Metformin use and risk of gastric adenocarcinoma in a Swedish population-based cohort study



Whether or not the use of metformin decreases the risk of gastric adenocarcinoma is unclear.


This was a population-based cohort study in 2005–2015. Associations between metformin use and gastric non-cardia and cardia adenocarcinomas were examined within two cohorts; a diabetes cohort of participants using anti-diabetes medications, and a matched cohort of common-medication users, where metformin non-users were frequency matched (10:1) with metformin users for sex and age. Multivariable Cox proportional hazard regression analyses provided hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, calendar year, comorbidity, Helicobacter pylori eradication treatment, use of non-steroidal anti-inflammatory drugs or aspirin and use of statins.


During the follow-up for a median of 5.8 years, 892 (0.1%) participants in the diabetes cohort and 6395 (0.1%) participants in the matched cohort of common-medication users developed gastric adenocarcinoma. Metformin users had no significantly decreased risk of gastric non-cardia adenocarcinoma (diabetes cohort: HR 0.93, 95% CI 0.78–1.12; matched cohort: HR 1.30, 95% CI 1.18–1.42) or cardia adenocarcinoma (diabetes cohort: HR 1.49, 95% CI 1.09–2.02; matched cohort: HR 1.58, 95% CI 1.38–1.81) compared with non-users in both cohorts.


This cohort study with <10 years of follow-up suggests metformin use may not prevent gastric adenocarcinoma.

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Author information

All authors designed the study. J.L. and S.X. collected the data for the study. G.S. analysed the data. J.Z. interpreted the results and drafted the paper. All listed authors revised the paper and approved the final version of the article, including the authorship list. J.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Correspondence to Shao-Hua Xie.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted conforming to the Declaration of Helsinki. According to the Swedish legislation (1998:543) on health data registries, informed consents were generally not needed for registry-based studies in Sweden if the studies had been approved by the local ethical board.43 This study was approved by Regional Ethical Review Board in Stockholm, Sweden (reference number 2016/982-3/4).

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This work was supported by Swedish Cancer Society (CAN 2015/460) and Swedish Research Council (SIMSAM D0547801). Both the founding resources were neither involved in the study design, data collection, data analysis and interpretation of the results nor in the writing of the report and in the decision to submit the article for publication.

Data availability

All the data in this study were retrieved from the Swedish Prescribed Drugs and Health Cohort. The original data are available from the related registries listed above but restrictions apply to the availability of these data, which were used under license for this study and therefore are not publicly available. The data are, however, available through applications to these registries or reasonable request to the corresponding author (S.X.). The codes for the data analysis are archived by the biostatistician (G.S.).


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Zheng, J., Xie, S., Santoni, G. et al. Metformin use and risk of gastric adenocarcinoma in a Swedish population-based cohort study. Br J Cancer 121, 877–882 (2019). https://doi.org/10.1038/s41416-019-0598-z

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