Association of Anorexia Nervosa With Risk of Cancer

A Systematic Review and Meta-analysis

Ferrán Catalá-López, Jaume Forés-Martos, Jane A. Driver, Matthew J. Page, Brian Hutton, Manuel Ridao, Adolfo Alonso-Arroyo, Diego Macías Saint-Gerons, Ricard Gènova-Maleras, José M. Valderas, Eduard Vieta, Alfonso Valencia, Rafael Tabarés-Seisdedos

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Importance: Anorexia nervosa is recognized as an important cause of morbidity in young people. However, the risk of cancer in people with anorexia nervosa remains uncertain. Objective: To evaluate the association of anorexia nervosa with the risk of developing or dying of cancer. Data Sources: MEDLINE, Scopus, Embase, and Web of Science from database inception to January 9, 2019. Study Selection: Published observational studies in humans examining the risk of cancer in people with anorexia nervosa compared with the general population or those without anorexia nervosa. Studies needed to report incidence or mortality rate ratios (RRs). Data Extraction and Synthesis: Screening, data extraction, and methodological quality assessment were performed by at least 2 researchers independently. A random-effects model was used to synthesize individual studies. Heterogeneity (I2) was assessed and 95% prediction intervals (PIs) were calculated. Main Outcomes and Measures: All cancer incidence and cancer mortality associated with anorexia nervosa. Secondary outcomes were site-specific cancer incidence and mortality. Results: Seven cohort studies published in 10 articles (42 602 participants with anorexia nervosa) were included. Anorexia nervosa was not associated with risk of developing any cancer (4 studies in women; RR, 0.97; 95% CI, 0.89-1.06; P = .53; I2, 0%; 95% PI, 0.80-1.18; moderate confidence). Anorexia nervosa was associated with decreased breast cancer incidence (5 studies in women; RR, 0.60; 95% CI, 0.50-0.80; P < .001; I2, 0%; 95% PI, 0.44-0.83; high confidence). Conversely, anorexia nervosa was associated with increased risk of developing lung cancer (3 studies in women; RR, 1.50; 95% CI, 1.06-2.12; P = .001; I2, 0%; 95% PI, 0.19-16.46; low confidence) and esophageal cancer (2 studies in women; RR, 6.10; 95% CI, 2.30-16.18; P < .001; I2, 0%; low confidence). Conclusions and Relevance: Among people with anorexia nervosa, risk of developing cancer did not differ compared with the general population, but a significantly reduced risk of breast cancer was observed. Understanding the mechanisms underlying these associations could have important preventive potential.

Original languageEnglish
Article numbere195313
Number of pages14
JournalJAMA network open
Volume2
Issue number6
DOIs
Publication statusPublished - 5 Jun 2019

