Breast cancer risk in female MSer's

[SuzE-Q]

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PLoS One.

2016 Oct 24;11(10)

Risk of Premenopausal and Postmenopausal Breast Cancer among Multiple Sclerosis Patients.

Hajiebrahimi M1,2, Montgomery S1,3,4, Burkill S5, Bahmanyar S5,2.

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.

CONCLUSION:
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.

[agate]

Hope everybody is getting mammograms as recommended.

A dear friend died of breast cancer, and I'm sure everyone here has known someone with this particularly grim disease.

But the abstract does mention that people with MS may be more likely to get diagnosed with breast cancer just because we probably have more health surveillance. We tend to go to doctors more often than the rest of the population.

[SuzE-Q]

Hope everybody is getting mammograms as recommended.

A dear friend died of breast cancer, and I'm sure everyone here has known someone with this particularly grim disease.

But the abstract does mention that people with MS may be more likely to get diagnosed with breast cancer just because we probably have more health surveillance. We tend to go to doctors more often than the rest of the population.

And, given the timeline of statistical significance, being on a DMD isn't a factor at increasing risk either, which is a good thing (assuming it's referringing to "diagnosis" being the breast cancer, and not the MS).

I'm just not sure I buy that it's because we see doctors more often.

A) my neuro has never offered me a breast exam while I'm there, nor have I ever mentioned a suspicious concern to him, and

B) my pcp hasn't suggested a breast exam or mammogram just because I may be there more often than a nonMSer.

It's also not like the MRI machine inadvertently scans down to that area either, although that would actually be quite nice to have it examine breast tissue as well while I'm enduring the scan, I wouldn't mind that.

But honestly, if we have an "overactive" immune system, you'd think we'd have lower incidence. I thought I'd read that we DID!!

[agate]

Healthier people tend not to go to doctors--ever. So they don't get routine reminders to get mammograms or do breast exams.

People with MS are probably seeing doctors more often just because once the MS is diagnosed, some doctor probably urges them to check in regularly. And we do have injuries and infections and exacerbations that send us to doctors.

SuzE-Q, you wouldn't be seeing your PCP much at all, maybe never, if you didn't have MS, and so you wouldn't have received any suggestions for breast exams or mammograms.

I saw no reason to go to doctors before MS came along-unless I had a condition that required medical attention. I didn't check in for regular exams, and many people don't.

I think that is what is meant in the abstract.

[agate]

And, given the timeline of statistical significance, being on a DMD isn't a factor at increasing risk either, which is a good thing (assuming it's referringing to "diagnosis" being the breast cancer, and not the MS).

...

Being on a DMT hasn't been shown to increase cancer risk but there is some evidence that it cancels out the slightly reduced cancer risk that people with MS have in general--talking here about cancers of all kinds.

From PubMed (October 25, 2016), "Decreased risk of cancer in multiple sclerosis patients and analysis of the effect of disease-modifying therapies on cancer risk":

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[SuzE-Q]

Being on a DMT hasn't been shown to increase cancer risk but there is some evidence that it cancels out the slightly reduced cancer risk that people with MS have in general--talking here about cancers of all kinds.

From PubMed (October 25, 2016), "Decreased risk of cancer in multiple sclerosis patients and analysis of the effect of disease-modifying therapies on cancer risk":

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This is what I was referring to:

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Breast Cancer Res Treat.

2005 Feb;89(3):265-70.

Cancer incidence in multiple sclerosis and effects of immunomodulatory treatments.

Achiron A1, Barak Y, Gail M, Mandel M, Pee D, Ayyagari R, Rotstein Z.

Multiple sclerosis (MS) has been linked to reduced rates of cancer prior to the era of immunomodulating treatments. We assessed the incidence of cancer in a cohort of 1338 MS patients and evaluated the effect of exposure to immunomodulatory treatment.

Cancer incidence in the MS population was compared with the expected age- and gender-matched incidence rates in the Israeli population for the period 1960-2003. Time-dependant Cox model analysis was used to estimate hazard ratios for glatiramer acetate, beta-interferons (1a and 1-b) and intravenous immunoglobulins (IVIg).

Among 892 female MS patients, 15 (1.7%) developed breast cancer, and 31 (3.5%) developed cancers of any type. Seventeen of 446 (3.8%) male MS patients developed cancer. The standardized incidence ratios (SIRs) computed until the time of first immunomodulatory treatment were 0.60 (95% CI, 0.38-0.92, p = 0.02) for all female cancer, and 1.11 (95% CI, 0.64-1.91) for all male cancer.

Time-dependent covariate analyses for female breast cancer yielded a relative risk for glatiramer acetate of 3.10 (95% CI, 0.86-11.1) and 0.52 (95% CI, 0.07-4.05) for beta-interferons. For IVIg, the analyses were uninformative.

Our findings indicate that cancer incidence is significantly lower in female MS patients than in the general population. Female MS patients treated with glatiramer acetate showed an elevated rate of breast cancer and all MS patients treated with beta-interferons showed an elevated risk of non-breast cancers though not statistically significant (p = 0.122 and 0.072, respectively). Further study is needed to assess possible associations between long-term exposure to the novel immunomodulatory treatments in MS and rate of cancer.

[Sunshine]

Hm. Everyone has cancer cells in the body. The immune system performs constant surveillance. And kills these individual cells, when it works well.

What if the MS either causes ,or is caused by, heightened ability to perform surveillance, and therefore a lower rate of developing cancer tumors?

[Virginia]

I tend to believe that we are neither at a higher or lower risk of breast cancer than anyone else. I had breast cancer 3 years after MS diagnosis, but finding it had nothing to do with going to any Doctor more often than anyone else would. However, that is just my personal opinion and everyone is entitled to that much.

If someone is going to do research of any kind I wish they would concentrate more on the MS and what the cause or causes are. They can never find a cure for something they don't understand and don't know what it is caused by. Again my opinion.

I guess I am just full of opinions today!

[Jeanie Z]

:)I had cervical cancer and breast cancer in 1964 and did not know I had MS then. I had cobalt inserted for the cervical cancer followed by a hysterectomy. I had breast surgery 6 weeks later. Because I was under 30 I had to have 3 doctors say I needed a hyst. The third one gave me a head to toe physical and discovered the breast lumps.

12 years later when I was 35 I decided to have reconstructive surgery on my breasts. They did a mammogram on the tissue I had left and found 3 more cancer tumors. They removed them and inserted silicone implants.

Two years later they ruptured one doing a mammogram. I then got silicone poisoning. They went in but could not find all the silicone but removed what they could. For more than 10 years pieces of silicone would work their way to the surface of the skin and itch. When I scratched them out came a clear ball. These occurred on my arms and legs mostly.

It took my immune system quite awhile to recoop from the silicone poisoning. That is when the Texas specialist had me take IVIG treatments to boost my immune system.

The cobalt was before I became a nurse and I had two baby boys. A man came in my hospital room looking like an astronaut covered from head to toe and carrying a container. He had me spread my legs and he inserted the cobalt in my vagina. Then he put a sign on the door do not enter radio active. Only old lady nurses came in my room, no one of child bearing age was allowed. It was scary. I am happy to have remained cancer free ever since. Jeanie :))

[Virginia]

Jeanie, so glad you have remained cancer free also. What a story! What you said about your silicone implants is why I turned down the reconstruction. The concern about the silicone really bothered me. I had been told that people had theirs removed because the silicone caused MS like symptoms. I already have and already had at the time the tingling in feet, etc. I wasn't willing to sit and wonder if it was MS or if something had happened to my silicone implants.

You have really been through a lot. Howie, should read your post - he might change his mind about his situation. You have been and still are a brave lady.

[agate]

Jeanie, you've been through some terrible ordeals.

MS must seem like a piece of cake sometimes, by comparison!

[SalpalSally]

Jeanie.....huggggggggs!!!

[Sunshine]

Oh Jeanie, what a litany of horrors you've been through. And so young.