title: Risk of Premenopausal and Postmenopausal Breast Cancer among Multiple Sclerosis Patients.
abstract: OBJECTIVE
  To investigate risk of premenopausal and postmenopausal breast cancer among Multiple Sclerosis (MS) patients, considering tumor stage.
  
  
  METHODS
  The Swedish Patient Register identified 19,330 women with MS between 1968 and 2012, matched individually with a cohort of 193,458 without MS. Matching variables were year of birth, sex, region of residence and vital status at the time of diagnosis. The cancer register identified 471 and 5,753 breast cancer cases among the MS and non-MS cohorts, respectively. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (CI) for premenopausal and postmenopausal breast cancer.
  
  
  RESULTS
  Overall risk of postmenopausal breast cancer was 13% higher among MS patients compared with women without MS (HR = 1.13, 95% CI 1.02-1.26). Stratified analyses showed that the risk was statistically significantly increased in women diagnosed between 1968 and 1980 and those who were diagnosed at age 65 or older age. We observed a non-statistically significant risk only for stage 0-1 postmenopausal breast cancer (HR = 1.17, 95% CI 0.93-1.48). MS was not associated with premenopausal breast cancer.
  
  
  CONCLUSIONS
  The modest increased risk of postmenopausal breast cancer in women with MS may be due to surveillance bias, where contact with health services for one disease increases the risk of a second diagnosis being recorded.
authors: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.|Department of Public Health, Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran.
authors: Mohammadhossein
authors: http://orcid.org/0000-0001-8118-4988
authors: M
authors: Hajiebrahimi
authors: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.|Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.|Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors: Scott
authors: S
authors: Montgomery
authors: Center for Pharmacoepidemiology & Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Sarah
authors: S
authors: Burkill
authors: Center for Pharmacoepidemiology & Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Public Health, Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran.
authors: Shahram
authors: S
authors: Bahmanyar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D017698:Postmenopause; D017697:Premenopause; D012042:Registries; D012307:Risk Factors; D013548:Sweden; D055815:Young Adult