Cite this

Catalá-López, F., Forés-Martos, J., Driver, J. A., Page, M. J., Hutton, B., Ridao, M., ... Tabarés-Seisdedos, R. (2019). Association of Anorexia Nervosa With Risk of Cancer: A Systematic Review and Meta-analysis. JAMA network open, 2(6), [e195313]. https://doi.org/10.1001/jamanetworkopen.2019.5313
Catalá-López, Ferrán ; Forés-Martos, Jaume ; Driver, Jane A. ; Page, Matthew J. ; Hutton, Brian ; Ridao, Manuel ; Alonso-Arroyo, Adolfo ; Macías Saint-Gerons, Diego ; Gènova-Maleras, Ricard ; Valderas, José M. ; Vieta, Eduard ; Valencia, Alfonso ; Tabarés-Seisdedos, Rafael. / Association of Anorexia Nervosa With Risk of Cancer : A Systematic Review and Meta-analysis. In: JAMA network open. 2019 ; Vol. 2, No. 6.
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title = "Association of Anorexia Nervosa With Risk of Cancer: A Systematic Review and Meta-analysis",
abstract = "Importance: Anorexia nervosa is recognized as an important cause of morbidity in young people. However, the risk of cancer in people with anorexia nervosa remains uncertain. Objective: To evaluate the association of anorexia nervosa with the risk of developing or dying of cancer. Data Sources: MEDLINE, Scopus, Embase, and Web of Science from database inception to January 9, 2019. Study Selection: Published observational studies in humans examining the risk of cancer in people with anorexia nervosa compared with the general population or those without anorexia nervosa. Studies needed to report incidence or mortality rate ratios (RRs). Data Extraction and Synthesis: Screening, data extraction, and methodological quality assessment were performed by at least 2 researchers independently. A random-effects model was used to synthesize individual studies. Heterogeneity (I2) was assessed and 95{\%} prediction intervals (PIs) were calculated. Main Outcomes and Measures: All cancer incidence and cancer mortality associated with anorexia nervosa. Secondary outcomes were site-specific cancer incidence and mortality. Results: Seven cohort studies published in 10 articles (42 602 participants with anorexia nervosa) were included. Anorexia nervosa was not associated with risk of developing any cancer (4 studies in women; RR, 0.97; 95{\%} CI, 0.89-1.06; P = .53; I2, 0{\%}; 95{\%} PI, 0.80-1.18; moderate confidence). Anorexia nervosa was associated with decreased breast cancer incidence (5 studies in women; RR, 0.60; 95{\%} CI, 0.50-0.80; P < .001; I2, 0{\%}; 95{\%} PI, 0.44-0.83; high confidence). Conversely, anorexia nervosa was associated with increased risk of developing lung cancer (3 studies in women; RR, 1.50; 95{\%} CI, 1.06-2.12; P = .001; I2, 0{\%}; 95{\%} PI, 0.19-16.46; low confidence) and esophageal cancer (2 studies in women; RR, 6.10; 95{\%} CI, 2.30-16.18; P < .001; I2, 0{\%}; low confidence). Conclusions and Relevance: Among people with anorexia nervosa, risk of developing cancer did not differ compared with the general population, but a significantly reduced risk of breast cancer was observed. Understanding the mechanisms underlying these associations could have important preventive potential.",
author = "Ferr{\'a}n Catal{\'a}-L{\'o}pez and Jaume For{\'e}s-Martos and Driver, {Jane A.} and Page, {Matthew J.} and Brian Hutton and Manuel Ridao and Adolfo Alonso-Arroyo and {Mac{\'i}as Saint-Gerons}, Diego and Ricard G{\`e}nova-Maleras and Valderas, {Jos{\'e} M.} and Eduard Vieta and Alfonso Valencia and Rafael Tabar{\'e}s-Seisdedos",
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month = "6",
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language = "English",
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Catalá-López, F, Forés-Martos, J, Driver, JA, Page, MJ, Hutton, B, Ridao, M, Alonso-Arroyo, A, Macías Saint-Gerons, D, Gènova-Maleras, R, Valderas, JM, Vieta, E, Valencia, A & Tabarés-Seisdedos, R 2019, 'Association of Anorexia Nervosa With Risk of Cancer: A Systematic Review and Meta-analysis', JAMA network open, vol. 2, no. 6, e195313. https://doi.org/10.1001/jamanetworkopen.2019.5313

Association of Anorexia Nervosa With Risk of Cancer : A Systematic Review and Meta-analysis. / Catalá-López, Ferrán; Forés-Martos, Jaume; Driver, Jane A.; Page, Matthew J.; Hutton, Brian; Ridao, Manuel; Alonso-Arroyo, Adolfo; Macías Saint-Gerons, Diego; Gènova-Maleras, Ricard; Valderas, José M.; Vieta, Eduard; Valencia, Alfonso; Tabarés-Seisdedos, Rafael.

In: JAMA network open, Vol. 2, No. 6, e195313, 05.06.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association of Anorexia Nervosa With Risk of Cancer

T2 - A Systematic Review and Meta-analysis

AU - Catalá-López, Ferrán

AU - Forés-Martos, Jaume

AU - Driver, Jane A.

AU - Page, Matthew J.

AU - Hutton, Brian

AU - Ridao, Manuel

AU - Alonso-Arroyo, Adolfo

AU - Macías Saint-Gerons, Diego

AU - Gènova-Maleras, Ricard

AU - Valderas, José M.

