Li Min Sun

Relationship of Zolpidem and Cancer Risk: A Taiwanese Population-Based Cohort Study

OBJECTIVE To evaluate the relationship between the use of zolpidem and subsequent cancer risk in Taiwanese patients. METHODS We used data from the National Health Insurance system of Taiwan to investigate whether use of zolpidem was related to cancer risk. For the study cohort, we identified 14,950 patients who had received a first prescription for zolpidem from January 1, 1998, through December 31, 2000. For each zolpidem user, we selected randomly 4 comparison patients without a history of using zolpidem who were frequency-matched by sex, age, and year of the index date. Incidence rates of all cancers and selected site-specific cancers were measured by the end of 2009, and related hazard ratios (HRs) and 95% confidence intervals (CIs) of the cancer were measured as well. RESULTS The risk of developing any cancer was greater in patients using zolpidem than in nonusers (HR, 1.68; 95% CI, 1.55-1.82). The stratified analysis showed that the overall HR for high-dosage zolpidem (≥300 mg/y) was 2.38. The site-specific cancer risk was the highest for oral cancer (HR, 2.36; 95% CI, 1.57-3.56), followed by kidney cancer, esophageal cancer, breast cancer, liver cancer, lung cancer, and bladder cancer (HR, 1.60; 95% CI, 1.06-2.41). Men were at higher risk than women. CONCLUSION This population-based study revealed some unexpected findings, suggesting that the use of zolpidem may be associated with an increased risk of subsequent cancer. Further large-scale and in-depth investigations in this area are warranted.

The Association Between Malignancy and End-stage Renal Disease in Taiwan

OBJECTIVE Patients with end-stage renal disease are suggestive to have a higher risk for the development of some kinds of cancer. The aim of this study is to evaluate the possible association between malignancy and end-stage renal disease in Taiwan. METHODS We used the data of the National Health Insurance system of Taiwan to assess this issue. The end-stage renal disease cohort contained 21 817 patients, and each patient was randomly frequency-matched with two people from the general population without end-stage renal disease based on their age and sex. The Cox proportional hazard regression analysis was conducted to estimate the effects of end-stage renal disease on the cancer risk. RESULTS In patients with end-stage renal disease, the risk of developing overall cancer was significantly higher than the normal healthy subjects (adjusted hazard ratio = 1.64, 95% confidence interval = 1.54-1.74). This was also true when we analyzed males and females separately. For individual cancer, the risks for developing urinary tract cancers, liver cancer and breast cancer among patients with end-stage renal disease were significantly higher. On the contrary, lung, prostate and esophageal cancer risks were significantly lower when compared with the normal healthy subjects. CONCLUSIONS Our study found Taiwanese patients with end-stage renal disease to have a higher risk to develop urinary tract, liver and breast cancer. We unexpectedly discovered these patients to have a lower risk to get lung, prostate and esophageal cancer.

The Analysis of Depression and Subsequent Cancer Risk in Taiwan

Background: Patients with depression are suggestive of having a tendency toward a marginally significant association with the subsequent cancer risk. The aim of this study was to evaluate the possible relationship between depression and cancer risk in Taiwan. Methods: We used the data of the National Health Insurance system of Taiwan to assess this issue. The Cox proportional hazard regression analysis was conducted to estimate the effects of depression on the cancer risk. Results: In patients with depression, there was no significant change in the risk of developing overall cancer or for the site-specific cancer and all showed the same direction (positive) except for colorectal cancer, which had a negative direction. Conclusions: This population-based study did not find Taiwanese patients with depression to have a higher risk to develop overall cancer or site-specific cancer. Impact: Depression does not increase cancer risk. Cancer Epidemiol Biomarkers Prev; 20(3); 473–5. ©2011 AACR.

Benzodiazepine Use Possibly Increases Cancer Risk: A Population-Based Retrospective Cohort Study in Taiwan

OBJECTIVE To evaluate the possible association between benzodiazepine use and subsequent cancer risk in Taiwan. METHOD In this population-based retrospective cohort study, we used data from 1996 to 2000 from the Taiwanese National Health Insurance system to investigate the possible association between benzodiazepine use and cancer risk. The exposure cohort (mean age = 47.9 years, standard deviation [SD] = 17.3 years) consisted of 59,647 patients with benzodiazepine use. Each patient from the exposure cohort was randomly frequency-matched by age and sex to a person from the cohort with no benzodiazepine exposure (the comparison group; mean age = 46.4 years, SD = 17.8 years). Each study subject was followed until a diagnosis of cancer was made (according to ICD-9-CM) or until the time the subject was censored for loss to follow-up, death, or termination of insurance-or to the end of 2009. A Cox proportional hazard regression analysis was conducted to estimate the effects of benzodiazepine use on cancer risk. RESULTS In the group with benzodiazepine use, the overall risk of developing cancer was 19% higher than in the group without benzodiazepine exposure, and the difference between the groups was statistically significant (hazard ratio [HR] = 1.19; 99.6% CI, 1.08-1.32). With regard to individual types of cancer, the risk of developing liver cancer (HR = 1.45; 99.6% CI, 1.10-1.90), prostate cancer (HR = 1.72; 99.6% CI, 1.10-2.70), and bladder and kidney cancer (HR = 1.76; 99.6% CI, 1.16-2.67) was significantly higher for the benzodiazepine cohort. CONCLUSIONS This population-based study has shed light on a possible relationship between benzodiazepine use and increased cancer risk. Further large, thorough investigations are needed to confirm these findings.

