Cancer risk in patients with nontuberculous mycobacterial pulmonary disease: a nationwide population-based cohort study

BACKGROUND: Although nontuberculous mycobacterial pulmonary disease (NTM-PD) is becoming increasingly prevalent worldwide, its associated cancer risk remains largely unknown. In this study, we aimed to determine whether patients with NTM-PD are at a higher risk of developing cancer than the general population. METHODS: In this retrospective nationwide cohort study using the National Health Insurance Service-National Health Information Database of South Korea, we identified 21,879 patients newly diagnosed with NTM-PD between 2010 and 2020, and included 218,790 age- and sex-matched control participants. Cumulative incidences of various cancer types were analyzed using competing risk analysis with all-cause mortality as a competing event, and cause-specific hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for demographic factors and baseline health checkup results. RESULTS: After adjustment, patients with NTM-PD showed a significantly higher risk of overall cancer than did matched controls (adjusted HR, 1.22; 95% confidence interval, 1.17-1.27; P < .001). In the analysis according to cancer type, the following cancers showed significant changes in risk (adjusted HR [95% confidence interval]): lung cancer (2.25 [2.06-2.45]), multiple myeloma (1.74 [1.26-2.42]), ovarian cancer (1.33 [1.06-1.68]), pancreatic cancer (1.26 [1.09-1.45]), and liver cancer (1.22 [1.07-1.39]). By contrast, stomach (0.83 [0.72-0.96]) and colorectal (0.83 [0.73-0.95]) cancers showed a reduced risk. These associations remained robust across multiple sensitivity analyses. CONCLUSIONS: Compared with the general population, patients with NTM-PD are at an increased risk of various cancers, particularly lung cancer. These findings underscore the need for increased cancer surveillance and long-term monitoring of patients with NTM-PD.