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Zhang Y, Song M, Yang Z, Huang X, Lin Y, Yang H. Healthy lifestyles, systemic inflammation and breast cancer risk: a mediation analysis. BMC Cancer 2024; 24:208. [PMID: 38360584 PMCID: PMC10868083 DOI: 10.1186/s12885-024-11931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Despite the known association between healthy lifestyles and reduced risk of breast cancer, it remains unclear whether systemic inflammation, as a consequence of unhealthy lifestyles, may mediate the association. METHODS A cohort study of 259,435 female participants in the UK Biobank was conducted to estimate hazard ratio (HR) for breast cancer according to 9 inflammation markers using Cox regression models. We further estimated the percentage of total association between healthy lifestyle index (HLI) and breast cancer that is mediated by these inflammation markers. RESULTS During 2,738,705 person-years of follow-up, 8,889 cases of breast cancer were diagnosed among 259,435 women in the UK Biobank cohort. Higher level of C-reactive protein (CRP), systemic immune-inflammation index (SII), CRP-to-albumin Ratio (CAR), CRP-to-lymphocyte Ratio (CLR), monocyte-to-HDL-c ratio (MHR), and neutrophil-to-HDL-c ratio (NHR) were associated with increased breast cancer risk, while a higher lymphocyte-to-monocyte ratio (LMR) was associated with a lower risk. The inverse association between HLI and breast cancer was weakly mediated by CRP (8.5%), SII (1.71%), CAR (8.66%), CLR (6.91%), MHR (6.27%), and NHR (7.33%). When considering individual lifestyle factors, CRP and CAR each mediated 16.58% and 17.20%, respectively, of the associations between diet score and breast cancer risk, while the proportion mediated for physical activity and breast cancer were 12.13% and 11.48%, respectively. Furthermore, MHR was found to mediate 13.84% and 12.01% of the associations between BMI, waist circumference, and breast cancer. CONCLUSION The association of HLI and breast cancer is weakly mediated by the level of inflammation, particularly by CRP and CAR. Systemic inflammatory status may be an intermediate in the biological pathway of breast cancer development.
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Affiliation(s)
- Yanyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xue Yuan Road 1, University Town, 350122, Fuzhou, China
| | - Mengjie Song
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xue Yuan Road 1, University Town, 350122, Fuzhou, China
| | - Zixuan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xue Yuan Road 1, University Town, 350122, Fuzhou, China
| | - Xiaoxi Huang
- Department of Breast, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Breast Cancer Institute, Fujian Medical University, Fuzhou, 350001, China.
| | - Haomin Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xue Yuan Road 1, University Town, 350122, Fuzhou, China.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden.
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Jia Y, Yao P, Li J, Wei X, Liu X, Wu H, Wang W, Feng C, Li C, Zhang Y, Cai Y, Zhang S, Ma X. Causal associations of Sjögren's syndrome with cancers: a two-sample Mendelian randomization study. Arthritis Res Ther 2023; 25:171. [PMID: 37715206 PMCID: PMC10503000 DOI: 10.1186/s13075-023-03157-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Several observational studies have explored the associations between Sjögren's syndrome (SS) and certain cancers. Nevertheless, the causal relationships remain unclear. Mendelian randomization (MR) method was used to investigate the causality between SS and different types of cancers. METHODS We conducted the two-sample Mendelian randomization with the public genome-wide association studies (GWASs) summary statistics in European population to evaluate the causality between SS and nine types of cancers. The sample size varies from 1080 to 372,373. The inverse variance weighted (IVW) method was used to estimate the causal effects. A Bonferroni-corrected threshold of P < 0.0031 was considered significant, and P value between 0.0031 and 0.05 was considered to be suggestive of an association. Sensitivity analysis was performed to validate the causality. Moreover, additional analysis was used to assess the associations between SS and well-accepted risk factors of cancers. RESULTS After correcting the heterogeneity and horizontal pleiotropy, the results indicated that patients with SS were significantly associated with an increased risk of lymphomas (odds ratio [OR] = 1.0010, 95% confidence interval [CI]: 1.0005-1.0015, P = 0.0002) and reduced risks of prostate cancer (OR = 0.9972, 95% CI: 0.9960-0.9985, P = 2.45 × 10-5) and endometrial cancer (OR = 0.9414, 95% CI: 0.9158-0.9676, P = 1.65 × 10-5). Suggestive associations were found in liver and bile duct cancer (OR = 0.9999, 95% CI: 0.9997-1.0000, P = 0.0291) and cancer of urinary tract (OR = 0.9996, 95% CI: 0.9992-1.0000, P = 0.0281). No causal effect of SS on other cancer types was detected. Additional MR analysis indicated that causal effects between SS and cancers were not mediated by the well-accepted risk factors of cancers. No evidence of the causal relationship was observed for cancers on SS. CONCLUSIONS SS had significant causal relationships with lymphomas, prostate cancer, and endometrial cancer, and suggestive evidence of association was found in liver and bile duct cancer and cancer of urinary tract, indicating that SS may play a vital role in the incidence of these malignancies.
