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Association Between Alzheimer Disease and Cancer With Evaluation of Study Biases: A Systematic Review and Meta-analysis

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Ospina-Romero, Monica, Glymour, M. Maria, Hayes-Larson, Eleanor, Mayeda, Elizabeth Rose, Graff, Rebecca E., Brenowitz, Willa D., Ackley, Sarah F., Witte, John S. +1 more·2020·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.25515PMC PMC7666424
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Abstract

Importance: Observational studies consistently report inverse associations between cancer and Alzheimer disease (AD). Shared inverse etiological mechanisms might explain this phenomenon, but a systematic evaluation of methodological biases in existing studies is needed. Objectives: To systematically review and meta-analyze evidence on the association between cancer and subsequent AD, systematically identify potential methodological biases in studies, and estimate the influence of these biases on the estimated pooled association between cancer and AD. Data Sources: All-language publications were identified from PubMed, Embase, and PsycINFO databases through September 2, 2020. Study Selection: Longitudinal cohort studies and case-control studies on the risk of AD in older adults with a history of any cancer type, prostate cancer, breast cancer, colorectal cancer, or nonmelanoma skin cancer, relative to those with no cancer history. Data Extraction and Synthesis: Two reviewers independently abstracted the data and evaluated study biases related to confounding, diagnostic bias, competing risks, or survival bias. Random-effects meta-analysis was used to provide pooled estimates of the association between cancer and AD. Metaregressions were used to evaluate whether the observed pooled estimate could be attributable to each bias. The study was designed and conducted according to the Preferring Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Incidence, hazard, or odds ratios for AD comparing older adults with vs without a previous cancer diagnosis. Results: In total, 19 cohort studies and 3 case-control studies of the associations between any cancer type (n = 13), prostate cancer (n = 5), breast cancer (n = 1), and nonmelanoma skin cancer (n = 3) with AD were identified, representing 9 630 435 individuals. In all studies combined, cancer was associated with decreased AD incidence (cohort studies: random-effects hazard ratio, 0.89; 95% CI, 0.79-1.00; case-control studies: random-effects odds ratio, 0.75; 95% CI, 0.61-0.93). Studies with insufficient or inappropriate confounder control or greater likelihood of AD diagnostic bias had mean hazard ratios closer to the null value, indicating that these biases could not explain the observed inverse association. Competing risks bias was rare. Studies with greater likelihood of survival bias had mean hazard ratios farther from the null value. Conclusions and Relevance: The weak inverse association between cancer and AD may reflect shared inverse etiological mechanisms or survival bias but is not likely attributable to diagnostic bias, competing risks bias, or insufficient or inappropriate control for potential confounding factors.

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  • Previous observational studies have found inverse associations between cancer and Alzheimer's disease, but the mechanism for this is unknown.

    “previous observational studies have found inverse associations between cancer and AD, but the mechanism for this is unknown50”

    From Clonal hematopoiesis is associated with protection from Alzheimer’s disease (2023) · cites this paper as [50]

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Authors
Ospina-Romero, M., Glymour, M. M., Hayes-Larson, E., Mayeda, E. R., Graff, R. E., Brenowitz, W. D., Ackley, S. F., Witte, J. S., & Kobayashi, L. C.
Affiliations
  • Department of Epidemiology and Biostatistics, University of California, San Francisco
  • University of California, San Francisco (US)
  • Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
  • University of California, Los Angeles (US)
  • University of Michigan (US)
Corresponding author
Kobayashi, Lindsay C.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2020-11-13
Volume
3
Issue
11
Pages
e2025515
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.25515
PMC
PMC7666424
OpenAlex
W3101422350
Cited by
124
References
3
Citations by year
2026: 19 · 2025: 26 · 2024: 24 · 2023: 22 · 2022: 21 · 2021: 12
FWCI
2.28
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (K01AG062722, RF1AG059872, P30AG044281)
  • National Cancer Institute (R03CA241841, R01CA201358)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
Keywords
Alzheimer's disease, cancer, inverse association, methodological bias, confounding, diagnostic bias, survivorship bias, prostate cancer, breast cancer, non-melanoma skin cancer, colorectal cancer, older adults, dementia risk, cancer survivorship, cancer mortality
MeSH terms
Alzheimer Disease, Breast Neoplasms, Female, Humans, Male, Neoplasms, Prostatic Neoplasms, Research Design, Skin Neoplasms, Cohort Studies, Bias, Incidence, Proportional Hazards Models, Odds Ratio, Case-Control Studies, Observational Studies as Topic

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