Editorial: Cancer risk in patients with acromegaly – is extensive screening needed?, volume II
Year: 2026
Type: editorial
Abstract: Thus, there was no clear evidence of an increased breast cancer risk. Interestingly, registrybased studies generally suggested neutral or only modestly increased risk, whereas some singlecentre and prospective studies reported higher incidence. Studies examining GH and IGF-1 concentrations have likewise produced conflicting results, with some reporting lower IGF-1 levels among patients with breast cancer and others finding no differences (8). These discrepancies may reflect surveillance bias, differences in study design, and limited adjustment for confounding factors. Overall, the findings are reassuring and support breast cancer screening according to recommendations for the general population rather than intensified surveillance solely on the basis of acromegaly (Lee et al.).The picture is different for colorectal neoplasia. Several previous studies have suggested an increased risk of colorectal cancer in acromegaly (9,10,11,12). A recent nationwide registry study with 44 years of follow-up further supports this association, reporting an increased risk of colorectal cancer (IRR 1.78, 95% CI 1.22-2.60), while overall cancer risk was not significantly increased. Notably, colorectal cancers were more often localized then disseminated, suggesting that increased detection may contribute to the observed association (13).These findings provide an important background for the contribution by Grifoni and colleagues, https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1820034/full. who explore a potential biological link between acromegaly and colorectal carcinogenesis.Grifoni et al. discuss alterations in the gut microbiota in patients with acromegaly and their potential relevance to colorectal cancer risk. Previous studies have described reduced faecal microbial diversity and changes in the relative abundance of several bacterial taxa, including a predominance of Bacteroidetes and a reduced Firmicutes/Bacteroidetes ratio, together with lower representation of Bifidobacterium, Oscillospira, and Dialister (14). Grifoni and colleagues propose that gut dysbiosis may interact with GH/IGF-1 excess, insulin resistance, and inflammatory signalling to create a tumourpromoting environment. Although this hypothesis remains to be demonstrated, it is an intriguing concept that moves the discussion beyond the traditional focus on GH and IGF-1 and raises the possibility that the gut microbiome may represent an additional pathway linking acromegaly to colorectal neoplasia https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1820034/full. The Research Topic also provides important insights into the molecular biology of acromegaly. Dillon et al. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1736208/full investigated the clinical relevance of somatic GNAS mutations by combining a meta-analysis with a series of 22 patients who underwent pituitary tumour resection between 2022 and 2024. Somatic GNAS mutations were identified in 41% of tumours, consistent with their meta-analysis of 55 studies reporting a prevalence of approximately 38%. GNAS-positive tumours were smaller and appeared less invasive at diagnosis. In the surgical series, patients with GNAS-positive tumours were older at surgery, and most tumours were classified as mammosomatotroph adenomas. They also demonstrated greater GH suppression following acute octreotide administration. However, most previous studies have not demonstrated a consistent association between GNAS status and biochemical response to somatostatin analogues. Thus, GNAS mutations appear to provide valuable biological insight, but their current role as prognostic or predictive biomarkers remains uncertain https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1736208/full. Boguslawska et al. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1464945/full further illustrate the clinical relevance of GNAS-related disease through a case of McCune-Albright syndrome (MAS) presenting with acromegaly, severe kyphoscoliosis, tertiary hyperparathyroidism, subclinical hyperthyroidism, and café-au-lait spots. Genetic testing identified a GNAS splice-site variant of uncertain significance, while 18F-FDG PET/CT showed no neoplastic lesions apart from the
Source: Frontiers in Endocrinology
Authors: Jakob Dal, Raluca Alexandra Trifanescu
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221168097