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Does growth hormone therapy increase the risk of cancer?

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 530–531 (2006)Cite this article

The possibility that growth hormone (GH) might affect risk of cancer occurrence is of considerable importance. Since its introduction in 1958, more than 100,000 patients have received GH therapy, and there is increasing evidence that the GH–IGF1 (insulin-like growth factor 1) axis could affect cancer risk in the general population.

Biological data suggest that GH might affect cancer risk. GH raises serum concentrations of IGF1, which is mitogenic and antiapoptotic in both normal and neoplastic cells in vitro. Supraphysiologic doses of GH can induce neoplasms in rats; transgenic mice that overexpress GH or IGF1 in the mammary gland have an increased incidence of mammary cancer; and GH treatment has induced mammary hyperplasia in monkeys. In humans, almost all cohort studies show raised risks of colorectal, prostate, and premenopausal breast cancers in relation to greater prior IGF1 levels, and a GH1 polymorphism that might result in reduced GH and IGF1 levels has been associated with decreased colorectal neoplasia risk in some populations. Breast cancer and, less consistently, colorectal and prostate cancer risks have been associated with tall stature, perhaps reflecting effects of the GH–IGF1 axis in childhood. Elevated serum GH levels were described in patients with breast cancer in one study. In men without acromegaly, GH levels were associated with subsequent overall cancer mortality, although site-specific data were not published. Studies of patients with acromegaly have demonstrated raised colon cancer risk and increased prevalence of precancerous colonic lesions, both significantly associated with GH levels. Although these studies indicate a potential for influence of GH treatment on cancer risk, none has addressed the question directly, and their results are often susceptible to alternative explanations. The final verdict must rest on epidemiologic studies of GH-treated patients. Unfortunately there have been few sizeable studies,1,2,3,4,5,6,7,8,9 and most have major shortcomings in methodology or reporting. These shortcomings, and not just the headline results, need to be considered in order to reach a valid judgment.

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Acknowledgements

I thank Professor M Preece and Dr P Adlard for unpublished information about bone cancer histology in the UK cohort, and Mrs M Snigorska for secretarial help.

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  1. Professor of Epidemiology at the Institute of Cancer Research, Sutton, Surrey, UK

    Anthony J Swerdlow

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Correspondence to Anthony J Swerdlow.

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Swerdlow, A. Does growth hormone therapy increase the risk of cancer?. Nat Rev Endocrinol 2, 530–531 (2006). https://doi.org/10.1038/ncpendmet0295

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