Breast cancer in systemic lupus.
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.
1 Faculty of Medicine, McGill University, Montreal, Canada.|2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada.
S
S
Bernatsky
3 Feinberg School of Medicine, Northwestern University, Chicago, USA.
R
R
Ramsey-Goldman
4 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA.
M
M
Petri
5 Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Canada.
M B
MB
Urowitz
5 Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Canada.
D D
DD
Gladman
6 Division of Rheumatology, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada.
P R
PR
Fortin
7 State University of New York-Downstate Medical Center, New York, USA.
E
E
Ginzler
8 Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
J
J
Romero-Diaz
9 University of Manitoba, Winnipeg, Canada.
C
C
Peschken
10 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
S
S
Jacobsen
11 Division of Rheumatology, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada.
J G
JG
Hanly
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.
C
C
Gordon
13 Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden.
O
O
Nived
14 Department of Medicine, University of California, San Francisco, USA.
E H
EH
Yelin
15 Centre for Rheumatology Research, University College London, London, UK.
D
D
Isenberg
15 Centre for Rheumatology Research, University College London, London, UK.
A
A
Rahman
16 The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea.
S-C
SC
Bae
1 Faculty of Medicine, McGill University, Montreal, Canada.|2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada.
L
L
Joseph
17 Department of Clinical Immunology, Hannover Medical School, Hannover, Germany.
T
T
Witte
18 Autoimmune Diseases Research Unit, Department Of Internal Medicine, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, Spain.
G
G
Ruiz-Irastorza
19 Feinstein Institute for Medical Research, New York, USA.
C
C
Aranow
20 Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, USA.
D
D
Kamen
13 Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden.
G
G
Sturfeldt
21 Departments of Oncology, Human Genetics and Medicine, McGill University, Montreal, Canada.
W D
WD
Foulkes
22 Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA.
J E
JE
Hansen
2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada.
Y
Y
St Pierre
2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada.
P Chrétien
PC
Raymer
23 Department of Anatomical Pathology, University of British Colombia, Vancouver, Canada.
B
B
Tessier-Cloutier
24 Division of Rheumatology, University of Calgary, Calgary, Canada.
A E
AE
Clarke
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007391:International Cooperation; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors
Breast cancer; systemic lupus erythematosus
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