TY - JOUR
T1 - Risk of primary haematologic cancers following incident non-metastatic breast cancer
T2 - A Danish population-based cohort study
AU - Hjorth, Cathrine F
AU - Farkas, Dóra K
AU - Schapira, Lidia
AU - Cullen, Mark R
AU - Sørensen, Henrik T
AU - Cronin-Fenton, Deirdre
N1 - Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2023/2
Y1 - 2023/2
N2 - BACKGROUND: Breast cancer survivors may have increased risk of subsequent haematologic cancer. We compared their risk of haematologic cancers with the general population during 38 years of follow-up.METHODS: Using population-based Danish medical registries, we assembled a nationwide cohort of women diagnosed with incident non-metastatic breast cancer during 1980-2017, with follow-up through 2018. We compared breast cancer survivors with the general population by computing standardised incidence ratios (SIR) and 95% confidence intervals (CI).RESULTS: Among 101,117 breast cancer survivors, we observed 815 incident haematologic cancers (median follow-up: 7.9 years). We observed excess risk of acute myeloid leukaemia (AML) (SIR: 1.65, 95%CI: 1.33-2.01), particularly in women who received chemotherapy (SIR: 3.33, 95%CI: 2.24-4.75) and premenopausal women (SIR: 3.23, 95%CI: 2.41-4.25). The risk of acute lymphoid leukaemia (ALL) was increased (SIR: 2.25, 95%CI: 1.29-3.66), whereas the risk of chronic lymphoid leukaemia (CLL) was decreased (SIR: 0.66, 95%CI: 0.53-0.82). An additional analysis showed elevated risk of CLL 0-6 months after breast cancer diagnosis (SIR: 3.00 95%CI: 1.75-4.80).CONCLUSION: Compared to the general population, breast cancer survivors had elevated risk of AML, particularly when treated with chemotherapy. The risk of ALL was elevated, whereas the risk of CLL was lower. The higher risk of CLL in the first six months after diagnosis likely reflects surveillance bias-due to intensified diagnostic efforts at breast cancer diagnosis and treatment-prompting earlier detection. This has likely reduced the long-term risk of CLL in breast cancer survivors.
AB - BACKGROUND: Breast cancer survivors may have increased risk of subsequent haematologic cancer. We compared their risk of haematologic cancers with the general population during 38 years of follow-up.METHODS: Using population-based Danish medical registries, we assembled a nationwide cohort of women diagnosed with incident non-metastatic breast cancer during 1980-2017, with follow-up through 2018. We compared breast cancer survivors with the general population by computing standardised incidence ratios (SIR) and 95% confidence intervals (CI).RESULTS: Among 101,117 breast cancer survivors, we observed 815 incident haematologic cancers (median follow-up: 7.9 years). We observed excess risk of acute myeloid leukaemia (AML) (SIR: 1.65, 95%CI: 1.33-2.01), particularly in women who received chemotherapy (SIR: 3.33, 95%CI: 2.24-4.75) and premenopausal women (SIR: 3.23, 95%CI: 2.41-4.25). The risk of acute lymphoid leukaemia (ALL) was increased (SIR: 2.25, 95%CI: 1.29-3.66), whereas the risk of chronic lymphoid leukaemia (CLL) was decreased (SIR: 0.66, 95%CI: 0.53-0.82). An additional analysis showed elevated risk of CLL 0-6 months after breast cancer diagnosis (SIR: 3.00 95%CI: 1.75-4.80).CONCLUSION: Compared to the general population, breast cancer survivors had elevated risk of AML, particularly when treated with chemotherapy. The risk of ALL was elevated, whereas the risk of CLL was lower. The higher risk of CLL in the first six months after diagnosis likely reflects surveillance bias-due to intensified diagnostic efforts at breast cancer diagnosis and treatment-prompting earlier detection. This has likely reduced the long-term risk of CLL in breast cancer survivors.
KW - Breast neoplasm. Neoplasms. Second Primary. Haematologic diseases. Chemically-induced disorders
KW - Breast Neoplasms/pathology
KW - Humans
KW - Risk Factors
KW - Neoplasms, Second Primary/etiology
KW - Incidence
KW - Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
KW - Denmark/epidemiology
KW - Leukemia, Myeloid, Acute/epidemiology
KW - Hematologic Neoplasms/epidemiology
KW - Female
KW - Registries
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85143766986&partnerID=8YFLogxK
U2 - 10.1016/j.canep.2022.102311
DO - 10.1016/j.canep.2022.102311
M3 - Journal article
C2 - 36508968
SN - 1877-7821
VL - 82
SP - 102311
JO - Cancer epidemiology
JF - Cancer epidemiology
M1 - 102311
ER -