Abstract
Background Early-onset gastric cancer (EOGC, age ≤ 60 years at diagnosis) now comprises >30% of new gastric cancers in the United States. It is hypothesized that chronic acid suppression with proton-pump inhibitors (PPIs) may promote tumorigenesis, while other medications including statins, nonsteroidal anti-inflammatory drugs (NSAIDs), metformin, and cyclooxygenase-2 (COX-2) inhibitors have been proposed as protective. We aimed to assess for an association between use of the aforementioned commonly prescribed medications and EOGC development. Methods We used a population-based medical record linkage system, to identify cases of EOGC in Olmsted County, Minnesota, between January 1, 1995, and December 31, 2020. Patients were matched 1 : 1 with controls based on age at diagnosis, sex, smoking status, and body mass index (BMI). Conditional logistic regression was used to examine associations with the odds of EOGC development. Results Ninety-six cases of EOGC were identified during the study period. On both univariate and multivariate regression analysis, there was no significant association between use of PPIs, statins, NSAIDs, or metformin and EOGC development. In a final multivariable model, there was a significant reduction in odds of EOGC with COX-2 inhibitor use for six months or more prior to cancer diagnosis (OR = 0.39, 95% CI 0.16-0.94). Conclusion In this retrospective, population-based study of individuals in Olmsted County, MN, we found significantly reduced odds of EOGC development associated with COX-2 inhibitor use for six months or more prior to diagnosis, but no association between EOGC development and use of PPIs and other commonly prescribed medications.
Highlights
Over the past several decades, the incidence of gastric cancer both in the United States and globally has declined [1, 2]
Evidence suggests that chronic acid suppression by pump inhibitors (PPIs) can lead to non-H. pylori bacterial overgrowth in the stomach which may cause chronic inflammation and atrophic gastritis [3, 4]
We found a significant reduction in early-onset gastric cancer (EOGC) risk in patients who had been taking COX-2 inhibitors for six months or more prior to index gastric cancer diagnosis
Summary
Over the past several decades, the incidence of gastric cancer both in the United States and globally has declined [1, 2]. The incidence of early-onset gastric cancer (EOGC) has been increasing in the United States during this same period, comprising >30% of new gastric cancer cases [2]. Ninety-six cases of EOGC were identified during the study period On both univariate and multivariate regression analysis, there was no significant association between use of PPIs, statins, NSAIDs, or metformin and EOGC development. In this retrospective, population-based study of individuals in Olmsted County, MN, we found significantly reduced odds of EOGC development associated with COX-2 inhibitor use for six months or more prior to diagnosis, but no association between EOGC development and use of PPIs and other commonly prescribed medications
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