Association of anorexia nervosa with risk of cancer. A systematic review and meta-analysis
Valderas Martinez, JM; Catala-Lopez, F; Forres-Martos, J; et al.Driver, JA; Page, MJ; Hutton, B; Ridao, M; Alonso-Arroyo, A; Saint-Gerons, DM; Genova-Maleras, R; Vieta, E; Valencia, A; Tabares-Seisdedos, R
Date: 7 June 2019
Journal
JAMA Network Open
Publisher
JAMA Network
Publisher DOI
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 ...
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 (I
2
) 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; I
2
, 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; I
2
, 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; I
2
, 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; I
2
, 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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