Oral Bisphosphonate Use Associated With a Decreased Risk of Breast Cancer

Dreyfuss, John Henry

doi:10.3322/caac.20091

Cited by 10 publications

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“…As commonly known, results from observational epidemiological studies cannot confirm causality 41. However, it is possibly difficult to conduct an RCT to address the effect of bisphosphonates in the primary prevention of BCa due to ethical challenges and the requirement for a considerably large sample size 41. Recently, the results from two RCTs (FIT and HORIZON-PFT) were published 14.…”

Section: Discussionmentioning

confidence: 99%

<p>Bisphosphonates and primary breast cancer risk: an updated systematic review and meta-analysis involving 963,995 women</p>

Liu

Zhang

Sun

et al. 2019

CLEP

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Importance Prevention of primary breast cancer (BCa) in women is of great public health importance. The existing results from observational epidemiologic studies focused on the association between bisphosphonates and primary BCa risk have been inconsistent. Objective To update this systematic review and meta-analysis to assess the effect of bisphosphonates on primary BCa risk. Data sources We comprehensively searched MEDLINE, EMBASE, Cochrane libraries, ProQuest, and Web of Science through June 25, 2018 for relevant studies. Study selection Epidemiological studies that assessed the effect of bisphosphonates on the risk of primary BCa in women. Data extraction and synthesis We reported this meta-analysis according to the PRISMA guidelines. Available multivariable-adjusted effect estimates and corresponding 95% CIs were pooled with a random-effects model. Main outcomes and measures The prespecified main outcome was the risk of primary BCa. Results In total, five cohort studies involving 657,558 women and 12,991 primary BCa patients, three population-based case-control studies involving 54,701 primary BCa cases and 237,962 healthy controls and two randomized controlled trials (RCTs) involving 13,774 women and 165 primary BCa patients were included in this meta-analysis. Bisphosphonates were associated with a 12% decreased risk of primary BCa (RR, 0.88; 95% CI, 0.83–0.94). However, when we analyzed study designs separately, the pooled results from observational studies were inconsistent with that from RCTs. The observed association of primary BCa risk with long-term use (≥1 year) of bisphosphonates seemed to be more robust and stronger than that of short-term use (<1 year) (RR, 0.75; 95% CI, 0.66–0.84; and 0.90; 95% CI, 0.84–0.97; respectively). Conclusion This meta-analysis adds to the body of evidence for an association between bisphosphonates and a significantly decreased risk of primary BCa. However, future large-scale RCTs are required to validate this concern.

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Section: Discussionmentioning

confidence: 99%

<p>Bisphosphonates and primary breast cancer risk: an updated systematic review and meta-analysis involving 963,995 women</p>

Liu

Zhang

Sun

et al. 2019

CLEP

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“…Some studies suggested a possible increase in the risk of esophageal cancer [8], [9], but others have not found a relationship[10]–[12]. Conversely, several studies have reported that bisphosphonate use may be associated with a decreased risk of breast cancer [13]–[17], though observational studies may yield misleading results, and experts urge caution in interpreting results [18].…”

Section: Introductionmentioning

confidence: 99%

A Higher Dosage of Oral Alendronate Will Increase the Subsequent Cancer Risk of Osteoporosis Patients in Taiwan: A Population-Based Cohort Study

et al. 2012

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BackgroundControversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer.MethodsThis paper explores the possible association between the use of oral ALN in osteoporosis patients and subsequent cancer risk using the National Health Insurance (NHI) system database of Taiwan with a Cox proportional-hazard regression analysis. The exposure cohort contained 5,624 osteoporosis patients used ALN and randomly frequency-matched by age and gender of 3 osteoporosis patients without any kind of anti-osteoporosis drugs in the same period.ResultsFor a dose ≥1.0 g/year, the risk of developing overall cancer was significantly higher (hazard ratio: 1.69, 95% confidence ratio: 1.39–2.04) than in osteoporosis patients without any anti-osteoporosis drugs. The risks for developing liver, lung, and prostate cancers and lymphoma were also significantly higher than in the control group.ConclusionsThis population-based retrospective cohort study did not find a relationship between ALN use and either esophageal or breast cancer, but unexpectedly discovered that use of ALN with dose ≥1.0 g/year significantly increased risks of overall cancer incidence, as well as liver, lung, and prostate cancers and lymphoma. Further large population-based unbiased studies to enforce our findings are required before any confirmatory conclusion can be made.

