title: Prediagnostic serum inflammatory markers in relation to breast cancer risk, severity at diagnosis and survival in breast cancer patients.
abstract: Inflammation has been linked to cancer but its role in breast cancer is unclear. We investigated common serum markers of inflammation: C-reactive protein (CRP), albumin, haptoglobin and white blood cells (WBC) in relation to breast cancer incidence, severity and survival. A total of 155179 women aged 20 and older without any history of cancer were selected from a large Swedish cohort. Hazard ratios (HRs) for breast cancer were estimated with Cox regression, adjusting for potential confounders. Ordered and binomial logistic regression models were used to assess the associations of serum inflammatory markers with breast cancer severity and oestrogen receptor (ER) positivity at diagnosis, on the other. Cumulative incidence functions by levels of inflammatory markers were assessed for early death from breast cancer and all causes. During a mean follow-up of 18.3 years, 6606 women were diagnosed with breast cancer, of whom 1474 died. A positive association with incident breast cancer was seen for haptoglobin ≥ 1.4g/l [HR 1.09; 95% confidence interval (CI): 1.00-1.18] compared to lower levels. No association was observed between inflammatory markers and breast cancer severity or ER positivity. Higher haptoglobin was linked to risk of early death from breast cancer (HR: 1.27, 95% CI: 1.02-1.59), whereas higher risk of early death from all causes was additionally found with CRP ≥ 10mg/l (HR: 1.19, 95% CI: 1.04-1.36) and WBC ≥ 10×10(9)/l (HR: 1.57, 1.14-2.16). Our findings indicate that prediagnostic serum inflammatory markers were weakly linked to incident breast cancer but corresponded to worse survival after diagnosis.
authors.affiliation: Division of Cancer Studies, King's College London, Cancer Epidemiology Group, 3rd Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK, wahyu.wulaningsih@kcl.ac.uk.
authors.forename: Wahyu
authors.initials: W
authors.lastname: Wulaningsih
authors.affiliation: Division of Cancer Studies, King's College London, Cancer Epidemiology Group, 3rd Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, Regional Cancer Centre, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: Division of Cancer Studies, King's College London, Cancer Epidemiology Group, 3rd Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK, Regional Cancer Centre, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Department of Epidemiology, Institute of Environmental Medicine and.
authors.forename: Håkan
authors.initials: H
authors.lastname: Malmstrom
authors.affiliation: Regional Cancer Centre, Uppsala, Sweden, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.affiliation: Department of Epidemiology, Institute of Environmental Medicine and AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.affiliation: Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden and.
authors.forename: Göran
authors.initials: G
authors.lastname: Walldius
authors.affiliation: Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Jungner
authors.affiliation: Division of Cancer Studies, King's College London, Cancer Epidemiology Group, 3rd Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011960:Receptors, Estrogen / Q000235:genetics; D011980:Receptors, Progesterone / Q000235:genetics; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D002097:C-Reactive Protein