Inhaled corticosteroids and the risk of lung cancer in COPD: a population-based cohort study

Abstract

Inhaled corticosteroids (ICSs) are often prescribed in patients with chronic obstructive pulmonary disease (COPD). Their impact on the risk of lung cancer, a leading cause of mortality in COPD patients, remains uncertain.Population-based linked administrative data between the years 1997 and 2007 from the province of British Columbia, Canada, were used to evaluate the association between lung cancer risk and ICS use in COPD patients. COPD was defined on the basis of receipt of three COPD-related prescriptions in subjects ≥50 years of age. Exposure to ICS was incorporated into multivariable Cox regression models using several time-dependent methods (“ever” exposure, cumulative duration of use, cumulative dose, weighted cumulative duration of use and weighted cumulative dose).There were 39 676 patients who met the inclusion criteria. The mean±sd age of the cohort was 70.7±11.1 years and 53% were female. There were 994 (2.5%) cases of lung cancer during follow-up. In the reference case analysis (time-dependent “ever” exposure), ICS exposure was associated with a 30% reduced risk of lung cancer (HR 0.70 (95% CI 0.61–0.80)). ICS exposure was associated with a decrease in the risk of lung cancer diagnosis over all five methods of quantifying exposure.This population-based study suggests that ICS use reduces the risk of lung cancer in COPD patients.

Incidence of cancer after asthma development: 2 independent population-based cohort studies

“…48 Interestingly, previous studies reported that ICS use reduced the risk of lung cancer by 21% in the general population, 24 by 56% in patients with asthma, 25 and by 30% in patients with COPD. 26 We also found that ICS use reduced the risk of lung cancer by 56% in patients with asthma. These results may be explained by the ICS-mediated reduction of local inflammation.…”

“…The cumulative ICS dose was calculated as the total dose of prescribed ICS medication and converted to fluticasone-equivalent dosages for comparison of different types of ICSs. 26 Atopic asthma was defined as asthma with 1 more atopic disorder (allergic rhinitis or atopic dermatitis), and nonatopic asthma as asthma without any atopic disorder. 31…”

“…However, previous studies on this topic were limited by small sample sizes, inadequate adjustment for confounding factors that could affect cancer development, use of cross-sectional or case-control designs, or focus on specific cancer types. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Moreover, an inflammatory response may mediate the link between asthma and lung cancer, [24][25][26] and use of an inhaled corticosteroid (ICS) could possibly reduce the risk of incident cancer in patients with asthma. 25 Therefore, we comprehensively investigated the association of the incidence of several types of cancer after new asthma diagnosis and the association of ICS use and cancer risk during a mean follow-up time of 8.5 years for the first cohort (nationwide full unmatched cohort), 7.6 years for the second cohort (nationwide propensity score-matched cohort), and 11.5 years for the third cohort.…”

New evidence on the chemoprevention of inhaled steroids and the risk of lung cancer in COPD

“…In this issue of the European Respiratory Journal, the study by RAYMAKERS et al [7] contributes to a growing body of scientific evidence in favour of lung cancer chemoprevention with ICS. RAYMAKERS et al [7] analysed a large population-based cohort of COPD patients and found that exposure to ICS in a sample of almost 40 000 individuals was associated with a 30% reduction in lung cancer risk (HR 0.70 (95% CI 0.61-0.80)). Their conclusion persisted after using five different time-dependent methods of quantifying exposure.…”

Serum TNFRII: A promising biomarker for predicting the risk of subcentimetre lung adenocarcinoma

“…Many validated inflammation indicators are linked to lung cancer risk; these include the use of corticosteroids, chronic obstructive pulmonary disease (COPD) and chronic pulmonary infection, even when smoking was ruled out . Our previous study also analysed 10 widely evaluated inflammatory biomarkers and noted an independent association between BLC and significant risk for early‐stage lung adenocarcinoma .…”