Rabin Medical Center, Petah-Tikva, ISRAEL ; b Clalit Health Services, Tel-Aviv, ISRAEL

* hadar_das@yahoo.com

Introduction: The potential association between acromegaly and cancer has long been hypothesized, with inconsistent study results, some reporting higher prevalence of cancer rates, especially colorectal and thyroid, whereas others show no increase. Cancer screening in acromegaly has been a highly controversial issue.

Objective: To investigate the prevalence of malignant neoplasms in patients with acromegaly, utilizing a large cohort of patients with acromegaly.

Material and methods: A retrospective study was performed between 2000 and 2021. We utilized the database of Clalit Health Services, the largest public healthcare provider organization in Israel. Data was collected from records of general community and primary clinics, referral centers as well from hospital care.

Results: A total of 601 acromegaly patients and 2,979 matched controls without acromegaly were included, 53% males, with mean age at diagnosis of 51 (±19) years. The prevalence of all solid malignancies was greater in acromegaly patients, 21.3% vs 14.2%, [OR] 1.6, CI 1.3-2.0, whereas specific evaluation of different cancers found that only thyroid cancer was more prevalent in patients with acromegaly than in control subjects, 2.5% vs 0.6%, [OR] 4.5, CI 2.2-9.0. Other malignancies showed a tendency for a greater prevalence without statistical significance -colorectal cancer, 3.2% vs 2.6%, [OR] 1.2 (0.7-2.0), prostate cancer, 2.3% vs 1.6% [OR] 1.5, CI 0.8-2.7, and lung cancer, 1.8% vs 1.4%, [OR] 1.3, CI 0.7-2.5. Breast cancer prevalence was similar between the acromegaly and the matched controls, 3% vs .3.2%, [OR] 0.9, CI 0.5-1.5. There was no significant increase in the prevalence of hematological malignancies among acromegaly patients.

Discussion: Overall, solid tumors were more prevalent in in a large cohort of acromegaly patients when compared to matched controls. Thus, active cancer screening may be considered for early detection of solid cancers, in particularly thyroid cancer.

The author has declared no conflict of interest.