title: Frequent antibiotic use and second breast cancer events.
abstract: BACKGROUND
  Antibiotic use may be associated with higher breast cancer risk and breast cancer mortality, but no study has evaluated the relation between antibiotic use and second breast cancer events (SBCE).
  
  
  METHODS
  We conducted a retrospective cohort study among women ≥18 years, diagnosed with incident stage I/II breast cancer during 1990-2008. Antibiotic use and covariates were obtained from health plan administrative databases and medical record review. Frequent antibiotic use was defined as ≥4 antibiotic dispensings in any moving 12-month period after diagnosis. Our outcome was SBCE defined as recurrence or second primary breast cancer. We used multivariable Cox proportional hazards models to estimate HR and 95% confidence intervals (CI), accounting for competing risks.
  
  
  RESULTS
  A total of 4,216 women were followed for a median of 6.7 years. Forty percent were frequent antibiotic users and 558 (13%) had an SBCE. Results are suggestive of a modest increased risk of SBCE (HR, 1.15; 95% CI, 0.88-1.50) among frequent antibiotic users compared with nonusers. Any potential increased risk was not supported when we evaluated recent use and past use. We observed no dose-response trends for SBCE with increasing duration of antibiotic use nor did we find evidence for altered SBCE risk in the antibiotic classes studied.
  
  
  CONCLUSIONS
  Frequent antibiotic use may be associated with modestly elevated risk of SBCEs, but the association was not significant.
  
  
  CONCLUSIONS
  Additional investigation by antibiotic class and underlying indication are important next steps given the high prevalence of frequent antibiotic use and growing number of breast cancer survivors.
authors.affiliation: Departments of Pharmacy, Biostatistics, Epidemiology, and Health Services, University of Washington, Seattle, WA 98101, USA.
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Wirtz
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gralow
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Shelly
authors.initials: S
authors.lastname: Gray
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.forename: Onchee
authors.initials: O
authors.lastname: Yu
authors.forename: Erin J A
authors.initials: EJ
authors.lastname: Bowles
authors.forename: Monica
authors.initials: M
authors.lastname: Fujii
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents