Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort
- Jane Green, clinical epidemiologist1,
- Gabriela Czanner, statistician1,
- Gillian Reeves, statistical epidemiologist1,
- Joanna Watson, epidemiologist1,
- Lesley Wise, manager, Pharmacoepidemiology Research and Intelligence Unit2,
- Valerie Beral, professor of cancer epidemiology1
– Author Affiliations
- Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF
- Medicines and Healthcare products Regulatory Agency, Pharmacoepidemiology Research Unit, London SW8 5NQ
BMJ 2010; 341:c4444
Conclusions The risk of oesophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period. In Europe and North America, the incidence of oesophageal cancer at age 60-79 is typically 1 per 1000 population over five years, and this is estimated to increase to about 2 per 1000 with five years’ use of oral bisphosphonates.
Also read,
Wysowski DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med2009;360:89-90.
few things to be noted
1) being a case control study, the problem of bias is to be kept in mind. plus expecting a high evidence study in this topic may not be realistic cuz of the low incidence of the problem (1% in gen population )
2) study itself mentions the inability to find out whether the patients were told bt upper GI safe guard measures ( to take it with plenty of water in empty stomach and to avoid lying down for 30 mts)
3) the confidence limits and intervals of relative risks of associated factors tells us few points
be careful in old patients who has previous h/o gastritis, GERD, smokers or alcoholics (alcoholics more dangerous). concurrents antacids not a bad idea. and always follow the upper GI safeguard tips
also would like to add a cohort study which showed that there s no increase in risk ,,so we will have to wait for a final statement.
http://jama.ama-assn.org/cgi/content/abstract/304/6/657?maxtoshow&hits=10&RESULTFORMAT&fulltext=bisphosphonate&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT