The use of proton pump inhibitors is linked to a lower risk of developing female cancers

Conclusions

• According to a 16 year-old nationwide population study conducted in Taiwan, women taking proton pump inhibitors (PPIs) may have a lower risk of developing female cancers.
• The risk reduction is greatest for breast and ovarian cancers in women aged 20 to 64 years and for cervical and endometrial cancers in women aged 40 to 64 years.
• No reduction in risk is expressly observed in older women.

Why it matters

• The results suggest that PPIs can prevent female cancers in non-elderly women.
• The use of PPIs has increased rapidly in recent years, due to their effectiveness in gastroesophageal reflux disease and peptic ulcers.
• Many individuals use PPIs long-term.
• The results possess biological plausibility, based on PPI-induced intracellular pH reduction, which possesses tumor prevention properties.

Study design

• Case-control study, nested, in a cohort of 23 million subjects from the Health and Welfare Data Science Center Taiwan drug and diagnosis database (2000–2016).
• The tumors received anatomical confirmation by linking to the Taiwan Population Cancer Registry.
• PPI use (for at least 2 months in the 2 years prior to cancer index diagnosis) was compared between newly diagnosed implanted female cancer cases (n=233,173) versus nested controls without female tumors (n=932,692) over the 16 year period, with matching based on age, sex, and date of visit.
• The association between PPI use and female cancers was corrected for potential confounding factors that included drug use (metformin, and statins, also known to reduce cancer risk).
• Funding: National Science and Technology Council of Taiwan; Ministry of Education of Taiwan.

Key results

• Overall, PPI use was associated with a 14% reduction in the risk of incident female cancers (aOR=0.86; 95% CI, 0.80–0.91).
• A reduction in risk was observed in incident ovarian and breast cancers in women aged 20 to 39 years:
  • breast cancer, aOR=0.69; 95% CI, 0.56–0.84, a 31% reduction;
  • ovarian cancer, aOR=0.58; 95% CI, 0.34–0.99, a reduction of 42%.
• A reduction in the risk of incident breast and ovarian cancers was also observed in women aged 40 to 64 years:
  • breast cancer, aOR=0.89; 95% CI, 0.86–0.94, an 11% reduction;
  • ovarian cancer, aOR=0.87; 95% CI, 0.75–0.99, a 13% reduction.
• A reduced risk of incident cervical and endometrial cancers was also observed in women aged 40 to 64 years:
  • cervical cancer, aOR=0.79; 95% CI, 0.73–0.86, a 21% reduction;
  • endometrial cancer, aOR=0.72; 95% CI, 0.65–0.81, a reduction of 28%.
• No significant associations were observed in women aged ≥65 years.

• breast cancer, aOR=0.69; 95% CI, 0.56–0.84, a 31% reduction;
• ovarian cancer, aOR=0.58; 95% CI, 0.34–0.99, a reduction of 42%.

• breast cancer, aOR=0.89; 95% CI, 0.86–0.94, an 11% reduction;
• ovarian cancer, aOR=0.87; 95% CI, 0.75–0.99, a 13% reduction.

• cervical cancer, aOR=0.79; 95% CI, 0.73–0.86, a 21% reduction;
• endometrial cancer, aOR=0.72; 95% CI, 0.65–0.81, a reduction of 28%.

Limits

• Observational retrospective drawing.
• The results were not causal.
• Lack of information on patients’ lifestyle, medication adherence, PPI dosage and laboratory data.

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