How lovely it is to be sat in the garden with a coffee, feeling the sun on my face whilst I type. Not so lovely that when I’m finished there’s a lot of weeding to do, but hey. Did you do your homework from last week? Did you reach out to someone you’ve been meaning to? If you did, I’ll bet you’re pleased you did. If not, what’s stopping you picking up your phone now? This week there is a double dose of research. In my video I’ll be discussing a trial assessing whether it makes any difference what time of day people take their blood pressure medication.
In my blog I wanted to mention a trial which made the rounds of all the major news outlets this week. I’m always interested in how medical research is portrayed in the mainstream press, as very often the devil is in the detail, which may be overlooked. It’s very easy to get clickbait with headlines like ‘halve your cancer risk with simple jab’! The jabs in question are of course GLP-1 agonist drugs, or weight-loss drugs such as Wegovy and Mounjaro. They are no doubt very effective at helping people lose weight, and latest evidence shows a reduction in heart attack risk, plus improvements in heart failure, but can we really add less cancer too??
The backstory is that being overweight increases the risk of certain cancers (possibly through inflammation and other factors) such as myeloma, oesophagus, stomach, colorectal, liver, ovary and some forms of breast cancer. Whether the obesity itself causes cancer, or whether there is simply a strong association is a big topic and not one I’ll go into here, but suffice it to say, obesity is felt to be a major preventable risk for cancer. Diabetes is also in the same bracket.
The study population here were Israeli, and importantly, this trial was what we call observational. That means that the study investigators reviewed medical records to make their assessment, but this was not a randomised controlled trial of one treatment over another. They wanted to understand any potential differences between bariatric metabolic surgery and GLP-1 drugs. Also importantly, this trial was conducted on ‘first generation’ drugs (Wegovy and Mounjaro are both second generation) as the dates of enrolment were 2010 – 2018 . From a starting population of over 30,000 diabetic patients, once they excluded certain things like previous cancer, kidney disease, pregnancy and so on, they were left with a little over 6000, split into two groups: surgery vs drugs. Nearly 2/3 were female, average age 52. Over an average of 7 years follow up, around 5% of patients developed cancer, the commonest being breast, colon and uterine.
Surgery was more effective than the drugs (31% body weight reduction compared with 13%), but remember these are first generation medications, and the results with second gen are far better (average 20%v body weight reduction at one year). However, despite the significant difference favouring surgery in terms of weight loss, the effect on reducing cancer risk was actually 41% higher in favour of the drugs.
At face value therefore, in diabetic patients treatment with these drugs appears to lower cancer risk…. but does it really? This is a relatively small study, in a non-randomised population who may have inherent differences, and it is observational data only so making larger generalisations is not possible. That’s not to say it’s not an interesting study, and adds to the body of evidence. I would love to see a large randomised trial specifically looking at the potential reduced cancer risk with current generation drugs, but for now, headlines such as the ones in the press this week seem a bit premature.
If you would like to read more on GLP-1 drugs, please click here
As a regular reader of my blog, I really hope you are finding yourself more curious when you inevitably see medical headlines in the press, and dig a bit deeper into the detail to see if the headlines really hold up! If you ever see a trial and wonder about its scientific value, feel free to pop a comment in the website and if I’m able I’ll take a look and write on it – chances are if you have seen it other members will have too and may have their own questions.