title: Cancer Risks in Patients Treated With Growth Hormone in Childhood: The SAGhE European Cohort Study.
abstract: Growth hormone (GH) is prescribed for an increasing range of indications, but there has been concern that it might raise cancer risk. Published data are limited.
  
  
  
  To examine cancer risks in relation to GH treatment.
  
  
  
  Cohort study.
  
  
  
  Population-based.
  
  
  
  Cohort of 23,984 patients treated with recombinant human GH (r-hGH) in eight European countries since this treatment was first used in 1984. Cancer expectations from country-specific national population statistics.
  
  
  
  Cancer incidence and cancer mortality.
  
  
  
  Incidence and mortality risks in the cohort were raised for several cancer sites, largely consequent on second primary malignancies in patients given r-hGH after cancer treatment. There was no clear raised risk in patients with growth failure without other major disease. Only for bone and bladder cancers was incidence significantly raised in GH-treated patients without previous cancer. Cancer risk was unrelated to duration or cumulative dose of r-hGH treatment, but for patients treated after previous cancer, cancer mortality risk increased significantly with increasing daily r-hGH dose (P trend < 0.001). Hodgkin lymphoma (HL) incidence increased significantly with longer follow-up (P trend = 0.001 for patients overall and 0.002 for patients without previous cancer).
  
  
  
  Our results do not generally support a carcinogenic effect of r-hGH, but the unexplained trend in cancer mortality risk in relation to GH dose in patients with previous cancer, and the indication of possible effects on bone cancer, bladder cancer, and HL risks, need further investigation.
authors.affiliation: Division of Genetics and Epidemiology, Institute of Cancer Research, London SW7 3RP, United Kingdom.|Division of Breast Cancer Research, Institute of Cancer Research, London SW7 3RP, United Kingdom.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Swerdlow
authors.affiliation: Division of Genetics and Epidemiology, Institute of Cancer Research, London SW7 3RP, United Kingdom.
authors.forename: Rosie
authors.initials: R
authors.lastname: Cooke
authors.affiliation: Unité d'Endocrinologie Pédiatrique, CHU NAMUR, Université Catholique de Louvain, 5530 Yvoir, Belgium.|Belgian Society for Pediatric Endocrinology and Diabetology, 1200 Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Beckers
authors.affiliation: Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
authors.forename: Birgit
authors.initials: B
authors.lastname: Borgström
authors.affiliation: University College London, Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom.|University College London Hospitals, National Health Service Foundation Trust, London NW1 2PG, United Kingdom.
authors.forename: Gary
authors.initials: G
authors.lastname: Butler
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Robert-Debré, Department of Pediatric Endocrinology and Diabetology, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France.|PROTECT, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Carel
authors.affiliation: Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital-Tor Vergata University, 00165 Rome, Italy.|Department of Women's and Children's Health, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cianfarani
authors.affiliation: Royal Manchester Children's Hospital, Central Manchester University Hospitals, National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom.|School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester M13 9PL, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Clayton
authors.affiliation: Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 1 Parvis Notre-Dame, 75004 Paris, France.|Equipe d'accueil 4360, University Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.affiliation: Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital-Tor Vergata University, 00165 Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Deodati
authors.affiliation: Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 1 Parvis Notre-Dame, 75004 Paris, France.|Equipe d'accueil 4360, University Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ecosse
authors.affiliation: Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Gausche
authors.affiliation: Centre for Pediatric Endocrinology and Diabetes, Pediatric Unit, Carlo Poma Hospital, 46100 Mantua, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Giacomozzi
authors.affiliation: Dutch Growth Research Foundation, Westzeedijk 106, 3016 AH Rotterdam, The Netherlands.|Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center/Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
authors.forename: Anita C S
authors.initials: ACS
authors.lastname: Hokken-Koelega
authors.affiliation: Royal Manchester Children's Hospital, Central Manchester University Hospitals, National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom.|School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester M13 9PL, United Kingdom.
authors.forename: Aysha J
authors.initials: AJ
authors.lastname: Khan
authors.affiliation: Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.affiliation: Division of Paediatric Endocrinology, Diabetology and Metabolism, University Children's Hospital Bern, Inselspital, 3010 Bern, Switzerland.
authors.forename: Primus-E
authors.initials: PE
authors.lastname: Mullis
authors.affiliation: Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Pfaffle
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Sävendahl
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
authors.forename: Grit
authors.initials: G
authors.lastname: Sommer
authors.affiliation: Belgian Society for Pediatric Endocrinology and Diabetology, 1200 Brussels, Belgium.
authors.forename: Muriel
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Tidblad
authors.affiliation: University College London, Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Tollerfield
authors.affiliation: Belgian Cancer Registry, Department Research, Koningsstraat 215, Box 7-B-1210 Brussels, Belgium.
authors.forename: Liesbet
authors.initials: L
authors.lastname: Van Eycken
authors.affiliation: Dutch Growth Research Foundation, Westzeedijk 106, 3016 AH Rotterdam, The Netherlands.|Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center/Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
authors.forename: Gladys R J
authors.initials: GRJ
authors.lastname: Zandwijken
mesh_terms: D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000150:complications; D001859:Bone Neoplasms / Q000453:epidemiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005060:Europe / Q000453:epidemiology; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology; D006689:Hodgkin Disease / Q000453:epidemiology / Q000401:mortality; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000150:complications; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000401:mortality; D011994:Recombinant Proteins / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012306:Risk; D014424:Turner Syndrome / Q000150:complications; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone