title: Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study.
abstract: OBJECTIVE
  GH and IGFs have mitogenic properties, causing speculation that GH treatment could increase risk of malignancy. While studies in GH-treated childhood cancer survivors have suggested a slight increase in second neoplasms, studies in GH-treated adults have been equivocal. Design Incidence of de novo and second cancers was evaluated in 6840 GH-treated and 940 non GH-treated adult patients in the Hypopituitary Control and Complications Study pharmacoepidemiological database.
  
  
  METHODS
  Evident cancer cases were evaluated in the main analysis, with sensitivity analyses including probable and possible cancers. Standardized incidence ratios (SIRs) for cancers were calculated using Surveillance, Epidemiology and End Results for the USA and GLOBOCAN for all other countries.
  
  
  RESULTS
  During the mean follow-up of 3.7 years/GH-treated patient, 142 evident cancer cases were identified, giving an overall SIR of 0.88 (95% confidence interval (CI) 0.74-1.04); 95% CIs included the value of 1.0 for each country examined. The SIR for GH-treated patients from the USA (71 cases) was 0.94 (95% CI 0.73-1.18), and for non GH-treated patients from the USA (27 cases) was 1.16 (95% CI 0.76-1.69). For GH-treated patients from the USA aged <35 years, the SIR (six cases) was 3.79 (1.39-8.26), with SIR not elevated for all other age categories; SIR for patients from the USA with childhood onset (CO) GH deficiency (GHD) was 2.74 (95% CI 1.18-5.41). The SIR for colorectal cancer in GH-treated patients (11 cases) was 0.60 (95% CI 0.30-1.08).
  
  
  CONCLUSIONS
  With relatively short follow-up, the overall primary cancer risk in 6840 patients receiving GH as adults was not increased. Elevated SIRs were found for subgroups in the USA cohort defined by age <35 years or CO GHD.
authors.affiliation: Lilly Research Laboratories, Lilly Research Centre, Erl Wood Manor, Windlesham, Surrey GU20 6PH, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Child
authors.forename: Alan G
authors.initials: AG
authors.lastname: Zimmermann
authors.forename: Whitney W
authors.initials: WW
authors.lastname: Woodmansee
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Jian J
authors.initials: JJ
authors.lastname: Li
authors.forename: Heike
authors.initials: H
authors.lastname: Jung
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Erfurth
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000009:adverse effects / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors
chemical_list: D019382:Human Growth Hormone