Gout May Raise Cancer Risk

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Gout is a significant risk factor for developing cancer, particularly stomach, liver, lung and bladder cancers. Patients with gout face a higher overall cancer risk, but the results highlight the need for more in-depth, high-quality studies to further examine the link between gout and specific cancer types.

Currently, gout affects approximately 9.2 million adults living in the United States and 41.2 million adults worldwide. Caused by an oversaturation of uric acid, gout can damage the kidneys and joints, create deformities and lead to chronic pain.

“The development of gout is often based on long-term metabolic disturbances,” wrote a group of investigators from The First Peoples Hospital of Zunyi/Third Affiliated Hospital of Zunyi, China. “There is increasing interest in the relevance of metabolism and immunity in the pathogenesis of gout, and it has been hypothesized that the metabolic syndrome is associated with carcinogenesis. In recent years, widespread interest has arisen in the association between gout, hyperuricemia, and cancer. High cellular metabolism may lead to hyperuricemia and tumorigenesis, implying a potential link between disturbances in purine metabolism and cancer.”

Investigators conducted a search of Pubmed, Embase, Cochrane, Scopus and Web of Science databases to identify studies related to gout and cancer risk. The quality and heterogeneity were assessed, and sensitivity analyses and publication bias tests were performed.

In total, six full-text studies comprised of 1,279,804 participants were included in the analysis. No publication bias was observed in any of the studies, including gout and lung cancer, liver cancer, stomach cancer and bladder cancer.

Results revealed patients with gout were at a generally heightened risk of developing cancer. Specifically, these patients were at an increased risk of developing gastric cancer, lung cancer, liver cancer and bladder cancer. While there was also a slight increase in the risk for cancers like head and neck and esophageal cancer, these links weren't strong enough to be statistically significant

One study reported the overall incidence of cancer was significantly higher in patients with gout when compared with controls, while another said patients with gout were more likely to develop kidney, liver, stomach, prostate, bladder and lung cancers. An additional study reported gout was not only linked to a higher risk of cancer, but that the likelihood was particularly high in colon, liver, pancreatic, esophageal, lung, ovarian, kidney and bladder cancers. Although one study said gout did not increase the risk of colon cancer, another reported a significant association between gout and breast cancer in all populations.

Investigators encourage future high-quality epidemiologic studies to determine the link between gout and individual cancers more accurately.

They mentioned limitations to the study including the fact that some of the studies only examined a single type of cancer while others analyzed multiple cancers. Additionally, subgroup analyses by age, sex, sample size, age and country were not possible, nor were analyses of the effect of confounders. As the six studies were observational, investigators could not assess the effect of certain causes, such as environmental carcinogens, family history and chronic inflammatory diseases, on the findings.

Despite these limitations, the statistical power was increased by including more studies than previous analyses on this topic and results did not change significantly when using the “leave-one-out” method, which showed that results were reliable. Additionally, investigators were able to examine possible common mechanisms of action of gout and cancer.

“For clinicians, we recommend regular and close monitoring of patients to detect occult malignancies and improve the quality of care for gout patients,” investigators concluded.