BACKGROUND: Cancer risk in acromegaly remains debated, with studies showing both increased and similar risk compared to the background population. We conducted a nationwide cohort study examining the risk of cancer and benign colorectal lesions in acromegaly patients. METHODS: The study included acromegaly patients diagnosed in Denmark (1977-2021, n = 809, median follow-up 12.2 IQR: 5.6-21.7 years (range: 0.04-44.0) and controls matched on sex and birth year (n = 80,900). All diagnoses of acromegaly were biochemically validated. We investigated the occurrence of cancer diagnoses, benign colorectal lesions, performance of colonoscopies and mortality with time-to-event statistics and logistic regression. FINDINGS: Overall cancer risk was not clearly increased (IRR: 1.10 0.93;1.30, p = 0.27), but patients with acromegaly had an increased risk of colorectal cancer (IRR: 1.78 1.22;2.60, p < 0.01) and thyroid cancer (IRR: 3.68 1.16;11.66, p = 0.03). Colorectal cancers were more often localized (IRR: 2.00 1.21;3.30, p = 0.007) as compared to controls, and the use of endoscopic colorectal procedures was increased (IRR: 2.85 2.54;3.19, p < 0.01). The incidence of benign colorectal lesions was elevated in acromegaly patients (IRR: 2.32 1.96;2.76, p < 0.01) and dominated by tubular adenomas (43.6%) and hyperplastic polyps (33.2%). Fecal immunochemical test (FIT) screening and clinical suspicion guided the use of colonoscopies, rather than systematic colonoscopy screening.All-cause mortality was elevated in acromegaly (IRR: 1.18 1.02; 1.36, p = 0.03), but cancer-specific mortality was not (IRR: 0.95 0.72;1.25, p = 0.72). INTERPRETATION: Acromegaly carries an increased risk of colorectal cancer, but neither overall cancer risk, nor cancer-specific mortality are increased.
Rosendal et al. (Mon,) studied this question.