A systematic assessment of the association between frequently-prescribed medicines and the risk of common cancers: a series of nested case-control studies

R D McDowell,, C Hughes, P Murchie, C Cardwell

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Studies systematically screening medications have successfully identified prescription medicines associated with cancer risk. However, adjustment for confounding factors in these studies has been limited. We therefore investigated the association between frequently-prescribed medicines and the risk of common cancers adjusting for a range of confounders.
Methods: A series of nested case-control studies were undertaken using the Primary Care Clinical Informatics Unit Research (PCCIUR) database containing general practice (GP) records from Scotland. Cancer cases at 22 cancer sites, diagnosed between 1999 and 2011, were identified from GP records and matched with up to five controls (based on age, gender, GP practice and date of registration). Odds ratios (OR) and 95% confidence intervals (CI) comparing any versus no prescriptions for each of the most commonly prescribed medicines, identified from prescription records, were calculated using conditional logistic
regression, adjusting for comorbidities. Additional analyses adjusted for smoking use. An association was considered a signal based upon the magnitude of its adjusted OR, p-value and evidence of an exposure-response relationship. Supplementary analyses were undertaken comparing 6 or more prescriptions versus less than 6 for each medicine.
Results: Overall, 62,109 cases and 276,580 controls were included in the analyses and a total of 5,622 medication-cancer associations were studied across the 22 cancer sites. After adjusting for comorbidities 1,992 medicine-cancer associations for any prescription had adjusted ORs greater than 1.25 (or less than 0.8), 214 had a corresponding p-value less than or equal to 0.01 and 118 had evidence of an exposure-dose relationship hence meeting the criteria for a signal. Seventy-seven signals were identified after additionally adjusting for smoking. Based upon an exposure of 6 or more prescriptions, there were 118 signals after adjusting for comorbidities and 82 after additionally adjusting for smoking.
Conclusions: In this study a number of novel associations between medicine and cancer were identified which require further clinical and epidemiological investigation. The majority of medicines were not associated with an altered cancer risk and many identified signals reflected known associations between medicine and cancer.
Original languageEnglish
Article number22
Number of pages16
JournalBMC medicine
Volume19
DOIs
Publication statusPublished - 26 Jan 2021

Keywords

  • screening study
  • cancer risk
  • pharmacoepidemiology

Fingerprint

Dive into the research topics of 'A systematic assessment of the association between frequently-prescribed medicines and the risk of common cancers: a series of nested case-control studies'. Together they form a unique fingerprint.

Cite this