Breast cancer in systemic lupus

Author:

Bernatsky S12,Ramsey-Goldman R3,Petri M4,Urowitz M B5,Gladman D D5,Fortin P F6,Ginzler E7,Romero-Diaz J8,Peschken C9,Jacobsen S10,Hanly J G11,Gordon C12,Nived O13,Yelin E H14,Isenberg D15,Rahman A15,Bae S-C16,Joseph L12,Witte T17,Ruiz-Irastorza G18,Aranow C19,Kamen D20,Sturfeldt G13,Foulkes W D21,Hansen J E22,St Pierre Y2,Raymer P Chrétien2,Tessier-Cloutier B23,Clarke A E24

Affiliation:

1. Faculty of Medicine, McGill University, Montreal, Canada

2. Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada

3. Feinberg School of Medicine, Northwestern University, Chicago, USA

4. Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA

5. Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Canada

6. Division of Rheumatology, Centre de recherche du CHU de Québec—Université Laval, Quebec City, Canada

7. State University of New York—Downstate Medical Center, New York, USA

8. Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico

9. University of Manitoba, Winnipeg, Canada

10. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

11. Division of Rheumatology, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada

12. Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham: Rheumatology department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust and NIHR/Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham; University Hospital Birmingham NHS Foundation Trust, Birmingham, UK

13. Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden

14. Department of Medicine, University of California, San Francisco, USA

15. Centre for Rheumatology Research, University College London, London, UK

16. The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea

17. Department of Clinical Immunology, Hannover Medical School, Hannover, Germany

18. Autoimmune Diseases Research Unit, Department Of Internal Medicine, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, Spain

19. Feinstein Institute for Medical Research, New York, USA

20. Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, USA

21. Departments of Oncology, Human Genetics and Medicine, McGill University, Montreal, Canada

22. Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA

23. Department of Anatomical Pathology, University of British Colombia, Vancouver, Canada

24. Division of Rheumatology, University of Calgary, Calgary, Canada

Abstract

Objective There is a decreased breast cancer risk in systemic lupus erythematosus (SLE) versus the general population. We assessed a large sample of SLE patients, evaluating demographic and clinical characteristics and breast cancer risk. Methods We performed case-cohort analyses within a multi-center international SLE sample. We calculated the breast cancer hazard ratio (HR) in female SLE patients, relative to demographics, reproductive history, family history of breast cancer, and time-dependent measures of anti-dsDNA positivity, cumulative disease activity, and drugs, adjusted for SLE duration. Results There were 86 SLE breast cancers and 4498 female SLE cancer-free controls. Patients were followed on average for 7.6 years. Versus controls, SLE breast cancer cases tended to be white and older. Breast cancer cases were similar to controls regarding anti-dsDNA positivity, disease activity, and most drug exposures over time. In univariate and multivariate models, the principal factor associated with breast cancers was older age at cohort entry. Conclusions There was little evidence that breast cancer risk in this SLE sample was strongly driven by any of the clinical factors that we studied. Further search for factors that determine the lower risk of breast cancer in SLE may be warranted.

Publisher

SAGE Publications

Subject

Rheumatology

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