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UK Study Suggests Possible Link Between Colorectal Cancer And Human Growth Hormone Therapy (p 273)
July 24, 2002Authors of an observational study in this week's issue of THE LANCET highlight a possible link between human growth hormone therapy and an increased risk of colorectal cancer. The investigators comment that further evidence is required before firm conclusions can be made, and stress that there is no evidence from their study as to whether there is an association between modern synthetic growth hormone treatment and increased cancer risk.
Human pituitary growth hormone was widely used to counteract short stature in children and young adults up to the mid 1980s; since then synthetic growth hormone has replaced human growth hormone therapy. Previous research has suggested a possible link between naturally occurring growth hormone concentrations and an increased risk of cancer; however there are no long-term follow-up data on growth-hormone-treated patients to support this association.
Anthony Swerdlow, Michael Preece, and colleagues from The Institute of Cancer Research and Institute of Child Health, UK, did a population study to investigate cancer incidence and death in 1848 people in the UK who were treated during childhood and early adulthood with human pituitary growth hormone between 1959 and 1985. The risk of cancer in the study population was compared with that in the general population.
Patients treated with human pituitary growth hormone had an almost threefold increased risk of death from cancer overall, and were at around an eleven times greater risk of dying from colorectal cancer or Hodgkin's disease. After the exclusion of patients whose reason for growth hormone treatment rendered them at a high risk of cancer, the risk of incidence of colorectal cancer was significant, as were the risks of death from colorectal cancer or Hodgkin's disease.
Anthony Swerdlow comments: "Our data do not show conclusively whether cancer incidence is increased by growth hormone treatment, but they do suggest the need for increased awareness of the possibility of cancer risks, and for surveillance of growth hormone-treated patients."
In an accompanying Commentary, Edward Giovannucci from Harvard School of Public Health, Boston, USA, concludes: "It must be emphasised that the treatment of growth hormone deficiency has established health benefits, and that there is no evidence that physiological growth-hormone replacement increases cancer risk. While the data reported by Swerdlow and colleagues should not discourage appropriate treatment of growth hormone deficiency, they should provoke reassessment of the risks and benefits of growth hormone therapy for more controversial indications that are unrelated to growth hormone deficiency, particularly if such treatment is prescribed for long periods."
Lancet
Patients treated with human pituitary growth hormone had an almost threefold increased risk of death from cancer overall, and were at around an eleven times greater risk of dying from colorectal cancer or Hodgkin's disease. After the exclusion of patients whose reason for growth hormone treatment rendered them at a high risk of cancer, the risk of incidence of colorectal cancer was significant, as were the risks of death from colorectal cancer or Hodgkin's disease.
Anthony Swerdlow comments: "Our data do not show conclusively whether cancer incidence is increased by growth hormone treatment, but they do suggest the need for increased awareness of the possibility of cancer risks, and for surveillance of growth hormone-treated patients."
In an accompanying Commentary, Edward Giovannucci from Harvard School of Public Health, Boston, USA, concludes: "It must be emphasised that the treatment of growth hormone deficiency has established health benefits, and that there is no evidence that physiological growth-hormone replacement increases cancer risk. While the data reported by Swerdlow and colleagues should not discourage appropriate treatment of growth hormone deficiency, they should provoke reassessment of the risks and benefits of growth hormone therapy for more controversial indications that are unrelated to growth hormone deficiency, particularly if such treatment is prescribed for long periods."
Lancet
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