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“…There is evidence from controlled trials and observational studies that bisphosphonate treatment is associated with a decreased risk of breast cancer (45)(46)(47)(48), colorectal cancer (49), gastric cancer (50), stroke (51) and myocardial infarction (52) as well as improved survival (17,53).…”

Section: Possible "Side Benefits" Of Bisphosphonate Therapymentioning

confidence: 99%

Long-term risks of bisphosphonate therapy

Watts

2014

Arq Bras Endocrinol Metab

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The objective this study was to summarize long-term risks associated with bisphosphonate therapy. Search of relevant medical publications for data from clinical trials, trial extensions, observational studies and post-marketing reports. Trial extensions and modifications did not reveal significant long-term safety issues. Observational data suggest at least as many benefits as risks. Post-marketing reports of musculoskeletal pain, osteonecrosis of the jaw and atypical femur fractures have been widely circulated in the lay press. Most focus on long-terms risks has been on osteonecrosis of the jaw and atypical femur fractures which occur in patients who have not received bisphosphonate therapy but may be more frequent (though still uncommon) in patients who have been on treatment for 5 years or longer. Lower-risk patients may be able to stop treatment after 3-5 years for a "drug holiday, " which mitigates these long-term risks; for higher risk patients, therapy through 6-10 years appears to be advisable and offers more benefits than risks. ReSumoO objetivo deste estudo foi resumir os riscos associados ao tratamento a longo prazo com bisfosfonatos. Foram pesquisadas as publicações médicas relevantes incluindo ensaios clíni-cos, extensões de ensaios clínicos, estudos observacionais e relatórios pós-comercialização (vigilância farmacológica). As extensões e modificações de ensaios clínicos não indicaram nenhuma situação de alarme quanto à segurança dos bisfosfonatos a longo prazo. Dados observacionais sugerem pelo menos tantos benefícios quanto riscos. Entretanto, relatos pós--comercialização de dor musculoesquelética, osteonecrose da mandíbula e fraturas de fêmur atípicas foram amplamente divulgados na imprensa leiga. O foco nos riscos a longo prazo do tratamento com bisfosfonatos tem sido pincipalmente a osteonecrose da mandíbula e as fraturas atípicas de fêmur. Essas últimas, embora mais frequentes (ainda que pouco comuns) em pacientes que receberam tratamento com bisfosfonatos por 5 anos ou mais, podem ocorrer em indivíduos não tratados com esses medicamentos. Pacientes com baixo risco de fratura podem potencialmente parar o tratamento depois de 3 a 5 anos ("drug holiday"). Esse procedimento reduz os riscos desses medicamentos a longo prazo. Não obstante, nos pacientes de maior risco a terapia por 6 a 10 anos parece ser aconselhável e oferece mais benefícios do que riscos.Arq Bras Endocrinol Metab. 2014;58(5):523-9

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Oral Bisphosphonate Use Associated With a Decreased Risk of Breast Cancer

Abstract: women in extreme fifths of polygenic risk score was much greater for estrogen receptor-positive (7.4% vs 3.4%) than for estrogen receptor-negative disease (1.4% vs 1.0%),'' explains Dr. Reeves.

Cited by 10 publications

References 0 publications

<p>Bisphosphonates and primary breast cancer risk: an updated systematic review and meta-analysis involving 963,995 women</p>

<p>Bisphosphonates and primary breast cancer risk: an updated systematic review and meta-analysis involving 963,995 women</p>

A Higher Dosage of Oral Alendronate Will Increase the Subsequent Cancer Risk of Osteoporosis Patients in Taiwan: A Population-Based Cohort Study

Long-term risks of bisphosphonate therapy

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