Socioeconomic position, psychiatric medical treatment and risk of breast cancer recurrence and mortality: A Danish population-based cohort study

TY - JOUR

T1 - Socioeconomic position, psychiatric medical treatment and risk of breast cancer recurrence and mortality

T2 - A Danish population-based cohort study

AU - Asmussen, Fanny Borne

AU - Hjorth, Cathrine F

AU - Plana-Ripoll, Oleguer

AU - Mailhac, Aurélie

AU - Cronin-Fenton, Deirdre

N1 - Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

PY - 2025/2

Y1 - 2025/2

N2 - BACKGROUND: Breast cancer patients with low socioeconomic position (SEP) have a higher risk of recurrence and mortality. We examined the extent to which prior psychiatric medication impacted this association.METHODS: We conducted a cohort study of premenopausal women diagnosed with breast cancer in Denmark from 2002 to 2011 (n = 5847), linking data from Denmark's nationwide population-based health registries on breast cancer diagnosis, treatment, psychiatric medication prescriptions and SEP indicators (marital status, cohabitation, income, education and employment). We followed the women up to 10 years from breast cancer diagnosis until recurrence, death, emigration, other malignancy, or September 2017. We used Cox regression to estimate hazard ratios (HRs) and corresponding 95 % confidence intervals (95 %CI) associating each SEP indicator with recurrence and all-cause mortality. To evaluate interaction by psychiatric medication use on the association between SEP and prognosis, we 1) stratified the models according to prior use of psychiatric medication and 2) added an interaction term to the regression model.RESULTS: Women with short compared with intermediate education level and prior psychiatric medication had increased risk of recurrence (HR = 1.41, 95 %CI = 1.05-1.91); this was higher than seen in those without prior psychiatric medication (HR = 1.06, 95 %CI = 0.87-1.29). Patterns were similar for all-cause mortality. Likewise, unemployed women with a history of psychiatric medication use had a higher risk of all-cause mortality (HR = 1.74, 95 %CI = 1.31-2.31) compared to unemployed women without prior psychiatric medication use (HR = 1.32, 95 %CI = 1.03-1.70). In contrast, prior psychiatric medication use did not have a negative impact on breast cancer prognosis in women who were single, living alone or had low income.CONCLUSION: Breast cancer patients with prior psychiatric disease who have short education or are unemployed may be particularly vulnerable to recurrence and mortality. These women may benefit from more frequent follow up examinations.

AB - BACKGROUND: Breast cancer patients with low socioeconomic position (SEP) have a higher risk of recurrence and mortality. We examined the extent to which prior psychiatric medication impacted this association.METHODS: We conducted a cohort study of premenopausal women diagnosed with breast cancer in Denmark from 2002 to 2011 (n = 5847), linking data from Denmark's nationwide population-based health registries on breast cancer diagnosis, treatment, psychiatric medication prescriptions and SEP indicators (marital status, cohabitation, income, education and employment). We followed the women up to 10 years from breast cancer diagnosis until recurrence, death, emigration, other malignancy, or September 2017. We used Cox regression to estimate hazard ratios (HRs) and corresponding 95 % confidence intervals (95 %CI) associating each SEP indicator with recurrence and all-cause mortality. To evaluate interaction by psychiatric medication use on the association between SEP and prognosis, we 1) stratified the models according to prior use of psychiatric medication and 2) added an interaction term to the regression model.RESULTS: Women with short compared with intermediate education level and prior psychiatric medication had increased risk of recurrence (HR = 1.41, 95 %CI = 1.05-1.91); this was higher than seen in those without prior psychiatric medication (HR = 1.06, 95 %CI = 0.87-1.29). Patterns were similar for all-cause mortality. Likewise, unemployed women with a history of psychiatric medication use had a higher risk of all-cause mortality (HR = 1.74, 95 %CI = 1.31-2.31) compared to unemployed women without prior psychiatric medication use (HR = 1.32, 95 %CI = 1.03-1.70). In contrast, prior psychiatric medication use did not have a negative impact on breast cancer prognosis in women who were single, living alone or had low income.CONCLUSION: Breast cancer patients with prior psychiatric disease who have short education or are unemployed may be particularly vulnerable to recurrence and mortality. These women may benefit from more frequent follow up examinations.

KW - Breast cancer

KW - Prognosis

KW - Psychiatric disease

KW - Recurrence

KW - Socioeconomic position

UR - http://www.scopus.com/inward/record.url?scp=85212665193&partnerID=8YFLogxK

U2 - 10.1016/j.canep.2024.102733

DO - 10.1016/j.canep.2024.102733

M3 - Journal article

C2 - 39709834

SN - 1877-7821

VL - 94

JO - Cancer epidemiology

JF - Cancer epidemiology

M1 - 102733

ER -