Cushing Syndrome Is Associated With a Higher Risk of Cancer—A Nationwide Cohort Study

Abstract

Abstract Context Patients with Cushing syndrome (CS) have higher risk of obesity and diabetes, which are important risk factors of cancers. However, if patients with CS have a higher incidence of cancer remains unknown. Objective To investigate whether endogenous CS is associated with increased cancer incidence. Methods A nationwide cohort study analyzing data retrieved from Taiwan's National Health Insurance program in 2006-2017. Between 2006 and 2017, 1278 patients with newly diagnosed endogenous CS were identified. Among them, 1246 patients without a history of malignancy were enrolled in this study. The age- and sex-standardized incidence rate of all-cause cancer and age-, sex-, and calendar year–standardized incidence ratio (SIR) of cancer in association with endogenous CS. Results The age- and sex-standardized incidences of CS decreased from 4.84 to 3.77 per million person-years between 2006 and 2017. The age at diagnosis of CS was 45.3 ± 14.8 years, and 80.0% of the patients were female. Cushing disease and adrenal CS accounted for 35.4% and 64.6% of patients with CS, respectively. The incidence rate of cancer in patients with CS was 7.77 (95% CI 5.84-10.14) per 1000 person-years, with a SIR of 2.08 (95% CI 1.54-2.75). The 3 most common cancer types were liver (27.7%), kidney (16.7%), and lung (13.0%). Conclusion Patients with endogenous CS have a higher incidence of cancer.