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Nationwide study of cancer risk among hip replacement patients in Sweden.
J Natl Cancer Inst 2001; 93(18):1405-10JNCI

Abstract

BACKGROUND

Orthopedic implants and their fixatives contain materials with carcinogenic potential. Whether these implants are linked to subsequent cancer development remains unknown, mainly because large-scale, long-term follow-up data are scarce.

METHODS

We conducted a nationwide cohort study in Sweden to examine cancer incidence among 116,727 patients who underwent hip replacement surgery during the period from 1965 through 1994. Through record linkage to the Swedish Cancer Register, we identified all incident cancers through 1995 in this population (693,954 person-years of observation). For each cancer type, the observed number of cases was divided by that expected in the general Swedish population to produce standardized incidence ratios (SIRs).

RESULTS

Relative to the general population, the cohort had no overall cancer excess (SIR = 1.01; 95% confidence interval [CI] = 0.99 to 1.03). However, we observed elevated SIRs for prostate cancer (SIR = 1.16; 95% CI = 1.11 to 1.22) and melanoma (SIR = 1.15; 95% CI = 1.01 to 1.30) and a reduction in stomach cancer risk (SIR = 0.83; 95% CI = 0.75 to 0.92). Long-term follow-up (>or=15 years) revealed an excess of multiple myeloma (SIR = 1.86; 95% CI = 1.01 to 3.11) and a statistically nonsignificant increase in bladder cancer (SIR = 1.42; 95% CI = 0.98 to 1.99). There was no material increase in risk for bone or connective tissue cancer for either men or women in any follow-up period.

CONCLUSIONS

In this, the largest study to date, hip implant patients had similar rates of most types of cancer to those in the general population. Although the excesses of melanoma, multiple myeloma, and prostate and bladder cancers may be due to chance, confounding, or detection bias and should be interpreted cautiously, they warrant further investigation because of the ever-increasing use of hip implants at younger ages.

Authors+Show Affiliations

International Epidemiology Institute, Rockville, MD 20850, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11562392

Citation

Signorello, L B., et al. "Nationwide Study of Cancer Risk Among Hip Replacement Patients in Sweden." Journal of the National Cancer Institute, vol. 93, no. 18, 2001, pp. 1405-10.
Signorello LB, Ye W, Fryzek JP, et al. Nationwide study of cancer risk among hip replacement patients in Sweden. J Natl Cancer Inst. 2001;93(18):1405-10.
Signorello, L. B., Ye, W., Fryzek, J. P., Lipworth, L., Fraumeni, J. F., Blot, W. J., ... Nyrén, O. (2001). Nationwide study of cancer risk among hip replacement patients in Sweden. Journal of the National Cancer Institute, 93(18), pp. 1405-10.
Signorello LB, et al. Nationwide Study of Cancer Risk Among Hip Replacement Patients in Sweden. J Natl Cancer Inst. 2001 Sep 19;93(18):1405-10. PubMed PMID: 11562392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nationwide study of cancer risk among hip replacement patients in Sweden. AU - Signorello,L B, AU - Ye,W, AU - Fryzek,J P, AU - Lipworth,L, AU - Fraumeni,J F,Jr AU - Blot,W J, AU - McLaughlin,J K, AU - Nyrén,O, PY - 2001/9/20/pubmed PY - 2002/1/5/medline PY - 2001/9/20/entrez SP - 1405 EP - 10 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 93 IS - 18 N2 - BACKGROUND: Orthopedic implants and their fixatives contain materials with carcinogenic potential. Whether these implants are linked to subsequent cancer development remains unknown, mainly because large-scale, long-term follow-up data are scarce. METHODS: We conducted a nationwide cohort study in Sweden to examine cancer incidence among 116,727 patients who underwent hip replacement surgery during the period from 1965 through 1994. Through record linkage to the Swedish Cancer Register, we identified all incident cancers through 1995 in this population (693,954 person-years of observation). For each cancer type, the observed number of cases was divided by that expected in the general Swedish population to produce standardized incidence ratios (SIRs). RESULTS: Relative to the general population, the cohort had no overall cancer excess (SIR = 1.01; 95% confidence interval [CI] = 0.99 to 1.03). However, we observed elevated SIRs for prostate cancer (SIR = 1.16; 95% CI = 1.11 to 1.22) and melanoma (SIR = 1.15; 95% CI = 1.01 to 1.30) and a reduction in stomach cancer risk (SIR = 0.83; 95% CI = 0.75 to 0.92). Long-term follow-up (>or=15 years) revealed an excess of multiple myeloma (SIR = 1.86; 95% CI = 1.01 to 3.11) and a statistically nonsignificant increase in bladder cancer (SIR = 1.42; 95% CI = 0.98 to 1.99). There was no material increase in risk for bone or connective tissue cancer for either men or women in any follow-up period. CONCLUSIONS: In this, the largest study to date, hip implant patients had similar rates of most types of cancer to those in the general population. Although the excesses of melanoma, multiple myeloma, and prostate and bladder cancers may be due to chance, confounding, or detection bias and should be interpreted cautiously, they warrant further investigation because of the ever-increasing use of hip implants at younger ages. SN - 0027-8874 UR - https://www.unboundmedicine.com/medline/citation/11562392/Nationwide_study_of_cancer_risk_among_hip_replacement_patients_in_Sweden_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/93.18.1405 DB - PRIME DP - Unbound Medicine ER -