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Affiliation(s)
- Yiwei Jia
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Peizhuo Yao
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Jia Li
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Xinyu Wei
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Xuanyu Liu
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Huizi Wu
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Weiwei Wang
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Cong Feng
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Chaofan Li
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Yu Zhang
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Yifan Cai
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Shuqun Zhang
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China.
| | - Xingcong Ma
- Department of Oncology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China.
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3
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Hardenbergh D, Molina E, Naik R, Geetha D, Chaturvedi S, Timlin H. Factors mediating cancer risk in systemic lupus erythematosus. Lupus 2022; 31:1285-1295. [PMID: 36059254 DOI: 10.1177/09612033221122163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) are at an elevated risk for certain cancers compared to the population at large. Cancers seen at higher rates in the SLE population include hematologic malignancies, such as non-Hodgkin lymphoma, and cancers of the lung and thyroid. SLE patients also have a decreased risk for certain malignancies, such as breast cancer, melanoma, and prostate cancer. We review the literature on risk factors for malignancy in patients with SLE and discuss the exogenous and innate factors that are thought to contribute to the unique pattern of cancer risk observed in this patient population. These risk factors are important for providers of SLE patients to understand in order to maintain high clinical suspicion and detect malignancy as soon as possible. Further research is needed to determine the most effective guidelines on counseling patients on cancer screening and prevention.
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Affiliation(s)
| | - Emily Molina
- 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rakhi Naik
- Division of Hematology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Duvuru Geetha
- Division of Nephrology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti Chaturvedi
- Division of Hematology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Homa Timlin
- Division of Rheumatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
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4
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Pancreatic Cancer and Primary Sjögren's Syndrome: A Case Report. Case Rep Rheumatol 2021; 2021:9915881. [PMID: 34395011 PMCID: PMC8356001 DOI: 10.1155/2021/9915881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Primary Sjögren syndrome (SS) is a chronic inflammatory systemic autoimmune disease with a high risk of malignancy development, namely, lymphoproliferative neoplasms. Few studies also reported a high risk of solid cancers; however, the coexistence of primary SS and pancreatic cancer has been rarely described. In this paper, we aim to describe a case of a 59-year-old woman who was an active smoker with sicca symptoms and symmetrical polyarthritis and was diagnosed with primary SS two years before the development of metastatic pancreatic adenocarcinoma. Despite institution of chemotherapy, the patient succumbed to the malignancy. Besides that, we explore the link between primary SS and solid cancers including the main predictors of malignancy and the role of primary SS as a paraneoplastic syndrome. Patients with primary SS should be closely monitored for malignancy, not only for hematological cancer, but also for solid tumors. Further research is necessary to understand which are the predictors of cancer proliferation in primary SS patients.
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5
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Shah AA, Igusa T, Goldman D, Li J, Casciola-Rosen L, Rosen A, Petri M. Association of systemic lupus erythematosus autoantibody diversity with breast cancer protection. Arthritis Res Ther 2021; 23:64. [PMID: 33632283 PMCID: PMC7905617 DOI: 10.1186/s13075-021-02449-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background Epidemiologic data suggest that patients with systemic lupus erythematosus (SLE) have a lower risk of breast cancer than women in the general population. In light of mechanistic studies suggesting that anti-DNA antibodies have anti-cancer effects, we sought to examine breast cancer risk in autoantibody strata in a well-characterized SLE cohort. Methods SLE patients without a cancer diagnosis prior to entry in the Hopkins Lupus Cohort were studied (N = 2431). Overall and site-specific cancer incidence was calculated in racial strata and compared with the US Surveillance, Epidemiology and End Results (SEER) registry. Breast cancer incidence was further examined in autoantibody subsets. Patients were considered positive for an autoantibody if they were ever positive for a specificity during their disease course. Results Patients with SLE had a 37% lower risk of breast cancer (SIR 0.63, 95% CI 0.39–0.95). The risk of HPV-associated cancers (SIR 4.39, 95% CI 2.87–6.44) and thyroid cancer (SIR 2.27, 95% CI 1.04–4.30) was increased. Cancer risk varied by race, with breast cancer protection occurring in non-African Americans (SIR 0.29, 95% CI 0.11–0.63) and the increased risk of HPV-associated cancers occurring in African Americans (SIR 7.23, 95% CI 4.35–11.3). Breast cancer risk was decreased in patients ever positive for anti-dsDNA (SIR 0.55, 95% CI 0.29–0.96), anti-La (SIR 0.00, 95% CI 0.00–0.78), and lupus anticoagulant (SIR 0.37, 95% CI 0.10–0.94). Patients who were positive for fewer (0–2) SLE autoantibodies did not have a lower risk of breast cancer (SIR 0.84, 95% CI 0.47–1.39), but patients with 3+ autoantibodies had a 59% decreased risk (SIR 0.41, 95% CI 0.16–0.84). Conclusions Positivity for multiple SLE autoantibodies was associated with a lower risk of breast cancer, supporting the hypothesis that a highly diversified immune response may exert an anti-cancer effect against some cancers. Validation of racial differences in cancer risk in SLE is required to determine whether cancer screening strategies should be targeted to racial subgroups. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02449-3.
