OP0123 RISK OF BREAST CANCER BEFORE AND AFTER RHEUMATOID ARTHRITIS, AND THE IMPACT OF HORMONAL FACTORS

Background:Large cohort studies have consistently reported decreased occurrence of breast cancer among women with RA. However, both the reasons behind this decreased risk and if it is present already before RA diagnosis, is unclear. The occurrence of RA following breast cancer is clinically and etiologically important also for other reasons. Long-term adjuvant anti-hormonal treatment with tamoxifen or aromatase inhibitors has become mainstay for estrogen receptor positive breast cancer, but are often associated with arthralgia as a side effect. Some studies have suggested that these therapies not only induce arthralgia, but also inflammatory arthritis.Objectives:To examine the risk of incident breast cancer in women with RA, and the risk of RA in women with a history of breast cancer, taking anti-hormonal treatment for breast cancer into account.Methods:Using nationwide Swedish registers, women with new-onset RA diagnosed 2006-2016 were identified. Each RA patient was matched on age, sex, and place of residence to 5 randomly selected control subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (age at childbirth, number of children, hormone replacement therapy), and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast was assessed using conditional logistic regression.Results:The risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95%CI 0.68-0.93)(Table 1). The risk was similar among seronegative RA, (HR=0.77, 95%CI 0.58-1.02), and seropositive RA, (HR=0.81, 95%CI, 0.67-0.98), and for all age groups. We noted reduced risks for all TNM stages, and for both pre- and postmenopausal breast cancer (assessed with age cutoff 50 years). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95%CI, 0.79-0.95). Odds ratios (OR) stratified by serostatus and age at RA diagnosis yielded similar results. There was no clear trend in the level of risk reduction when examining the risk by menopausal status, or cancer stage at breast cancer diagnosis. Women with breast cancer treated with tamoxifen (OR=0.86, 95%CI 0.62-1.20), or aromatase inhibitors (OR=0.97, 95%CI 0.69-1.37), did not have an increased risk of RA compared to women with breast cancer treated differently.Table 1.Risk of breast cancer in women with RA, overall and by serostatus (events and hazard ratios), and risk of RA in women with a history of breast cancer, overall and by serostatus (events and odds ratios)No. of breast cancers, patients with RANo. of breast cancers, comparators/controlsRR (95% CI)Risk of breast cancer in women with RA19011910.80 (0.68-0.93)Seronegative RA553460.77 (0.58-1.02)Seropositive RA1247720.81 (0.67-0.98)Risk of RA in women with breast cancer55531930.87 (0.79-0.95)Seronegative RA1579210.85 (0.71-1.01)Seropositive RA36720880.88 (0.78-0.98)Conclusion:There is a decreased risk of breast cancer in patients with RA, and a similar decrease in risk of breast cancer before RA diagnosis. We did not find evidence to support that the decreased risk of breast cancer was due to known risk determinants. Furthermore, adjuvant anti-hormonal therapy as used in secondary breast cancer pharmacoprevention did not seem to increase the risk of RA.Disclosure of Interests:Hjalmar WADSTRÖM: None declared, Andreas Pettersson: None declared, Karin Ekström Smedby: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma

Download Full-text

Risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216756 ◽

2020 ◽

Vol 79 (5) ◽

pp. 581-586 ◽

Cited By ~ 8

Author(s):

Hjalmar Wadström ◽

Andreas Pettersson ◽

Karin E Smedby ◽

Johan Askling

Keyword(s):

Breast Cancer ◽

Rheumatoid Arthritis ◽

Risk Factors ◽

Relative Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Risk Factors ◽

Breast Cancer Risk Factors ◽

History Of ◽

Incident Breast Cancer

ObjectivesTo examine the risk of incident breast cancer in women with rheumatoid arthritis (RA), and the risk of RA in women with a history of breast cancer, taking antihormonal treatment for breast cancer into account.MethodsUsing nationwide Swedish registers, women with new-onset RA diagnosed in 2006–2016 were identified and analysed using a cohort and a case–control design. Each patient with RA was matched on age, sex and place of residence to five randomly selected subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (reproductive history and hormone replacement therapy) and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast cancer was assessed using conditional logistic regression.ResultsThe risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95% CI 0.68 to 0.93). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95% CI 0.79 to 0.95). Women with breast cancer treated with tamoxifen (OR=0.86, 95% CI 0.62 to 1.20) or aromatase inhibitors (OR=0.97, 95% CI 0.69 to 1.37) did not have an increased risk of RA compared with women with breast cancer treated differently.ConclusionsThe decreased occurrence of breast cancer in patients with RA is present already before RA diagnosis; these reduced risks are not readily explained by hormonal risk factors. Adjuvant antihormonal therapy for breast cancer does not seem to increase RA risk.

