This target trial emulation evaluated whether GLP-1 receptor agonist (GLP-1RA) use reduces the risk of 13 obesity-associated cancers (OACs) in obese, nondiabetic adults without prior OAC, comparing GLP-1RA users to those receiving diet/exercise counseling, with a median follow-up of 2 years.
After 1:1 propensity score matching (n=161,798), GLP-1RA users had a significantly lower incidence of any OAC compared to diet/exercise controls (HR 0.59, 95% CI 0.53–0.67); the benefit was consistent across most subgroups except Black patients.
- Median follow-up was only 2 years, which may be too short to capture cancer development and cannot establish long-term risk reduction. - Observational design (target trial emulation) limits causal inference; residual confounding is possible despite propensity score matching. - The lack of benefit in Black patients is unexplained and warrants further study, as this subgroup may be underrepresented.
GLP-1RAs may offer meaningful short-term cancer risk reduction in obese, nondiabetic patients — a potential benefit worth discussing alongside weight management goals. Prospective trials are still needed before this finding changes prescribing practice.
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