title: Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study.
abstract: BACKGROUND
  The concern regarding cancer risk has resulted in the recommendation to pull calcitonin nasal spray (CNS) from the market.
  
  
  OBJECTIVE
  We conducted a nested case-control study to evaluate the association between CNS use in osteoporosis patients in Taiwan and their subsequent risk of cancer.
  
  
  METHODS
  This was a population-based nested case-control study.
  
  
  METHODS
  Data were obtained from the Taiwan National Health Insurance Research Database.
  
  
  METHODS
  The study cohort consisted of 28 222 patients diagnosed with osteoporosis between January 1, 2000, and December 31, 2011. We identified 1925 cancer patients as the study group and 2 noncancer patients frequency matched according to age at index date, sex, comorbidity, index-year, and osteoporosis-year as the control group.
  
  
  METHODS
  Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression analysis.
  
  
  RESULTS
  Use of CNS in women with osteoporosis significantly increased the risk of liver cancer (OR = 1.94, 95% CI = 1.23-3.05) but decreased the risk of breast cancer (OR = 0.35, 95% CI = 0.15-0.80). Further analysis of monthly CNS dosages showed that the association between CNS and liver cancer is limited to higher-dose users.
  
  
  CONCLUSIONS
  The findings of this population-based nested case-control study suggest that CNS use might increase the risk of liver cancer in female osteoporosis patients but decrease the risk of breast cancer. Our data do not completely support the decision to discontinue use of CNS in osteoporosis patients.
authors.affiliation: Department of Radiation Oncology (L.-M.S.), Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung 813, Taiwan; Department of Nuclear Medicine (M.-C.L.), E-DA Hospital, Kaohsiung 82445, Taiwan; Management Office for Health Data (C.-H.M.); and Graduate Institute of Clinical Medical Science (J.-A.L., C.-H.K.), School of Medicine, College of Medicine; and Department of Radiation Oncology (J.-A.L.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung 40447, Taiwan.
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Sun
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Lin
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D002116:Calcitonin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D059085:Nasal Sprays; D010024:Osteoporosis / Q000188:drug therapy*; D012306:Risk; D013624:Taiwan / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D059085:Nasal Sprays; D002116:Calcitonin