Is antibiotic use a risk factor for breast cancer? A meta-analysis.
OBJECTIVE
Breast cancer is a disease integrating hormonal and non-hormonal factors. Given the widespread antibiotic use, attention has been recently drawn upon the association between antibiotic use and breast cancer; however, the published studies have yielded contradictory results. In addition, various types of quantification in antibiotic use have been adopted. This meta-analysis aims to examine whether antibiotic use is associated with breast cancer risk presenting two analyses: one on antibiotic ever-use and one on the number of antibiotic prescriptions.


METHODS
Eligible studies were retrieved by a search in MEDLINE, Cochrane, and EMBASE databases till July 2009. Odds ratios (OR) pertaining to antibiotic ever-use were appropriately calculated. The random effects model was used to estimate the pooled OR. Publication bias was assessed through Begg's and Egger's tests. Meta-regression with the number of antibiotic prescriptions was performed.


RESULTS
Five case-control studies were eligible at the ever-use versus never-use analysis (13 069 cases and 73 920 controls). Antibiotic ever-use was associated with slightly elevated breast cancer risk (pooled OR = 1.175, 95%CI: 0.994-1.387). No publication bias became apparent. Meta-regression showed a borderline dose-response effect implicating the number of antibiotic prescriptions.


CONCLUSIONS
Antibiotic use seems associated with slightly elevated breast cancer risk. The underlying nature of the association remains elusive, as it may be direct or due to secondary associations, that is, causal or confounding. At any case, this is a finding with potentially important public health implications, which should be further examined in the literature.
Sergentanis
Theodoros N
TN
1st Department of Propaedeutic Surgery, Breast Unit, Hippokratio Hospital, University of Athens, Athens, Greece.
Zagouri
Flora
F
Zografos
George C
GC
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D017594:Publication Bias; D012044:Regression Analysis; D012307:Risk Factors
D000900:Anti-Bacterial Agents