Download Full-text

Breast cancer epidemiologic risk factors by HER2/neu status

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.585 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 585-585

Author(s):

W. Y. Chen ◽

G. A. Colditz ◽

B. Rosner

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Risk Factor ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Benign Breast Disease ◽

Breast Disease ◽

Breast Cancers ◽

Cancer Risk Factors ◽

Breast Cancer Risk Factors

585 Background: Although breast cancers categorized by estrogen receptor (ER) and progesterone receptor (PR) status are recognized to differ in their associations with standard breast cancer risk factors, little data exist on differences by HER2/neu status. Methods: The Nurses’ Health Study is a prospective cohort study of 121,700 registered nurses aged 30–55 in 1976 who answered biennial questionnaires to update medical and lifestyle factors and disease occurrence. Medical record review was used to confirm invasive breast cancer and abstract ER, PR, and HER2/neu status. Statistical analyses included both proportional hazards models to estimate relative risks and control for potential confounders and polytomous logistic regression to compare the effects. Only cases diagnosed from return of the 1998 questionnaire until June 2002 were included in the analysis since HER2/neu was only routinely assessed beginning with the 1998 follow-up cycle. Results: 211 HER2/neu positive and 770 HER2/neu negative cases were included in the analysis. In this predominantly postmenopausal group aged 52–77 in 1998, HER2neu negative cancers were more likely to be ER+/PR+ (72%) and less likely to be ER-/PR- (11%) than HER2/neu positive ones (58% ER+/PR+ and 24% ER-/PR-), but the majority of cancers were still ER+/PR+. In multivariate models, risk factor associations by HER2/neu status were similar with positive associations seen for family history, benign breast disease, body mass index, current postmenopausal hormone use, and cumulative alcohol consumption. However, when the subgroup of ER-/PR-/HER2/neu negative cancers were evaluated separately (N=83), most of these risk factor associations disappeared with the only significant risk factor being a prior history of benign breast disease. Conclusions: This is the first prospective data study to report on risk factor association by HER2/neu status. For the standard epidemiologic breast cancer risk factors, ER and PR status appear to better represent separate etiologic pathways, rather than HER2/neu status. However, the subgroup of ER/PR/HER2neu negative breast cancers appears to be distinct, although power was limited and HER2/neu status was not confirmed by central review. Additional analyses stratified by ER/PR status will also be presented. No significant financial relationships to disclose.

Download Full-text

Knowledge and Awareness on Risk Factors of Breast Cancers Among Homemakers

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.3450 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 1439-1445

Author(s):

Indumathi M ◽

Kavitha S ◽

Vishnupriya V ◽

Gayathri R

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Online Survey ◽

Information Source ◽

College Education ◽

Breast Cancers ◽

Cancer Risk Factors ◽

Breast Cancer Risk Factors

Globally the major cause of cancer associated death among women is breast cancer. Reports showed that all over world approximately 1.15 million women are affected by breast cancer. Lack of awareness and late diagnosis are the prime reasons behind the raising mortality associated with breast cancer. Breast cancer is becoming the principal cause of mortality worldwide and has greater impact in developing countries. The aim of the present study is to access the knowledge and awareness on risk factors of breast cancers among homemakers. About 150 participants were involved in the study. Self-administered questionnaire of close ended questions was prepared related to risk factors, symptoms, diagnostic modalities, prevention and treatment of breast cancer and distributed among homemakers through online survey forms. In the present study about 62.7% were aware of risk factors of breast cancer and 37.3% were not aware. Regarding the information source of breast cancer risk factors, most of the participants (43.3%) responded to from school or college education. The majority of the participants (60.7%) were aware that breast cancer is among the most prevailing cancers among women. Regarding the risk factors of breast cancer, 36% responded to obesity,10% responded to advanced age and 54% responded to family history of breast cancer. The majority of the participants (56.7%) responded age as a major risk factor. In the present study, knowledge and awareness on the breast cancer, risk factors among homemakers is moderate.

Download Full-text