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Affiliation(s)
- Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| | - Takeru Igusa
- Departments of Civil and Systems Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe Hall 212, Baltimore, MD, 21218, USA
| | - Daniel Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Antony Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
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6
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Abstract
Systemic lupus erythematosus is associated with a small overall increased cancer risk compared with the general population. This risk includes a 4-fold increased risk of non-Hodgkin lymphoma, but a decreased risk of other cancers (such as breast cancer). The pathophysiology underlying the increased risk of hematologic cancer is not fully understood, but many potential mechanisms have been proposed, including dysfunction of the tumor necrosis factor and other pathways. A decreased risk of breast, ovarian, and endometrial cancer might be driven by hormonal factors or lupus-related antibodies, but these links have not been proved.
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7
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Wadström H, Pettersson A, Smedby KE, Askling J. Risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors. Ann Rheum Dis 2020; 79:581-586. [PMID: 32161056 PMCID: PMC7213316 DOI: 10.1136/annrheumdis-2019-216756] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
Objectives To examine the risk of incident breast cancer in women with rheumatoid arthritis (RA), and the risk of RA in women with a history of breast cancer, taking antihormonal treatment for breast cancer into account. Methods Using nationwide Swedish registers, women with new-onset RA diagnosed in 2006–2016 were identified and analysed using a cohort and a case–control design. Each patient with RA was matched on age, sex and place of residence to five randomly selected subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (reproductive history and hormone replacement therapy) and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast cancer was assessed using conditional logistic regression. Results The risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95% CI 0.68 to 0.93). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95% CI 0.79 to 0.95). Women with breast cancer treated with tamoxifen (OR=0.86, 95% CI 0.62 to 1.20) or aromatase inhibitors (OR=0.97, 95% CI 0.69 to 1.37) did not have an increased risk of RA compared with women with breast cancer treated differently. Conclusions The decreased occurrence of breast cancer in patients with RA is present already before RA diagnosis; these reduced risks are not readily explained by hormonal risk factors. Adjuvant antihormonal therapy for breast cancer does not seem to increase RA risk.
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Affiliation(s)
- Hjalmar Wadström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Pettersson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Patient Area Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Solna, Sweden
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8
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Song L, Wang Y, Zhang J, Song N, Xu X, Lu Y. The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis Res Ther 2018; 20:270. [PMID: 30522515 PMCID: PMC6282326 DOI: 10.1186/s13075-018-1760-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/31/2018] [Indexed: 12/18/2022] Open
Abstract
Background Although accumulating data have suggested the development of cancer in systemic lupus erythematosus (SLE) patients, these results remain inconsistent. To examine such a putative association, this analysis reports the association between SLE and the risks of 24 cancer types. Methods Online databases PubMed, EMBASE, and Web of Science were searched comprehensively for eligible studies, published up to 15 May 2018. Pooled standardized incidence rates (SIRs) with 95% confidence intervals (CIs) were utilized to reveal their associations. Results A total of 24 eligible studies were ultimately enrolled. Our results indicated that SLE was associated with increased risk of overall cancers, cancer risk in both genders, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, leukemia, multiple myeloma, cervix, vagina/vulva, renal, bladder, esophagus, gastric, hepatobiliary, lung, oropharynx, larynx, non-melanoma skin, and thyroid cancers. Additionally, SLE could reduce the risk of prostate cancer and cutaneous melanoma; however, it was not significantly associated with breast, uterus, ovarian, pancreatic, colorectal, or brain cancers. Conclusions Our results shed light SLE being correlated with increased risk for 16 involved cancers and decreased risk for prostate cancer and cutaneous melanoma. This comprehensive meta-analysis provides epidemiological evidence supporting the associations between SLE and cancer risk. This evidence could be utilized to drive public policies and to help guide personalized medicine to better manage SLE and reduce associated cancer morbidity and mortality. Electronic supplementary material The online version of this article (10.1186/s13075-018-1760-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lebin Song
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jiayi Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiaoyun Xu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Yan Lu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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9
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Ladouceur A, Bernatsky S, Ramsey-Goldman R, Clarke AE. Managing cancer risk in patients with systemic lupus erythematous. Expert Rev Clin Immunol 2018; 14:793-802. [DOI: 10.1080/1744666x.2018.1519394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Alexandra Ladouceur
- Medical Resident. Division of Internal medicine, University of Montreal, Montreal, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University Health Center, McGill University, Montreal, Canada
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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10
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The Prevalence of Systemic Rheumatic Diseases Among Breast Cancer Patients and Its Relationship With Survival. Arch Rheumatol 2018; 34:141-147. [PMID: 31497760 DOI: 10.5606/archrheumatol.2019.6803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/07/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the prevalence of systemic rheumatic diseases (SRDs) among patients with breast cancer (BC) and to identify the clinicopathological characteristics of these patients. Patients and methods A total of 3,744 female patients with BC (mean age 49±11.7 years; range, 18 to 92 years) followed in Hacettepe University Faculty of Medicine, Medical Oncology Department between January 2006 and December 2015 were retrospectively assessed. Patients with or without SRD were compared in terms of clinicopathological features including age, menopausal state, smoking status, Body Mass Index (BMI), age of menarche, age at first labor, and number of children. The groups were also evaluated regarding tumor grade, stage, estrogen receptor and progesterone receptor expression, human epidermal growth factor receptor 2 overexpression, and survival. Results Of the patients analyzed, 68 (1.81%) had concomitant SRD. Among these patients, 33 (48.6%) had rheumatoid arthritis, eight (11.8%) had familial Mediterranean fever, eight (11.8%) had Behçet's disease, four (5.8%) had Sjögren's syndrome, four (5.8%) had systemic lupus erythematosus, six (8.8%) had ankylosing spondylitis, three (4.4%) had systemic sclerosis, one (1.4%) had polymyositis, and one (1.4%) had temporal arteritis. The groups with or without SRDs were similar in terms of age, smoking status, BMI, menopausal state, breast feeding duration, age at menarche and first birth. Stage 1 and 2 BC was more prevalent in SRD patients (74.6% vs. 64.5%, p=0.018). The rate to receive chemotherapy was significantly lower in patients with SRD. However, there was no significant difference in five-year overall survival rates between patients with or without SRD. Conclusion Among patients with BC, 1.81% had concomitant SRD. These patients were diagnosed at early stages and given chemotherapy less frequently. However, they had similar survival rates compared to those without SRDs.
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11
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Nisihara R, Machoski MCC, Neppel A, Maestri CA, Messias-Reason I, Skare TL. Anti-nuclear antibodies in patients with breast cancer. Clin Exp Immunol 2018; 193:178-182. [PMID: 29645079 DOI: 10.1111/cei.13136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
Abstract
To study the prevalence of anti-nuclear antibodies (ANA) in breast cancer patients and its association with tumour characteristics. Ninety-one patients with breast mass detected by image studies and assigned to conduct diagnostic biopsy and eventual surgical treatment were studied for demographical, tumour data and presence of ANA. Serum of positive ANA patients was screened for the extractable nuclear antigen (ENA) profile. As comparison, 91 healthy individuals matched for age and from the same geographical area were included. In this sample 72 of 91 (79·1%) had malignant lesions (83% ductal infiltrative carcinoma). ANA was positive in 44·4% of patients with malignant tumour and in 15·7% of those with benign lesions (malignant versus benign with P = 0·03). Controls had ANA positivity in 5·4%, and when compared with tumour samples showed P < 0·0001. The most common immunofluorescence pattern was a fine dense speckled pattern. In the ANA-positive patients with malignant lesions, seven had positivity for ENA profile (three for anti-RNP and anti-Sm, one for just anti-RNP, two for anti-Ro and anti-La e two for just anti-La). It was not possible to associate ANA positivity with tumour histological characteristics or staging or with patient's age. A negative association of ANA with hormonal (oestrogen or oestrogen plus progesterone) receptor status was found (P = 0·01). In this sample, there was a high prevalence of ANA positivity in breast cancer patients with a negative association with the presence of hormonal receptors. More studies are needed to understand the real value of this finding.
