title: Risk of cancer after lumbar fusion surgery with recombinant human bone morphogenic protein-2 (rh-BMP-2).
abstract: METHODS
  Retrospective cohort study among Medicare beneficiaries with lumbar spinal fusion surgery.
  
  
  OBJECTIVE
  To determine the risk of subsequent cancer among patients who received recombinant human bone morphogenic protein (rhBMP) at surgery compared with those who did not.
  
  
  BACKGROUND
  rhBMP is commonly used to promote bone union after spinal surgery. BMP receptors are present on multiple cancer types, but the risk of cancer after receiving rhBMP has not been well studied.
  
  
  METHODS
  We identified 146,278 subjects aged 67 years and older who underwent surgery in 2003 to 2008 and were followed through 2010 for a new diagnosis of 1 of 26 cancers. Proportional hazards models were used to determine cancer risk associated with rhBMP use.
  
  
  RESULTS
  rhBMP was administered in 15.1% of the cohort. After an overall average follow-up of 4.7 years, 15.4% of rhBMP-treated and 17.0% of untreated patients had a new cancer diagnosis, with most commonly recorded types as prostate, breast, lung, and colorectal. In a multivariate proportional hazards model, there was no association of rhBMP with cancer risk (hazard ratio: 0.99, 95% confidence interval: 0.95-1.02). There was also no association of rhBMP with the risk of any individual cancer types. The results were consistent in analyses using 2 secondary definitions of incident cancer.
  
  
  CONCLUSIONS
  In this large population-based analysis of Medicare beneficiaries, we found no evidence that administration of rhBMP at the time of lumbar fusion surgery was associated with cancer risk.
  
  
  METHODS
  4.
authors.affiliation: From the Division of Gastroenterology; University Hospitals Case Medical Center, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Tzuyung Doug
authors.initials: TD
authors.lastname: Kou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2 / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000139:chemically induced / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D014481:United States
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins