The Incidence of Cancer Among Acromegaly Patients: Results From the German Acromegaly Registry

Abstract

Cancer screening strategies need to take incidence into account, which does not seem to be substantially higher in treated acromegaly patients than in the general population for any site of cancer.

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and cancer: an old debate revisited

“…Standardized incidence ratio (SIR) was available from 11 series, and in three of them, cancer incidence was not increased (12,18,28). In five series, the estimated overall SIR for malignancies was increased by a magnitude of 1.5-to 3.4-fold (15,16,19,21,23), whereas in two studies, increased risk was only observed for women (13) and in one only for men (20) (Table 1).…”

“…A review of 17 series published between 1957 and 2015, where overall cancer incidence in acromegaly was investigated, revealed 7723 patients with 708 cases of cancer, resulting in a mean cancer incidence of 10.8%, with percentages varying from 4.8 to 21.3% (12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28). Standardized incidence ratio (SIR) was available from 11 series, and in three of them, cancer incidence was not increased (12,18,28).…”

“…There are five larger series from the United States (16), the United Kingdom (18), Sweden/Denmark (21), Finland (23) and Germany (28), which have assessed the overall cancer rate in acromegaly in comparison with that in the general population. Together, they report on 439 cases of several types of malignancies in 4690 patients, with estimated SIR higher in three studies (16,21,23) and lower or not different from the general population in two (18,28).…”

“…Together, they report on 439 cases of several types of malignancies in 4690 patients, with estimated SIR higher in three studies (16,21,23) and lower or not different from the general population in two (18,28). One possibility for these conflicting findings, which still persist considering only large-scale comparable studies, is that cancer risk in both acromegaly and non-acromegaly populations might actually vary among different settings, preventing a reliable generalization of the results (30).…”

Mortality in acromegaly: a 20-year follow-up study

“…Routine thyroid ultrasound (US) screening has been suggested in a recent meta-analysis (Wolinski et al 2014), and in a large, cross-sectional study with extensive US and fine-needle aspiration analyses (Reverter et al 2014). However, in a recent study, Petroff and coworkers reported, by analysing a cohort of 446 German patients with acromegaly, that cancer incidence is not increased in treated patients with acromegaly when compared with the general population, not for any type of cancer studied (Petroff et al 2015). In line with this, in the present study, 31 patients (27%) died of cancer, with an identical cancer death rate of 27% in the large general population during 20 years of follow-up.…”