AU - Vieta, Eduard

AU - Valencia, Alfonso

AU - Tabarés-Seisdedos, Rafael

PY - 2019/6/5

Y1 - 2019/6/5

N2 - Importance: Anorexia nervosa is recognized as an important cause of morbidity in young people. However, the risk of cancer in people with anorexia nervosa remains uncertain. Objective: To evaluate the association of anorexia nervosa with the risk of developing or dying of cancer. Data Sources: MEDLINE, Scopus, Embase, and Web of Science from database inception to January 9, 2019. Study Selection: Published observational studies in humans examining the risk of cancer in people with anorexia nervosa compared with the general population or those without anorexia nervosa. Studies needed to report incidence or mortality rate ratios (RRs). Data Extraction and Synthesis: Screening, data extraction, and methodological quality assessment were performed by at least 2 researchers independently. A random-effects model was used to synthesize individual studies. Heterogeneity (I2) was assessed and 95% prediction intervals (PIs) were calculated. Main Outcomes and Measures: All cancer incidence and cancer mortality associated with anorexia nervosa. Secondary outcomes were site-specific cancer incidence and mortality. Results: Seven cohort studies published in 10 articles (42 602 participants with anorexia nervosa) were included. Anorexia nervosa was not associated with risk of developing any cancer (4 studies in women; RR, 0.97; 95% CI, 0.89-1.06; P = .53; I2, 0%; 95% PI, 0.80-1.18; moderate confidence). Anorexia nervosa was associated with decreased breast cancer incidence (5 studies in women; RR, 0.60; 95% CI, 0.50-0.80; P < .001; I2, 0%; 95% PI, 0.44-0.83; high confidence). Conversely, anorexia nervosa was associated with increased risk of developing lung cancer (3 studies in women; RR, 1.50; 95% CI, 1.06-2.12; P = .001; I2, 0%; 95% PI, 0.19-16.46; low confidence) and esophageal cancer (2 studies in women; RR, 6.10; 95% CI, 2.30-16.18; P < .001; I2, 0%; low confidence). Conclusions and Relevance: Among people with anorexia nervosa, risk of developing cancer did not differ compared with the general population, but a significantly reduced risk of breast cancer was observed. Understanding the mechanisms underlying these associations could have important preventive potential.

AB - Importance: Anorexia nervosa is recognized as an important cause of morbidity in young people. However, the risk of cancer in people with anorexia nervosa remains uncertain. Objective: To evaluate the association of anorexia nervosa with the risk of developing or dying of cancer. Data Sources: MEDLINE, Scopus, Embase, and Web of Science from database inception to January 9, 2019. Study Selection: Published observational studies in humans examining the risk of cancer in people with anorexia nervosa compared with the general population or those without anorexia nervosa. Studies needed to report incidence or mortality rate ratios (RRs). Data Extraction and Synthesis: Screening, data extraction, and methodological quality assessment were performed by at least 2 researchers independently. A random-effects model was used to synthesize individual studies. Heterogeneity (I2) was assessed and 95% prediction intervals (PIs) were calculated. Main Outcomes and Measures: All cancer incidence and cancer mortality associated with anorexia nervosa. Secondary outcomes were site-specific cancer incidence and mortality. Results: Seven cohort studies published in 10 articles (42 602 participants with anorexia nervosa) were included. Anorexia nervosa was not associated with risk of developing any cancer (4 studies in women; RR, 0.97; 95% CI, 0.89-1.06; P = .53; I2, 0%; 95% PI, 0.80-1.18; moderate confidence). Anorexia nervosa was associated with decreased breast cancer incidence (5 studies in women; RR, 0.60; 95% CI, 0.50-0.80; P < .001; I2, 0%; 95% PI, 0.44-0.83; high confidence). Conversely, anorexia nervosa was associated with increased risk of developing lung cancer (3 studies in women; RR, 1.50; 95% CI, 1.06-2.12; P = .001; I2, 0%; 95% PI, 0.19-16.46; low confidence) and esophageal cancer (2 studies in women; RR, 6.10; 95% CI, 2.30-16.18; P < .001; I2, 0%; low confidence). Conclusions and Relevance: Among people with anorexia nervosa, risk of developing cancer did not differ compared with the general population, but a significantly reduced risk of breast cancer was observed. Understanding the mechanisms underlying these associations could have important preventive potential.

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