Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses

Ioannidis, John P. A.; Zhou, Yingjun; Chang, Ching-Wen; Schully, Sheri D.; Khoury, Muin J.; Freedman, Andrew

doi:10.1093/annonc/mdt372

Cited by 36 publications

(32 citation statements)

References 88 publications

(43 reference statements)

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“…Alternatively, antihypertensive medication may increase cancer risk, though findings are conflicting. A 2001 meta-analysis found an independent association between thiazide diuretics and an increased risk for cancer (hazard ratio 2.00, 95% CI 1.55-2.59), though this finding was not supported in a second meta-analysis which concluded that no single antihypertensive class has sufficient or consistent evidence for a significant increase in malignancy risk, including thiazide diuretics [13,25]. Our results are consistent with the latter finding insofar as cancer risk was similar in both treated and untreated hypertension groups.…”

Section: Comparison To Literaturementioning

confidence: 99%

Hypertension, antihypertensive treatment and cancer incidence and mortality

Harding

Sooriyakumaran

Anstey

et al. 2016

Journal of Hypertension

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Section: Comparison To Literaturementioning

confidence: 99%

Hypertension, antihypertensive treatment and cancer incidence and mortality

Harding

Sooriyakumaran

Anstey

et al. 2016

Journal of Hypertension

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“…6 Biases have been suspected, documented, or debated in observational epidemiology of cancer for multiple putative carcinogens, risk factors, biomarkers, and prognostic factors. [7][8][9][10][11][12][13] To understand the strength of evidence and extent of potential biases in the claimed associations between type 2 diabetes and risk of developing cancer, we performed an umbrella review of the evidence across published meta-analyses or systematic reviews. We summarised the evidence on the incidence of cancer and cancer mortality for each site that has been studied in its association with type 2 diabetes; described the magnitude, direction, and significance of the observed associations; evaluated whether there are hints of biases in this evidence and how they manifest; and identified which are the most robust associations without potential biases.…”

Section: Introductionmentioning

confidence: 99%

Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies

Tsilidis

Kasimis

López

et al. 2015

BMJ

610

484

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Objectives To summarise the evidence and evaluate the validity of the associations between type 2 diabetes and the risk of developing or dying from cancer.Design An umbrella review of the evidence across meta-analyses of observational studies of type 2 diabetes with risk of developing or dying from any cancer.Data sources PubMed, Embase, Cochrane database of systematic reviews, and manual screening of references.Eligibility criteria Meta-analyses or systematic reviews of observational studies in humans that examined the association between type 2 diabetes and risk of developing or dying from cancer.Results Eligible meta-analyses assessed associations between type 2 diabetes and risk of developing cancer in 20 sites and mortality for seven cancer sites. The summary random effects estimates were significant at P=0.05 in 20 meta-analyses (74%); and all reported increased risks of developing cancer for participants with versus without diabetes. Of the 27 meta-analyses, eventually only seven (26%) compiled evidence on more than 1000 cases, had significant summary associations at P≤0.001 for both random and fixed effects calculations, and had neither evidence of small study effects nor evidence for excess significance. Of those, only six (22%) did not have substantial heterogeneity (I 2 >75%), pertaining to associations between type 2 diabetes and risk of developing breast, cholangiocarcinoma (both intrahepatic and extrahepatic), colorectal, endometrial, and gallbladder cancer. The 95% prediction intervals excluded the null value for four of these associations (breast, intrahepatic cholangiocarcinoma, colorectal, and endometrial cancer).Conclusions Though type 2 diabetes has been extensively studied in relation to risk of developing cancer and cancer mortality and strong claims of significance exist for most of the studied associations, only a minority of these associations have robust supporting evidence without hints of bias.

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“…Umbrella reviews can overcome these problems by assessing the level of the evidence provided by systematic reviews and meta-analyses 14 for each risk or protective factor, through strict criteria that probe a standard list of potential biases. These criteria have been extensively validated in various areas of medicine, such as neurology, oncology, nutrition medicine, internal medicine, psychiatry, paediatrics, dermatology and neurosurgery [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] . In the current study, we applied the umbrella review approach to the published evidence on risk or protective factors for psychotic disorders.…”

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confidence: 99%

What causes psychosis? An umbrella review of risk and protective factors

et al. 2018

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Psychosis is a heterogeneous psychiatric condition for which a multitude of risk and protective factors have been suggested. This umbrella review aimed to classify the strength of evidence for the associations between each factor and psychotic disorders whilst controlling for several biases. The Web of Knowledge database was searched to identify systematic reviews and meta-analyses of observational studies which examined associations between socio-demographic, parental, perinatal, later factors or antecedents and psychotic disorders, and which included a comparison group of healthy controls, published from 1965 to January 31, 2017. The literature search and data extraction followed PRISMA and MOOSE guidelines. The association between each factor and ICD or DSM diagnoses of non-organic psychotic disorders was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of psychotic cases, random-effects p value, largest study 95% confidence interval, heterogeneity between studies, 95% prediction interval, small study effect, and excess significance bias. In order to assess evidence for temporality of association, we also conducted sensitivity analyses restricted to data from prospective studies. Fifty-five meta-analyses or systematic reviews were included in the umbrella review, corresponding to 683 individual studies and 170 putative risk or protective factors for psychotic disorders. Only the ultra-high-risk state for psychosis (odds ratio, OR59.32, 95% CI: 4.91-17.72) and Black-Caribbean ethnicity in England (OR54.87, 95% CI: 3.96-6.00) showed convincing evidence of association. Six factors were highly suggestive (ethnic minority in low ethnic density area, second generation immigrants, trait anhedonia, premorbid IQ, minor physical anomalies, and olfactory identification ability), and nine were suggestive (urbanicity, ethnic minority in high ethnic density area, first generation immigrants, North-African immigrants in Europe, winter/spring season of birth in Northern hemisphere, childhood social withdrawal, childhood trauma, Toxoplasma gondii IgG, and non-right handedness). When only prospective studies were considered, the evidence was convincing for ultra-high-risk state and suggestive for urbanicity only. In summary, this umbrella review found several factors to be associated with psychotic disorders with different levels of evidence. These risk or protective factors represent a starting point for further etiopathological research and for the improvement of the prediction of psychosis.

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Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses

Cited by 36 publications

References 88 publications

Hypertension, antihypertensive treatment and cancer incidence and mortality

Hypertension, antihypertensive treatment and cancer incidence and mortality

Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies

What causes psychosis? An umbrella review of risk and protective factors

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