慢性健康狀況用藥與癌症風險的相關性

The Association between Medications of Chronic Health Conditions and Risks of Cancers

台灣的全民健康保險成立於1995 年3 月，到2010 年底它涵蓋了兩千三百零八萬人約占全國人口的99.64%，大多數（92.1%）的醫療院所都與全民健康保險局簽約。自實施以來，即建立相當可觀的資料庫。本文將使用健保資料庫的資料發表於國際期刊的論文作整理，並摘要其重要的發現，例如：糖尿病患者使用胰島素治療可能會增加罹癌風險，但加入metformin 後，則會降低罹癌風險；thiazolidinediones 會降低罹肝癌、肺癌、及大腸直腸癌的風險；使用alpha-glucosidase inhibitors 會降低罹肺癌的風險；B 型肝炎病人使用statin 會降低罹肝癌風險；高血壓病人使用angiotensin II receptor blockers （ARB）藥物會降低罹癌的風險；女性使用angiotensin-converting enzyme （ACE）抑制劑合併aspirin 或NSAIDs 會降低罹乳癌的風險；感染幽門螺旋桿菌（Helicobacter pylori, HP）的病人且規則使用NSAIDs 會降低罹胃癌的風險；良性攝護腺肥大病人使用finasteride 會有顯著增加罹攝護腺癌的風險，使用dutasteride 有顯著增加罹腎臟癌的風險。本文著重於慢性健康狀況的藥物治療與罹癌風險有關的28 篇論文。提供醫療人員在治療這些疾病時的參考，並適時與病人及家屬溝通。

The National Health Insurance (NHI) of Taiwan was set up in March 1995, covering about 99.64% of the country's population (23.08 million people) by the end of 2010. Most of the medical institutions (92.1%) have contracts with the Bureau of NHI, Taiwan. The National Health Insurance Research Database (NHIRD) with scrambled-identification numbers of subjects was released by the Bureau of NHI, Taiwan, for academic research. This review study aimed to analyze the research articles published in the international journals using the data from the NHIRD, for example: patients with diabetes mellitus treated with insulin may increase the risk of cancer, but may reduce the risk of cancer after adding metformin; diabetic patients treated with thiazolidinediones may reduce the risk of liver cancer, lung cancer and colorectal cancer, and treated with alpha-glucosidase inhibitors may reduce the risk of lung cancer; statin use may reduce the risk of hepatocellular carcinoma in HBV-infected patients; angiotensin II receptor blockers use may reduce the risk of cancer in patients with hypertension; Angiotensin-converting enzyme inhibitors combined with aspirin or NSAIDs use may reduce the risk of breast cancer in female patients; effective reduction of gastric cancer risk was found in Helicobacter pylori-infected patients with regular use of NSAIDs; patients with benign prostate hypertrophy treated with finasteride may increase the risk of prostate cancer, and treated with dutasteride increased the risk of renal cell cancer. Due to the excessive number of articles, this paper focused on the 28 cancer-related English articles published within 5 years. The research topics from the selected articles included the issues about whether the medications of certain chronic diseases (e.g., diabetes mellitus) reduces or increases the risk of cancer. These findings suggested that patients with higher risks of cancers due to some medications for chronic conditions need more attentions from physicians. Physicians should also communicate with patients and their families about the related health risks.