Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study

Cathrine F Hjorth; Dóra K Farkas; Lidia Schapira; Mark R Cullen; Henrik T Sørensen; Deirdre Cronin-Fenton

doi:10.1016/j.canep.2022.102311

Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study

Cathrine F Hjorth, Dóra K Farkas, Lidia Schapira, Mark R Cullen, Henrik T Sørensen, Deirdre Cronin-Fenton

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Article number	102311
Journal	Cancer epidemiology
Volume	82
Pages (from-to)	102311
ISSN	1877-7821
DOIs	https://doi.org/10.1016/j.canep.2022.102311
Publication status	Published - Feb 2023

Keywords

Breast neoplasm. Neoplasms. Second Primary. Haematologic diseases. Chemically-induced disorders
Breast Neoplasms/pathology
Humans
Risk Factors
Neoplasms, Second Primary/etiology
Incidence
Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
Denmark/epidemiology
Leukemia, Myeloid, Acute/epidemiology
Hematologic Neoplasms/epidemiology
Female
Registries
Cohort Studies

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@article{576a6bb3caef4410850ff6ab32a37073,

title = "Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study",

abstract = "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.",

keywords = "Breast neoplasm. Neoplasms. Second Primary. Haematologic diseases. Chemically-induced disorders, Breast Neoplasms/pathology, Humans, Risk Factors, Neoplasms, Second Primary/etiology, Incidence, Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology, Denmark/epidemiology, Leukemia, Myeloid, Acute/epidemiology, Hematologic Neoplasms/epidemiology, Female, Registries, Cohort Studies",

author = "Hjorth, {Cathrine F} and Farkas, {D{\'o}ra K} and Lidia Schapira and Cullen, {Mark R} and S{\o}rensen, {Henrik T} and Deirdre Cronin-Fenton",

year = "2023",

month = feb,

doi = "10.1016/j.canep.2022.102311",

language = "English",

volume = "82",

pages = "102311",

journal = "Cancer epidemiology",

issn = "1877-7821",

publisher = "Elsevier Ltd",

}

Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study. / Hjorth, Cathrine F ; Farkas, Dóra K; Schapira, Lidia et al.
In: Cancer epidemiology, Vol. 82, 102311, 02.2023, p. 102311.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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

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 -

Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study

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