A population-based cohort study in Taiwan––use of insulin sensitizers can decrease cancer risk in diabetic patients?

BACKGROUND The purpose of the study was to explore the possible association between the use of insulin sensitizers (thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients. PATIENTS AND METHODS From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabetic patients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752 patients were on other anti-diabetic medications (non-TZDs). RESULTS In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreatic cancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups. CONCLUSION This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted.BACKGROUND The purpose of the study was to explore the possible association between the use of insulin sensitizers (thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients. PATIENTS AND METHODS From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabetic patients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752 patients were on other anti-diabetic medications (non-TZDs). RESULTS In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreatic cancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups. CONCLUSION This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted.

Non-apnea sleep disorders will increase subsequent liver cancer risk – A nationwide population-based cohort study

INTRODUCTION It is well known that patients with sleep disorders (SD) have an increased risk of cardiovascular disease, diabetes mellitus, obesity, and total mortality. However, little information exists regarding the relationship between non-apnea SD and the risk of cancer. The goal of this study was to determine if any association between SD and malignancy exists in Taiwan. METHODS We used data from the National Health Insurance system of Taiwan to assess this issue. The SD cohort contained 42,351 patients, and each patient was randomly frequency-matched by age and sex with two people from the general population without SD. The Coxs proportional hazard regression analysis was conducted to estimate the effects of SD on cancer risk. RESULTS In patients with SD, the overall risk of developing cancer was significantly higher than in normal healthy subjects (adjusted Hazard ratio [HR]=1.12, 95% confidence interval=1.06-1.18). This held true even when we analyzed males and females separately. In regards to individual types of cancer, the risk for developing liver cancer among patients with SD was significantly higher than in subjects without SD. For breast cancer the risk showed a marginally significant increase. CONCLUSION The nationwide population-based cohort study found Taiwanese patients with SD have a higher risk of developing cancer, particularly liver cancer and, possibly, breast cancer.

Analysis of Parkinson’s Disease and Subsequent Cancer Risk in Taiwan: A Nationwide Population-Based Cohort Study

Background: Patients with Parkinson’s disease (PD) are suggested to be at a lower risk for the development of certain cancers and at a higher risk for melanoma. The aim of this study is to evaluate the possible association between PD and malignancy in Taiwan. Materials and Methods: We used the data of the National Health Insurance System of Taiwan to assess this issue. The PD cohort contained 4,957 patients, and each patient was randomly frequency matched by age and sex with 4 people from the general population without PD. Cox’s proportional hazard regression analysis was conducted to estimate the effects of PD on the cancer risk. Results: In patients with PD, the risk of developing overall cancer was marginally significantly lower than in subjects without PD [adjusted hazard ratio (HR) = 0.88; 95% CI = 0.78–0.99]. For individual cancers, the risks of developing colorectal and lung cancers among patients with PD were marginally significantly lower than in subjects without PD. In contrast, despite the higher HR for the development of melanoma, it did not reach statistical significance because of the relatively small sample size. Conclusion: Our study found that Taiwanese patients with PD have a lower risk of developing colorectal and lung cancers. The findings of this study are compatible with those of prior studies from other countries.

Increased breast cancer risk for patients with multiple sclerosis: a nationwide population‐based cohort study

Studies have suggested that multiple sclerosis (MS) might be linked to an overall reduced cancer rate, but a positive relationship is also found for several types of cancer. This study determines whether MS is associated with cancer risk in Taiwan.

Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study.

CONTEXT The concern regarding cancer risk has resulted in the recommendation to pull calcitonin nasal spray (CNS) from the market. OBJECTIVE We conducted a nested case-control study to evaluate the association between CNS use in osteoporosis patients in Taiwan and their subsequent risk of cancer. DESIGN This was a population-based nested case-control study. SETTING Data were obtained from the Taiwan National Health Insurance Research Database. PATIENTS OR OTHER PARTICIPANTS The study cohort consisted of 28 222 patients diagnosed with osteoporosis between January 1, 2000, and December 31, 2011. We identified 1925 cancer patients as the study group and 2 noncancer patients frequency matched according to age at index date, sex, comorbidity, index-year, and osteoporosis-year as the control group. MAIN OUTCOME MEASURES Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression analysis. RESULTS Use of CNS in women with osteoporosis significantly increased the risk of liver cancer (OR = 1.94, 95% CI = 1.23-3.05) but decreased the risk of breast cancer (OR = 0.35, 95% CI = 0.15-0.80). Further analysis of monthly CNS dosages showed that the association between CNS and liver cancer is limited to higher-dose users. CONCLUSION The findings of this population-based nested case-control study suggest that CNS use might increase the risk of liver cancer in female osteoporosis patients but decrease the risk of breast cancer. Our data do not completely support the decision to discontinue use of CNS in osteoporosis patients.

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

Background Controversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer. Methods This 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. Results For 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. Conclusions This 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.