Acromegaly and Cancer: A Doctor’s Perspective, Now Backed by the Numbers

After years of clinical suspicion, large studies confirm elevated risk across multiple cancers

From Lewis S Blevins Jr., MD – Professor of Neurological Surgery, Medical Director of the California Center for Pituitary Disorders at UCSF and PWN co-founder – There has been a long-standing concern that elevated growth levels might lead to initiation and progression of malignant conditions.  Studies in the early 1990s showed that patients with breast cancer and prostate cancer had IGF-1 levels in the higher quarter of the normal range.   Of course, people being people, there have been malignancies reported in patients with acromegaly, but these same malignancies are seen in patients who don’t have acromegaly.

When you see it, you don’t tend to doubt that there might be an increased cancer risk in patients with this disease. I had one patient with severe acromegaly who died of rapidly progressive breast carcinoma. I had another acromegalic patient who was diagnosed with colon carcinoma in his mid-20s.  He did well after colon surgery and has not had any evidence of recurrence.  The problem is I’ve seen plenty of cancers in my patients with other pituitary disorders.   Acromegaly and Cushing’s are equally common in my practice. I don’t get the sense that my patients with acromegaly have had more cancers than my patients with Cushing’s.   So, is there really an increased risk?

The answer is, resoundingly, yes.  While an increased risk has been suspected for some time, a presentation at the Endocrine Society meeting in 2025 confirmed the association.  Researchers evaluated 10,207 patients with acromegaly and 102,070 control patients, matched for age and sex.  In general, cancers appeared younger or earlier in patients with acromegaly than they did in the matched controls.  They were also associated with higher GH levels.  Women with acromegaly had a 1.8 times higher risk of having breast cancer. They also had a greater likelihood of ovarian cancer, which was 1.9 times higher than the risk compared to the control group.  Men with acromegaly had a likelihood of prostate cancer that was 1.5 times greater than in controls.  The risk of developing lymphoma or leukemia was 3.3 times higher, and the likelihood of developing lung cancer was 1.9 times higher.  Colon and gastric cancers were also seen in the acromegaly population.

A manuscript published in 2023 reported the results of a meta-analysis of the literature, in which several large studies were collected to gain insights into the risk of cancer in patients with acromegaly.   The study included an analysis of 11,494 patients. Of these, 1108 patients had a malignancy of some type. This represents almost 10% of the population studied. The incidence of thyroid cancer was estimated to be about seven times higher than expected in the normal population.  Other cancers where there was a higher risk than in the normal population were colorectal, small intestine, stomach, pancreatic, anal region, and central nervous system tumors such as meningioma and astrocytoma.

So what does all this mean? I believe it calls for comprehensive regular examinations by a general internist or other primary care physician. Perhaps regular thyroid ultrasound, upper and lower endoscopy, mammography, CBC, and other cancer screening tests should be performed. Coordinating these studies is beyond the scope of an endocrinologist’s practice, and this type of information underscores the importance of a team approach to patient evaluation and management.

Patients and family members should strongly advocate for these evaluations.  Here is the reference to the article published in 2023 that you might find and print to take to your doctor’s office to initiate conversations about the need for routine cancer screening.

Xiao Z et al. Risk of cancer in acromegaly patients: An updated meta-analysis and systematic review  –   Learn more about the study here

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