Use of Systemic Corticosteroids and Risk of Esophageal Cancer
Notice bibliographique
Résumé
To the Editor: The incidence of adenocarcinoma of the esophagus has increased steeply in several industrialized countries in the last few decades, whereas the incidence of squamous cell carcinoma has remained almost unchanged. Overall, esophageal cancer has become the eighth most common type of cancer worldwide in the 1990s. 1 The reasons for this increase are largely unknown, although elevated risk has been demonstrated with gastroesophageal reflux, obesity, and drugs relaxing the lower esophageal sphincter. 2,3 Corticosteroids are increasingly used in the treatment of several chronic diseases, eg, rheumatoid arthritis, polymyalgia rheumatica, asthma, chronic obstructive lung disease, and inflammatory bowel diseases. As both obesity and esophageal candidiasis 4 are known side effects of corticosteroids, the increased risk of esophageal cancer associated with these conditions might partly be a result of the use of corticosteroids. We examined the incidence of esophageal cancer in a large cohort of corticosteroid users in Denmark. We used the population-based Pharmaco-Epidemiological Prescription Database in North Jutland County, Denmark (population 490,000) to identify 233,728 corticosteroid prescriptions for tablets and injections filled for 59,685 individuals between January 1, 1989 and December 31, 1996. All pharmacies in the county are equipped with a computerized accounting system from which data are transferred both to the National Health Service (to secure reimbursement of the costs associated with the purchase of corticosteroids and other drugs) and to the Prescription Database. Through linkage to the Danish Cancer Registry, the cohort was followed for the occurrence of esophageal cancer from the date of the first prescription for corticosteroids until the date of death or until December 31, 1996. The number of incident cases with esophageal cancer observed among cohort members was compared with the number expected on the basis of age-, sex-, county-, and calendar year-specific cancer incidence rates. The standardized incidence ratio was calculated as the ratio of the observed to the expected number of cases by years of follow-up and the total number of prescriptions issued by the patient. The cohort of corticosteroid users accrued 245,775 person-years of follow-up, with a mean follow-up period of 3.7 years. We found an increased risk of esophageal cancer in users of corticosteroids, on the basis of 36 observed cases compared with 18.8 expected cases, yielding a standardized incidence ratio of 1.92 (95% confidence interval = 1.34–2.65). The risk was increased in all latency periods (Table 1).Table 1: Observed and Expected Numbers and Standardized Incidence Ratio (SIR) of Esophageal Cancer in 59,685 Users of Systemic Corticosteroids, 1989–1996, North Jutland County, DenmarkOur study indicates a positive association between use of corticosteroids and esophageal cancer. Confounding from, eg, alcohol, smoking, body weight, and concomitant use of other sphincter-relaxing drugs 3,5 may play a role, but in the present study we could not determine the impact of these factors. The association between use of corticosteroids and esophageal cancer deserves further explanation. Henrik Toft Sørensen Lene Mellemkjaer Søren Friis Jørgen H. Olsen
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».