Pharmaceuticals and Cancer

描述(申请人提供)：越来越多的儿童和成人定期服用药物，但相对较少的药物经过了充分的上市后监测的不良反应，包括增加的癌症发病率。 这项研究的主要目标是确定与癌症发病率较低或较高相关的药物，并检查这些相关性是否值得进一步研究。这项拟议的研究建立在过去30年来在Kaiser Permanente健康计划内进行的药物监测计划的基础上。具体来说，我们建议： 1)从1991年开始，将继续在毕马威会计师事务所全体成员(约300万人)中对200种最常用的处方药进行可能的致癌作用监测。使用特定药物或药物组的患者的癌症发病率将根据整个毕马威会计师事务所成员的发病率与预期的发病率进行比较。 2)对上述筛查分析中发现的某些药物-癌症关联进行试点病例对照研究，以确定这些关联是否可能是由于混淆造成的，如果不是，则确定是否有证据表明存在剂量-反应效应，或有证据反对生物学上的合理性。 Kaiser Permanente会员和数据库为研究潜在的药物-癌症关联提供了独特的资源。成员众多(310万)，稳定，种族多样化，几乎所有的医疗保健都来自预付费的综合医疗保健计划。每年约有2000万张处方分发给健康计划成员。拟议的研究将提供一个宝贵的机制，以确定最常用药物可能致癌作用的早期迹象，或对其在这方面的安全性作出保证。

DESCRIPTION (provided by applicant): A growing proportion of children and adults take medication regularly, yet relatively few drugs have undergone adequate post-marketing surveillance for adverse effects, including elevated cancer rates. The main objective of this study is to identify drugs that are associated with lower or higher rates of cancer and examine whether these associations deserve further study. The proposed research builds on a drug surveillance program conducted within the Kaiser Permanente health plan over the last 30 years. Specifically, we propose to: 1) Continue surveillance of the 200 most commonly used prescription drugs for possible carcinogenic effects will be conducted among the entire KPMCP membership, about 3 million persons, starting, in part, in 1991. Cancer incidence among users of specific medications or groups of medications will be compared with those expected, based on rates in entire KPMCP membership. 2) Conduct pilot case-control studies of selected drug-cancer associations found in the above screening analyses will be conducted to determine whether the associations are likely due to confounding and, if not, whether there is evidence of a dose-response effect, or evidence against biological plausibility. The Kaiser Permanente membership and databases provide a unique resource for studying potential drug-cancer associations. The membership is large (3.1 million), stable, ethnically diverse, and receives virtually all of its health care from the pre-paid, integrated medical care program. Each year approximately 20 million prescriptions are dispensed to health plan members. The proposed research will provide a valuable mechanism to identify early signs of possible carcinogenic effects of the most commonly used medications or reassurance as to their safety in this regard.