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. 2021 Jun;32(6):597-607.
doi: 10.1007/s10552-021-01413-5. Epub 2021 Mar 22.

Antibiotic use prior to a lung cancer diagnosis: a population-based study

Lukas Löfling  1   2 , Shahram Bahmanyar  3 , Helle Kieler  3   4 , Mats Lambe  5   6 , Gunnar Wagenius  7
Affiliations

Antibiotic use prior to a lung cancer diagnosis: a population-based study

Lukas Löfling et al. Cancer Causes Control. 2021 Jun.

Abstract

Aim: To examine patterns of recent pre-diagnostic fillings of antibiotics as an indicator of early symptoms of lung cancer.

Methods: Individuals diagnosed with lung cancer (cases) in 2009-2016 were identified in the Swedish National Lung Cancer Register, a population-based register, and randomly matched with up to five individuals free of lung cancer (controls) from the general population. Conditional logistic models were used to estimate odds ratios for the association between lung cancer and a recent history of filled antibiotic prescriptions.

Results: The study included 27,017 cases and 129,355 controls. The likelihood of recent exposure was approximately two times higher in cases compared to controls. The magnitude of the effect size became more pronounced with proximity to the diagnosis of lung cancer and an increasing number of filled prescriptions. While the magnitude of the effect size did not differ by sex or educational level, it became attenuated with increasing age. There was no evidence supporting a trend in the magnitude of the effect size for the association between lung cancer and a history of repeated fillings by cancer stage.

Conclusion: Lung cancer was associated with an increased likelihood of a recent history of filled antibiotic prescriptions. However, there was no evidence of an association between repeated fillings and a diagnostic delay, as reflected by stage. Our findings underscore the importance of clinical reassessment to rule out lung cancer following pneumonia treatment, especially for patients with multiple treatment cycles.

Keywords: Antibiotics; Early symptoms; Lung cancer; Pneumonia; Sweden.

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Conflict of interest statement

Lukas Löfling, Shahram Bahmanyar, and Helle Kieler are employees at the Centre for Pharmacoepidemiology at Karolinska Institutet, which receives funding from several entities (pharmaceutical companies, regulatory agencies, and contract research organizations). Mats Lambe declares stock ownership in Pfizer and Astra Zeneca. Gunnar Wagenius has no conflict of interest to declare. The funding bodies had no role in the data collection and analysis and were not involved in the interpretation of results, writing, revision, or approval of the manuscript.

Figures

Fig. 1
Fig. 1
The proportion of cases (individuals with lung cancer) and controls (individuals free of lung cancer) with at least one filled prescription of antibiotics recommended for the treatment of pneumonia. Presented for separate months of the observation period, overall and by history of chronic obstructive pulmonary disease. Cases and controls were matched by sex, year of birth and place of residence. Lung Cancer DataBase Sweden, 2009–2016
Fig. 2
Fig. 2
Odds ratios (solid line) and 95% confidence intervals (shaded area) for the association between a diagnosis of lung cancer and the number of recently filled prescriptions of antibiotics recommended for the treatment of pneumonia. Cases and controls were matched by sex, year of birth and place of residence. The odds ratios were adjusted for sex, year of birth, place of residence, highest attained education, previous chronic obstructive pulmonary disease diagnosis, previous use of antibiotics recommended for the treatment of pneumonia, and history of any cancer. Lung Cancer DataBase Sweden, 2009–2016
Fig. 3
Fig. 3
Odds ratios for the association between a diagnosis of lung cancer and a recent history of at least one filled prescription of antibiotics recommended for the treatment of pneumonia in different time intervals before diagnosis. Cases and controls were matched by sex, year of birth and place of residence. The odds ratios were adjusted for sex, year of birth, place of residence, highest attained education, previous chronic obstructive pulmonary disease diagnosis, previous use of antibiotics recommended for the treatment of pneumonia, and history of any cancer. Lung Cancer DataBase Sweden, 2009–2016
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References

    1. Ebell MH, Thai TN, Royalty KJ. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev. 2018;39:7. - PMC - PubMed
    1. Löfling L, et al. Clinical characteristics and survival in non-small cell lung cancer patients by smoking history: a population-based cohort study. Acta Oncol. 2019;58(11):1618–1627. - PubMed
    1. Karl-Gustav Kölbeck and H. Almer. Regionalt Vårdprogram - Lungcancer [Regional Care Program - Lung Cancer]. 2018 [cited 2019 20190114]; Available from: http://www.viss.nu/Handlaggning/Vardprogram/Andning/Lungcancer/.
    1. National Health Service (NHS). Lung cancer symptoms. 2019 20190815 [cited 2019 190827]; Available from: https://www.nhs.uk/conditions/lung-cancer/symptoms/#.
    1. Zhang H, Garcia Rodriguez LA, Hernandez-Diaz S. Antibiotic use and the risk of lung cancer. Cancer Epidemiol Biomarkers Prev. 2008;17(6):1308–1315. - PubMed

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