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Meta-Analysis
. 2019 Jun 5;2(6):e195313.
doi: 10.1001/jamanetworkopen.2019.5313.

Association of Anorexia Nervosa With Risk of Cancer: A Systematic Review and Meta-analysis

Ferrán Catalá-López  1   2   3 , Jaume Forés-Martos  2 , Jane A Driver  4   5   6 , Matthew J Page  7 , Brian Hutton  3   8 , Manuel Ridao  9 , Adolfo Alonso-Arroyo  10   11 , Diego Macías Saint-Gerons  2 , Ricard Gènova-Maleras  12 , José M Valderas  13 , Eduard Vieta  14 , Alfonso Valencia  15 , Rafael Tabarés-Seisdedos  2
Affiliations
Meta-Analysis

Association of Anorexia Nervosa With Risk of Cancer: A Systematic Review and Meta-analysis

Ferrán Catalá-López et al. JAMA Netw Open. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Vieta reported receiving grants outside this work from AB Biotics, Abbott Laboratories, AstraZeneca, the Brain and Behaviour Research Foundation, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, Janssen Pharmaceutica, Lundbeck, Pfizer, Roche Holding, Sage Therapeutics, Sanofi, Servier Laboratoires, Shire, the Spanish Ministry of Science, Innovation and Universities (CIBERSAM), Horizon 2020, and the Stanley Medical Research Institute and reported receiving personal fees outside this work from Abbott Laboratories, Allergan, Angelini Pharma, AstraZeneca, Bristol-Myers Squibb, Farmindustria, Ferrer, Gedeon Richter, GlaxoSmithKline, Janssen Pharmaceutica, Lundbeck, Otsuka Pharmaceutical, Pfizer, Roche Holding, Sage Therapeutics, Sanofi, Servier Laboratoires, Shire, Sunovion, and Takeda Pharmaceutical Company. Dr Tabarés-Seisdedos reported receiving grants from Generalitat Valenciana and Carlos III Health Institute. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Study Selection
Figure 2.
Figure 2.. Treemap Summarizing the Amount of Data According to Site-Specific Cancers
1 indicates gallbladder; 2, lip and oral cavity; 3, bladder; 4, bone; 5, prostate; 6, testicular; and CNS, central nervous system.
Figure 3.
Figure 3.. Association of Anorexia Nervosa With Risk of Cancer
The size of each box indicates the effect of each study by weight assigned using the random-effects model; diamond, estimated effect size; width of diamond, the precision of the estimate (95% CI); NA, not applicable; and RR, risk ratio.
See this image and copyright information in PMC

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