Madhur Nayan1, David N Juurlink2, Peter C Austin3, Erin M Macdonald4, Antonio Finelli1, Girish S Kulkarni5, Robert J Hamilton6. 1. Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada. 2. Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, M4N 3M5, Canada; Institute for Clinical Evaluative Sciences, Toronto, M4N 3M5, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, M4N 3M5, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, M4N 3M5, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, M4N 3M5, Canada. 5. Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada; Institute for Clinical Evaluative Sciences, Toronto, M4N 3M5, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. 6. Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, M5G 2M9, Canada. Electronic address: rob.hamilton@uhn.ca.
Abstract
BACKGROUND: Exposure to commonly prescribed medications may be associated with cancer risk. However, there is limited data in kidney cancer. Furthermore, methods of classifying cumulative medication exposure in previous studies may be prone to bias. METHODS: We conducted a population-based case-control study of 10,377 incident kidney cancer cases aged ≥66 years matched with 35,939 controls on age, sex, history of hypertension, comorbidity score, and geographic location. Cumulative exposure to commonly prescribed medications hypothesised to modulate cancer risk was obtained using prescription claims data. We modelled exposure in four different fashions: (1) as continuous exposures using (a) fractional polynomials (which allow for a non-linear relationship between an exposure and outcome) or (b) assuming linear relationships; and 2) as dichotomous exposures denoting (a) ≥3 years versus <3 years exposure; or (b) "ever" versus "never" exposure. We used conditional logistic regression to estimate the association of medication exposure on incident kidney cancer. RESULTS: The directions of association were relatively consistent across analyses; however, the magnitudes were sensitive to the method of analysis. When utilising fractional polynomials, increasing cumulative exposure to acetylsalicylic acid, selective serotonin reuptake inhibitors, and proton-pump inhibitors was associated with significantly reduced risk of kidney cancer, while increasing exposure to antihypertensive drugs was associated with significantly increased risk. CONCLUSIONS: Our study provides impetus to further explore the effect of commonly prescribed medications on carcinogenesis to identify modifiable pharmacological interventions to reduce the risk of kidney cancer.
BACKGROUND: Exposure to commonly prescribed medications may be associated with cancer risk. However, there is limited data in kidney cancer. Furthermore, methods of classifying cumulative medication exposure in previous studies may be prone to bias. METHODS: We conducted a population-based case-control study of 10,377 incident kidney cancer cases aged ≥66 years matched with 35,939 controls on age, sex, history of hypertension, comorbidity score, and geographic location. Cumulative exposure to commonly prescribed medications hypothesised to modulate cancer risk was obtained using prescription claims data. We modelled exposure in four different fashions: (1) as continuous exposures using (a) fractional polynomials (which allow for a non-linear relationship between an exposure and outcome) or (b) assuming linear relationships; and 2) as dichotomous exposures denoting (a) ≥3 years versus <3 years exposure; or (b) "ever" versus "never" exposure. We used conditional logistic regression to estimate the association of medication exposure on incident kidney cancer. RESULTS: The directions of association were relatively consistent across analyses; however, the magnitudes were sensitive to the method of analysis. When utilising fractional polynomials, increasing cumulative exposure to acetylsalicylic acid, selective serotonin reuptake inhibitors, and proton-pump inhibitors was associated with significantly reduced risk of kidney cancer, while increasing exposure to antihypertensive drugs was associated with significantly increased risk. CONCLUSIONS: Our study provides impetus to further explore the effect of commonly prescribed medications on carcinogenesis to identify modifiable pharmacological interventions to reduce the risk of kidney cancer.
Authors: Patrick O Richard; Ardalan E Ahmad; Shaheena Bashir; Alexandre Zlotta; Bimal Bhindi; Ricardo Leao; Madhur Nayan; Aza Mohammed; Neil E Fleshner; Girish S Kulkarni Journal: Can Urol Assoc J Date: 2018-02-23 Impact factor: 1.862
Authors: Tommi Eskelinen; Thea Veitonmäki; Andres Kotsar; Teuvo L J Tammela; Antti Pöyhönen; Teemu J Murtola Journal: Cancer Causes Control Date: 2021-12-18 Impact factor: 2.506