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Cancer Risks in Patients Treated With Growth Hormone in Childhood: The SAGhE European Cohort Study.

  • Swerdlow AJ Division of Genetics and Epidemiology, Institute of Cancer Research, London SW7 3RP, United Kingdom.
  • Cooke R Division of Genetics and Epidemiology, Institute of Cancer Research, London SW7 3RP, United Kingdom.
  • Beckers D Unité d'Endocrinologie Pédiatrique, CHU NAMUR, Université Catholique de Louvain, 5530 Yvoir, Belgium.
  • Borgström B Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
  • Butler G University College London, Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom.
  • Carel JC 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.
  • Cianfarani S Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital-Tor Vergata University, 00165 Rome, Italy.
  • Clayton P Royal Manchester Children's Hospital, Central Manchester University Hospitals, National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom.
  • Coste J Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 1 Parvis Notre-Dame, 75004 Paris, France.
  • Deodati A Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital-Tor Vergata University, 00165 Rome, Italy.
  • Ecosse E Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 1 Parvis Notre-Dame, 75004 Paris, France.
  • Gausche R Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
  • Giacomozzi C Centre for Pediatric Endocrinology and Diabetes, Pediatric Unit, Carlo Poma Hospital, 46100 Mantua, Italy.
  • Hokken-Koelega ACS Dutch Growth Research Foundation, Westzeedijk 106, 3016 AH Rotterdam, The Netherlands.
  • Khan AJ Royal Manchester Children's Hospital, Central Manchester University Hospitals, National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom.
  • Kiess W Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
  • Kuehni CE Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
  • Mullis PE Division of Paediatric Endocrinology, Diabetology and Metabolism, University Children's Hospital Bern, Inselspital, 3010 Bern, Switzerland.
  • Pfaffle R Hospital for Children and Adolescents and Centre of Pediatric Research, University of Leipzig, Liebigstr. 20a, D-04103 Leipzig, Germany.
  • Sävendahl L Department of Women's and Children's Health, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
  • Sommer G Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
  • Thomas M Belgian Society for Pediatric Endocrinology and Diabetology, 1200 Brussels, Belgium.
  • Tidblad A Department of Women's and Children's Health, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
  • Tollerfield S University College London, Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom.
  • Van Eycken L Belgian Cancer Registry, Department Research, Koningsstraat 215, Box 7-B-1210 Brussels, Belgium.
  • Zandwijken GRJ Dutch Growth Research Foundation, Westzeedijk 106, 3016 AH Rotterdam, The Netherlands.
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  • 2017-02-11
Published in:
  • The Journal of clinical endocrinology and metabolism. - 2017
Adolescent
Bone Diseases, Developmental
Bone Neoplasms
Child
Child, Preschool
Cohort Studies
Dose-Response Relationship, Drug
Europe
Female
Growth Disorders
Hodgkin Disease
Human Growth Hormone
Humans
Hypopituitarism
Incidence
Infant
Infant, Newborn
Male
Neoplasms
Neoplasms, Second Primary
Recombinant Proteins
Renal Insufficiency, Chronic
Risk
Turner Syndrome
Urinary Bladder Neoplasms
Young Adult
English Context
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.


Objective
To examine cancer risks in relation to GH treatment.


Design
Cohort study.


Setting
Population-based.


Patients
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.


Main Outcome Measures
Cancer incidence and cancer mortality.


Results
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).


Conclusions
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.
Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/157123
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