Annals of Internal MedicineRisk for Cancer with Glucagon-Like Peptide-1 Receptor Agonists and Dual Agonists

Meta-analysis of 48 trials with 94,245 patients found GLP-1RAs show no increased cancer risk across 14 obesity-related malignancies, including thyroid, pancreatic, breast, and kidney cancers. Most evidence rated moderate certainty despite short trial follow-up periods.

🔬 KEY CLINICAL CONSIDERATIONS

• No elevated risk detected for thyroid cancer (OR 1.37, CI 0.82-2.31), addressing long-standing theoretical concern from animal studies
• Pancreatic cancer risk unchanged (OR 0.84, CI 0.53-1.35) despite ongoing surveillance requirements in drug labeling and monitoring protocols
• Results held across different GLP-1RA classes including semaglutide and tirzepatide, multiple dosing regimens, and both diabetes and obesity treatment populations
• Short median follow-up (1-2 years in most trials) insufficient to detect slow-developing malignancies requiring 5-10 year observation periods

💊 PRACTICE APPLICATIONS

• Counsel patients that current evidence shows no cancer signal across 14 malignancy types studied
• Continue routine cancer screening per guidelines—GLP-1RA use doesn’t warrant enhanced surveillance protocols currently
• Document discussion of limited long-term data when initiating therapy in patients with cancer concerns
• Monitor emerging post-market surveillance data as real-world use extends beyond typical 2-year trial periods

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