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Incidence of cancer after asthma development: 2 independent population-based cohort studies - 09/01/21

Doi : 10.1016/j.jaci.2020.04.041 
Ala Woo, MD a, , Seung Won Lee, MD, PhD b, , Hyun Yong Koh, MD, PhD c, Mi Ae Kim, MD, PhD d, Man Yong Han, MD e, Dong Keon Yon, MD e, f,
a Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 
b Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea 
c F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Mass 
d Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea 
e Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea 
f Armed Force Medical Command, Republic of Korea Armed Forces, Seongnam, Korea 

Corresponding author: Dong Keon Yon, MD, Department of Pediatrics CHA University School of Medicine 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-712, Korea.Department of Pediatrics CHA University School of Medicine 351 Yatap-dongBundang-guSeongnamGyeonggi-do463-712Korea

Abstract

Background

Evidence regarding the risk of cancer development after asthma diagnosis is controversial and inconclusive.

Objective

This study sought to determine whether asthma is associated with an increased risk for incident cancer.

Methods

Two independent, population-based, longitudinal cohorts were examined, and estimated hazard ratios were determined using Cox regression. One group consisted of an unmatched cohort of 475,197 participants and a propensity score–matched cohort of 75,307 participants from the National Health Insurance Service–National Sample Cohort (NHIS-NSC; claims-based data from 2003 to 2015). The other group consisted of 5,440 participants from the Ansan-Ansung cohort (interview-based data from 2001 to 2014).

Results

The NHIS-NSC matched cohort had 572,740 person-years of follow-up, 6,885 people with new asthma diagnoses, and 68,422 people without asthma diagnoses. Adults with asthma had a 75% greater risk of incident cancer overall. The excess risk for incident cancer was greatest during the first 2 years after asthma diagnosis, and this risk remained elevated throughout follow-up. Patients with nonatopic asthma had a greater risk of overall cancer than those with atopic asthma. A high cumulative dose of inhaled corticosteroids among asthma patients was associated with a 56% reduced risk of lung cancer, but had no effect on the risk of overall cancer. The results from the NHIS-NSC unmatched cohort and the Ansan-Ansung cohort were similar to the primary results from the NHIS-NSC matched cohort.

Conclusions

Asthma development was associated with an increased risk of subsequent cancer in 2 different Korean cohorts. Our findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis and suggest that clinicians should be aware of the higher risk of incident cancer among patients with asthma.

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Graphical abstract




Il testo completo di questo articolo è disponibile in PDF.

Key words : Asthma, cancer, chronic inflammation, carcinogenesis, tumor mutation burden

Abbreviations used : aHR, COPD, HR, ICD-10, ICS, NHIS-NSC


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 This work was supported by the National Research Foundation of Korea grant funded by the Korea government (NRF2019R1G1A109977912). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
 Disclosure of potential conflict of interest: All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.


© 2020  American Academy of Allergy, Asthma & Immunology. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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