Evidence map›Paper›PMID 42100998›Full record

ArticleEuropean journal of clinical investigation2026

Iron Status, Erythropoietin, and Cancer Incidence in the General Population.

Siem J van Alfen, Pien Rawee, Li Luo, Ilja M Nolte, Bert van der Vegt, Jenny E Kootstra-Ros, Stephan J L Bakker, Ron T Gansevoort, Thera P Links, Wouter T Zandee and 1 more

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Article in European journal of clinical investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Siem J van AlfenDivision of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0009-0000-8565-5791
Pien RaweeDivision of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Li LuoDivision of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0001-7855-4669
Ilja M NolteDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Bert van der VegtDepartment of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Jenny E Kootstra-RosDepartment of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Stephan J L BakkerDivision of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Ron T GansevoortDivision of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Thera P LinksDivision of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Wouter T ZandeeDivision of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Michele F EisengaDivision of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Funding

Hartstichting 2001.005Ministerie van Volksgezondheid, Welzijn en SportNierstichting E.033NIH HHSUniversitair Medisch Centrum Groningen
6 · The paper itself

Abstract

backgroundIron is essential for cellular function and cancer growth. While iron imbalance has been implicated in cancer development, epidemiological evidence remains inconsistent. Erythropoietin (EPO) may influence tumour progression. We aimed to investigate the associations between iron status, EPO levels, and cancer incidence in the general population.

methodData were obtained from 6109 participants (mean age 52 ± 12 years; 49% male) in the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort. Iron biomarkers, including ferritin, transferrin saturation, soluble transferrin receptor (sTfR), hepcidin and EPO levels, were measured at baseline.

resultsOver a median 18.5 year follow-up, 1090 participants developed cancer. Multivariable Cox regression revealed that higher EPO (HR 1.26; 95% CI 1.07-1.47; p = 0.005) was associated with increased overall cancer risk, while elevated hepcidin levels were associated with a lower risk (HR 0.88; 95% CI 0.80-0.96; p = 0.006). Higher sTfR (HR 1.35; 95% CI 1.01-1.80; p = 0.043) was suggestive for an increased risk of overall cancer. After excluding early diagnoses, the increased risk associated with higher EPO levels and decreased risk associated with higher hepcidin levels remained significant. Lower transferrin saturation was associated with increased haematological cancer risk, while higher hepcidin was associated with reduced gastrointestinal cancer risk, especially in women and those with BMI < 25 kg/m

conclusionThese findings underscore the putative roles of iron metabolism and EPO in cancer, with consistently decreased risks associated with elevated hepcidin levels, particularly among women and individuals with lower BMI.

Indexed as

ErythropoietinIronNeoplasmsAdultFemaleFerritinsHepcidinsHumansIncidenceMaleMiddle AgedProportional Hazards ModelsReceptors, TransferrinRisk FactorsTransferrinErythropoietinFerritinsHepcidinsIronReceptors, TransferrinTransferrincancer riskEPO levelsgeneral populationiron statussite‐specific cancer

Identifiers

PMID42100998
PMCPMC13154720

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.