Endocarditis and risk of cancer: a Danish nationwide cohort study.

Abstract

BACKGROUND:

Endocarditis may be a marker for bacteremia-associated occult cancer. Intensive antibiotic treatment in endocarditis is suggested to reduce long-term cancer risk. We examined these hypotheses in a nationwide cohort study.

METHODS:

Endocarditis patients and cancer cases were identified from the Danish National Registry of Patients and the Danish Cancer Registry during 1978-2008. We compared the incidences of various cancers among study subjects to expected incidences based on national age-, sex-, and site-specific rates.

RESULTS:

We observed 997 cancers among 8445 endocarditis patients (median follow-up of 3.5 years), reflecting an increased standardized incidence rate (SIR) of 1.61 (95% confidence interval [CI], 1.51-1.71). Cancer risk was highly elevated during the first 3 months of follow-up (SIR=8.03; 95% CI, 6.92-9.26), partly due to a 15- to 30-fold increased risk of hematological or liver cancers. Between 3-month and 5-year follow-ups, cancer incidence remained 1.5-fold higher than expected, including 2- and 4-fold increased SIRs for colorectal and liver cancers, respectively. Beyond 5 years of observation, the overall cancer SIR was 1.21 (95% CI, 1.10-1.34). Long-term associations were weak for several cancers hypothesized to be associated with antibiotic use, including prostate, gastric, and breast cancer.

CONCLUSION:

Endocarditis is a substantial clinical marker for presence of occult cancer. We found no evidence of decreased long-term cancer risk after antibiotic treatment for endocarditis.

• Authors: Reimar Wernich Thomsen, Dóra Körmendiné Farkas, Søren Friis, Claus Sværke, Anne Gulbech Ording, Mette Nørgaard, Henrik Toft Sørensen
• Journal: The American journal of medicine (Am J Med) Vol. 126 Issue 1 Pg. 58-67 (Jan 2013) ISSN: 1555-7162 [Electronic] United States
• PMID: 23260503 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Cohort Studies
• Denmark (epidemiology)
• Endocarditis (drug therapy, epidemiology)
• Female
• Humans
• Immunosuppression Therapy
• Incidence
• Male
• Middle Aged
• Neoplasms (epidemiology)
• Risk Assessment
• Risk Factors
• Young Adult