IARC 60th Anniversary - 19-21 May 2026
Session : 21/05/26 - Posters
Systemic glucocorticoid use and risk of site-specific cancers: a methodological systematic review of observational studies
CAIRAT M. 1,2,3, OLIVIER E. 1, NEAU J. 4, PONS A. 1, PERUCHET-NORAY L. 5, MAHAMAT-SALEH Y. 5, SEVERI G. 1,7, POTTEGÅRD A. 2, FONTVIEILLE E. 5, DOWNHAM L. 6, HICKS B. 2,8
1 Université Paris Saclay, Uvsq, Inserm, Gustave Roussy, CESP, Villejuif, France; 2 Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark; 3 Université de Bordeaux, INSERM, BPH, team AHeaD, U1219, Bordeaux, France; 4 Université de Tours, Tours, France; 5 Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; 6 Early detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; 7 Department of Statistics, Computer Science and Applications « G. Parenti », Florence, Italy; 8 Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
Background
Systemic glucocorticoids, widely prescribed for inflammatory and autoimmune diseases, have long been suspected of increasing cancer risk through immunosuppressive and metabolic effects. Randomized trials assessing this risk are difficult to conduct and may be unethical, leaving observational studies the best option to determine whether use of glucocorticoids impact cancer development. However, these studies face significant methodological issues that may compromise the validity of their findings.
Objectives
We therefore conducted a systematic review to evaluate the methodological rigor of published observational studies that examined the associations between systemic glucocorticoid use and site-specific cancer risks.
Methods
We performed a systematic review of observational studies on glucocorticoids and cancer published until May 1, 2025, using PubMed, Web of Science, Embase or Cochrane Library. We assessed methodological issues, including unclear research objectives, inappropriate exposure definitions, prevalent user bias, immortal-time bias, time-window bias, reverse causation, detection bias, confounding by indication, and inappropriate adjustment for time-varying covariates such as body mass index and surveillance factors. We also presented results for cancer sites reported in more than three studies.
Results
Of the 56 studies included, only about one-quarter (N=14) were designed to investigate exclusively the effect of glucocorticoids on cancer risk. Eighteen studies were excluded from the quality evaluation due to presenting multiple adjusted estimates in a single table without clear model specification. Among the 38 studies evaluated (8 cohort, 13 case-control, 16 nested case-control, and 1 case-cohort studies), most investigated non-Hodgkin lymphoma (N=9), skin (N=7), breast (N=5), colorectal cancer (N=5), or lung (N=4). Methodological limitations were frequent: 34% had time-window bias, 50% lacked appropriate lag-time, 74% were not restricted to specific patient populations based on glucocorticoid indications and 16% inadequately adjusted for time-varying covariates. While some studies reported positive associations for non-Hodgkin lymphoma, lung cancer, and non-melanoma skin cancer, these findings were inconsistent and likely influenced by confounding and inadequate latency consideration. In contrast, evidence was largely null for melanoma or breast cancer, while results were inconsistent for colorectal cancer.
Conclusions/implications
This systematic review of observational studies provided an overview of the existing literature on the effect of glucocorticoids on cancer risk. The high prevalence of study design and analysis limitations could explain the contradictory findings reported to date on the associations between the use of glucocorticoids and cancer risk. Our review highlights the need to apply robust study designs and analytical approaches to generate unbiased estimates of the potential effect of glucocorticoids on cancer incidence in future studies.