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Affiliation(s)
- R Nisihara
- Medicine Department, Positivo University, Curitiba, Brazil.,Medicine Department, Evangelical University, Curitiba, Brazil
| | - M C C Machoski
- Medicine Department, Evangelical University, Curitiba, Brazil
| | - A Neppel
- Medicine Department, Evangelical University, Curitiba, Brazil
| | - C A Maestri
- Erasto Gaertner Hospital, Liga Paranaense de Combate ao Câncer, Curitiba, Brazil.,Immunopathology Laboratory, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - I Messias-Reason
- Immunopathology Laboratory, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - T L Skare
- Medicine Department, Evangelical University, Curitiba, Brazil
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12
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Rezaieyazdi Z, Tabaei S, Ravanshad Y, Akhtari J, Mehrad-Majd H. No association between the risk of breast cancer and systemic lupus erythematosus: evidence from a meta-analysis. Clin Rheumatol 2018; 37:1511-1519. [PMID: 29294194 DOI: 10.1007/s10067-017-3950-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/23/2017] [Accepted: 12/06/2017] [Indexed: 01/23/2023]
Abstract
Several studies have estimated breast cancer risk in patients with systemic lupus erythematosus (SLE) relative to the general population. However, the results have been inconclusive. Therefore, we conducted a meta-analysis to ascertain a more comprehensive conclusion. A systematic literature search of electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and Scopus was conducted to identify eligible studies using multiple search strategies. Based on the degree of heterogeneity, a random-effect model was chosen to calculate the pooled standardized incidence rate (SIR) with 95% confidence interval (CI), to estimate the strength of association between SLE and breast cancer incidence risk. A total of 18 eligible studies including 110,720 patients with SLE were enrolled in this meta-analysis. The combined results showed no significant association between SLE and breast cancer incidence (SIRs = 1.012 (95% CI, 0.797-1.284)). Subgroup analysis by study type, ethnicity, follow-up years, sample size, and SLE diagnostic criteria also showed no altered risk for breast cancer incidence (the summary risk estimate of each subgroup ranged from 0.82 to 1.40 with no statistical significance). This meta-analysis suggests no direct association between SLE and risk of breast cancer incidence.
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Affiliation(s)
- Zahra Rezaieyazdi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Tabaei
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Ravanshad
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Akhtari
- Immunogenetics Research Center, Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hassan Mehrad-Majd
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
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Schairer C, Pfeiffer RM, Gadalla SM. Autoimmune diseases and breast cancer risk by tumor hormone-receptor status among elderly women. Int J Cancer 2017; 142:1202-1208. [PMID: 29144542 DOI: 10.1002/ijc.31148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
The female preponderance of many autoimmune diseases suggests a possible hormonal etiology. Little research exists on systemic and organ-specific autoimmune diseases and risk of breast cancer by tumor estrogen receptor (ER)- and progesterone receptor (PR)- status. Here, we evaluate associations between selected systemic and organ-specific autoimmune diseases and breast cancer risk overall and by tumor ER- and PR-status. We used linked Surveillance, Epidemiology and End Results (SEER)-Medicare data, with first female breast cancer cases ages ≥66 years identified by SEER registries (years 1992-2011; N = 209,929). We selected female controls (N = 200,000) from a stratified 5% random sample of Medicare recipients who were alive and breast cancer-free. We assessed exposures until 12 months before breast cancer diagnosis/selection using Medicare claims data. We estimated odds ratios (OR) and 99.9% confidence intervals (CI) using unconditional and multinomial logistic regression. We found reduced breast cancer risk among those with rheumatoid arthritis (OR = 0.84; 99.9% CI 0.79-0.89), systemic lupus erythematosus (OR = 0.82; 99.9% CI 0.70-0.97) and pernicious anemia (OR = 0.90; 99.9% CI 0.83-0.97) and increased risk among those with psoriasis (OR = 1.16; 99.9% CI 1.06-1.27). Statistically significant alterations in risk for rheumatoid arthritis were limited to ER-positive (+) breast cancer, whereas those for the other three conditions were further limited to ER+/PR+ breast cancer. However, only differences for rheumatoid arthritis by ER-status were statistically significant (p-heterogeneity = 0.0001). The reasons for these associations need to be investigated in future studies accounting for host characteristics and autoimmune disease treatment.
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Affiliation(s)
- Catherine Schairer
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD
| | - Ruth M Pfeiffer
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD
| | - Shahinaz M Gadalla
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD
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Is primary Sjögren's syndrome a risk factor for malignancies different from lymphomas? What does the literature highlight about it? Reumatologia 2017; 55:136-139. [PMID: 28769137 PMCID: PMC5534508 DOI: 10.5114/reum.2017.68913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/12/2017] [Indexed: 12/29/2022] Open
Abstract
Background Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease with an elevated risk of developing lymphoproliferative malignancies (LM). Whether pSS is a risk factor or not for non-lymphoma malignancies (NLM) has been scarcely evaluated in the literature. Age is per se a risk factor for malignancies: patients over 70 years old have 4 times higher risk for cancers than adults. Even if the mean age of pSS onset usually is in the 4th and 5th decade, its onset in patients aged over 65 years (Elderly Onset pSS – EOpSS) is not uncommon. Material and methods To evaluate pSS as a risk factor for NLM we performed a systematic electronic search on PubMed in the period 2006–2016 to identify all the publications on this topic. The studies were eligible for inclusion if they reported specific Standardized Incidence Ratio (SIR) with 95% CI. Studies that did not report sufficient published and/or original data were excluded. Results Only 7 articles of 494 that we found in PubMed fulfilled the inclusion criterion. In the vast majority of these, SIR values were not statistically significant for NLM. The occurrence of NLM after LM was statistically significant in some studies and a NLM represented the most frequent cause of death. The possibility that NLM may represent a paraneoplastic syndrome seems much more frequent than LM, the risk of which increases with time after the diagnosis. Data regarding the neoplastic weight of EOpSS are mainly pointed out by case reports. Conclusions Primary Sjögren’s syndrome is not associated with an increased risk for NLM. However the possibility that NLM may appear after recovery from lymphoma should be carefully considered because it could be cause of the patient’s death. Similarly the possibility that NLM may represent a paraneoplastic syndrome must be highlighted. The relationship between EOpSS and SIRs for NLM should be deepened with studies on ad hoc cohorts.
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Shafrin J, Tebeka MG, Price K, Patel C, Michaud K. The Economic Burden of ACPA-Positive Status Among Patients with Rheumatoid Arthritis. J Manag Care Spec Pharm 2017; 24:4-11. [PMID: 29290168 PMCID: PMC10398189 DOI: 10.18553/jmcp.2017.17129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anticitrullinated protein antibodies (ACPAs) are serological biomarkers associated with early, rapidly progressing rheumatoid arthritis (RA), including more severe disease and joint damage. ACPA testing has become a routine tool for RA diagnosis and prognosis. Furthermore, treatment efficacy has been shown to vary by ACPA-positive status. However, it is not clear if the economic burden of patients with RA varies by ACPA status. OBJECTIVE To determine if the economic burden of RA varies by patient ACPA status. METHODS IMS PharMetrics Plus health insurance claims and electronic medical record (EMR) data from 2010-2015 were used to identify patients with incident RA. Patients were aged ≥ 18 years, had ≥ 1 inpatient or ≥ 2 outpatient claims reporting an RA diagnosis code (ICD-9-CM code 714.0), and had an anticyclic citrullinated peptide (anti-CCP; a surrogate of ACPA) antibody test within 6 months of diagnosis. Incident patients were defined as those who had no claims with an RA diagnosis code in the 6 months before the first observed RA diagnosis. The primary outcome of interest was RA-related medical expenditures, defined as the sum of payer- and patient-paid amounts for all claims with an RA diagnosis code. Secondary outcomes included health care utilization metrics such as treatment with a disease-modifying antirheumatic drug (DMARD) and physician visits. Generalized linear regression models were used for each outcome, controlling for ACPA-positive status (defined as anti-CCP ≥ 20 AU/mL), age, sex, and Charlson Comorbidity Index score as explanatory variables. RESULTS Of 647,171 patients diagnosed with RA, 89,296 were incident cases, and 47% (n = 42,285) had an anti-CCP test. After restricting this sample to patients with a linked EMR and reported anti-CCP test result, 859 remained, with 24.7% (n = 212) being ACPA-positive. Compared with ACPA-negative patients, adjusted results showed that ACPA-positive patients were more likely to use either conventional (71.2% vs. 49.6%; P < 0.001) or biologic (20.3% vs. 11.8%; P < 0.001) DMARDs during the first year after diagnosis and had more physician visits (5.58 vs. 3.91 times per year; P < 0.001). Annual RA-associated total expenditures were $7,941 for ACPA-positive and $5,243 for ACPA-negative patients (Δ = $2,698; P = 0.002). RA-associated medical expenditures were $4,380 for ACPA-positive and $3,427 for ACPA-negative patients (Δ = $954; P = 0.168), whereas DMARD expenditures were $3,560 and $1,817, respectively (Δ = $1,743; P = 0.001). CONCLUSIONS RA-related economic burden is higher for patients who are ACPA-positive compared with those who are ACPA-negative. Providers may wish to inform patients diagnosed with ACPA-positive RA about the likely future disease and economic burden in hopes that both stakeholders can be more proactive in addressing them. DISCLOSURES Funding for this research was contributed by Bristol-Myers Squibb. Patel and Price are employees and stockholders of Bristol-Myers Squibb. Shafrin and Tebeka are employees of Precision Health Economics, a health care consulting firm that received funding from Bristol-Myers Squibb to conduct this study. Michaud has received a grant from Pfizer and is employed by the National Data Bank for Rheumatic Diseases, which has received funds from Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, and Regeneron. Study concept and design were contributed by Shafrin, Price, Patel, and Michaud. Shafrin, Price, and Patel collected the data, and all authors contributed equally to data analysis. The manuscript was written by Shafrin and Tebeka and revised by Shafrin, Price, Patel, and Michaud.
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Affiliation(s)
- Jason Shafrin
- 1 Precision Health Economics, Los Angeles, California
| | | | - Kwanza Price
- 2 Bristol-Myers Squibb, Princeton Pike, New Jersey
| | - Chad Patel
- 2 Bristol-Myers Squibb, Princeton Pike, New Jersey
| | - Kaleb Michaud
- 3 University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
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16
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Chan K, Clarke AE, Ramsey-Goldman R, Foulkes W, Tessier Cloutier B, Urowitz MB, Gladman D, Nived O, Romero-Diaz J, Petri M, Ginzler E, Fortin PR, Bae SC, Wallace DJ, Yelin EH, Bernatsky S. Breast cancer in systemic lupus erythematosus (SLE): receptor status and treatment. Lupus 2017; 27:120-123. [PMID: 28595511 DOI: 10.1177/0961203317713146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective There is a decreased risk of breast cancer in systemic lupus erythematosus (SLE) versus the general population; little is known regarding the receptor status of breast cancers in SLE, or treatment. Methods Breast cancer cases occurring after SLE diagnosis were ascertained through linkage with tumor registries. We determined breast cancer positivity for estrogen receptors (ER), progesterone receptors (PR), and/or Human Epidermal Growth Factor Receptor 2 (HER2), as well as cancer treatment. Results We obtained information on ER, PR, and/or HER2 status for 63 SLE patients with breast cancer. Fifty-three had information on ER and/or PR status; 36 of these (69%) were ER positive. Thirty-six of the 63 had information on HER2 status; of these, 26 had complete information on all three receptors. Twenty-one of these 26 (81%) were HER2 negative; seven of 26(27%) were triple negative. All but one patient underwent surgery; 11.5% received both non-tamoxifen chemotherapy and radiotherapy, 16.4% radiotherapy without non-tamoxifen chemotherapy, and 14.7% received non-tamoxifen chemotherapy without radiotherapy. Conclusion ER positivity was similar to historical general population figures, with a trend toward a higher proportion of triple-negative breast cancers in SLE (possibly reflecting the relatively young age of our SLE patients).
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Affiliation(s)
- K Chan
- 1 Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - A E Clarke
- 2 Division of Rheumatology, University of Calgary, AB, Canada
| | - R Ramsey-Goldman
- 3 Northwestern University and Feinberg School of Medicine, Chicago, IL, USA
| | - W Foulkes
- 4 Department of Human Genetics, McGill University, Montreal, QC, Canada
| | | | - M B Urowitz
- 6 Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada
| | - D Gladman
- 6 Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada
| | - O Nived
- 7 Department of Rheumatology, University Hospital Lund, Lund, Sweden
| | - J Romero-Diaz
- 8 Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - M Petri
- 9 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Ginzler
- 10 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - P R Fortin
- 11 Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, QC, Canada
| | - S C Bae
- 12 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - D J Wallace
- 13 Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - E H Yelin
- 14 Department of Medicine and Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - S Bernatsky
- 15 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
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Choi MY, Flood K, Bernatsky S, Ramsey-Goldman R, Clarke AE. A review on SLE and malignancy. Best Pract Res Clin Rheumatol 2017; 31:373-396. [PMID: 29224679 PMCID: PMC6742439 DOI: 10.1016/j.berh.2017.09.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 12/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population. There is increasing evidence to suggest that patients with SLE have a slightly higher overall risk of malignancy. The risk of malignancy in SLE is of considerable interest because the immune and genetic pathways underlying the pathogenesis of SLE and the immunosuppressant drugs (ISDs) used in its management may mediate this altered risk. Our current understanding of these and other risk factors and the implications for treating SLE and screening for malignancy is still evolving. This review summarizes the association between SLE and malignancy. The first section discusses the risk of overall and site-specific malignancies in both adult- and pediatric-onset SLE. Next, we evaluate the risk factors and possible mechanisms underlying the link between malignancy and SLE, including the use of ISDs, presence of certain SLE-related autoantibodies, chronic immune dysregulation, environmental factors, and shared genetic susceptibility. Finally, we review guidelines regarding cancer screening and vaccination for human papilloma virus.
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Affiliation(s)
- May Y Choi
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada.
| | - Kelsey Flood
- Northwestern University and Feinberg School of Medicine, 420 E Superior St, Chicago, 60611, Illinois, USA.
| | - Sasha Bernatsky
- Divisions of Rheumatology, McGill University Health Centre, McGill University, A6-1650 Cedar Avenue A6.163, Montreal, H3G 1A4, Quebec, Canada.
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Northwestern University and Feinberg School of Medicine, 633 N. St. Clair, 18th Floor, Chicago, 60611, Illinois, USA.
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada.
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18
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Bernatsky S, Ramsey-Goldman R, Petri M, Urowitz MB, Gladman DD, Fortin PR, Ginzler E, Romero-Diaz J, Peschken C, Jacobsen S, Hanly JG, Gordon C, Nived O, Yelin EH, Isenberg D, Rahman A, Bae SC, Joseph L, Witte T, Ruiz-Irastorza G, Aranow C, Kamen D, Sturfeldt G, Foulkes WD, Hansen JE, St Pierre Y, Raymer PC, Tessier-Cloutier B, Clarke AE. Breast cancer in systemic lupus. Lupus 2017; 26:311-315. [PMID: 27687028 PMCID: PMC5250552 DOI: 10.1177/0961203316664595] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective There is a decreased breast cancer risk in systemic lupus erythematosus (SLE) versus the general population. We assessed a large sample of SLE patients, evaluating demographic and clinical characteristics and breast cancer risk. Methods We performed case-cohort analyses within a multi-center international SLE sample. We calculated the breast cancer hazard ratio (HR) in female SLE patients, relative to demographics, reproductive history, family history of breast cancer, and time-dependent measures of anti-dsDNA positivity, cumulative disease activity, and drugs, adjusted for SLE duration. Results There were 86 SLE breast cancers and 4498 female SLE cancer-free controls. Patients were followed on average for 7.6 years. Versus controls, SLE breast cancer cases tended to be white and older. Breast cancer cases were similar to controls regarding anti-dsDNA positivity, disease activity, and most drug exposures over time. In univariate and multivariate models, the principal factor associated with breast cancers was older age at cohort entry. Conclusions There was little evidence that breast cancer risk in this SLE sample was strongly driven by any of the clinical factors that we studied. Further search for factors that determine the lower risk of breast cancer in SLE may be warranted.
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Affiliation(s)
- S Bernatsky
- 1 Faculty of Medicine, McGill University, Montreal, Canada
- 2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - R Ramsey-Goldman
- 3 Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - M Petri
- 4 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - M B Urowitz
- 5 Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Canada
| | - D D Gladman
- 5 Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Canada
| | - P R Fortin
- 6 Division of Rheumatology, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - E Ginzler
- 7 State University of New York-Downstate Medical Center, New York, USA
| | - J Romero-Diaz
- 8 Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico
| | - C Peschken
- 9 University of Manitoba, Winnipeg, Canada
| | - S Jacobsen
- 10 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J G Hanly
- 11 Division of Rheumatology, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - C Gordon
- 12 Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham: Rheumatology department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust and NIHR/Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham; University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - O Nived
- 13 Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - E H Yelin
- 14 Department of Medicine, University of California, San Francisco, USA
| | - D Isenberg
- 15 Centre for Rheumatology Research, University College London, London, UK
| | - A Rahman
- 15 Centre for Rheumatology Research, University College London, London, UK
| | - S-C Bae
- 16 The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea
| | - L Joseph
- 1 Faculty of Medicine, McGill University, Montreal, Canada
- 2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - T Witte
- 17 Department of Clinical Immunology, Hannover Medical School, Hannover, Germany
| | - G Ruiz-Irastorza
- 18 Autoimmune Diseases Research Unit, Department Of Internal Medicine, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, Spain
| | - C Aranow
- 19 Feinstein Institute for Medical Research, New York, USA
| | - D Kamen
- 20 Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, USA
| | - G Sturfeldt
- 13 Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - W D Foulkes
- 21 Departments of Oncology, Human Genetics and Medicine, McGill University, Montreal, Canada
| | - J E Hansen
- 22 Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Y St Pierre
- 2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - P Chrétien Raymer
- 2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - B Tessier-Cloutier
- 23 Department of Anatomical Pathology, University of British Colombia, Vancouver, Canada
| | - A E Clarke
- 24 Division of Rheumatology, University of Calgary, Calgary, Canada
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Abstract
Autoantibodies reactive against host DNA are detectable in the circulation of most people with systemic lupus erythematosus (SLE). The long-held view that antibodies cannot penetrate live cells has been disproved. A subset of lupus autoantibodies penetrate cells, translocate to nuclei, and inhibit DNA repair or directly damages DNA. The result of these effects depends on the microenvironment and genetic traits of the cell. Some DNA-damaging antibodies alone have little impact on normal cells, but in the presence of other conditions, such as pre-existing DNA-repair defects, can become highly toxic. These findings raise new questions about autoimmunity and DNA damage, and reveal opportunities for new targeted therapies against malignancies particularly vulnerable to DNA damage. In this Perspectives article, we review the known associations between SLE, DNA damage and cancer, and propose a theory for the effects of DNA-damaging autoantibodies on SLE pathophysiology and cancer risk.
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20
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Egiziano G, Clarke AE, Ramsey-Goldman R, Bernatsky S. Malignancy in Systemic Lupus Erythematosus. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buchbinder R, Van Doornum S, Staples M, Lassere M, March L. Malignancy risk in Australian rheumatoid arthritis patients treated with anti-tumour necrosis factor therapy: analysis of the Australian Rheumatology Association Database (ARAD) prospective cohort study. BMC Musculoskelet Disord 2015; 16:309. [PMID: 26481039 PMCID: PMC4615333 DOI: 10.1186/s12891-015-0772-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignancy risk with tumour necrosis factor inhibitor (TNFi) therapy remains unclear. Our primary aim was to assess malignancy risk with TNFi therapy in a cohort of Australian patients with rheumatoid arthritis (RA). We also assessed risk in a biologic-naïve group. METHODS Demographic data of all RA patients enrolled in the Australian Rheumatology Association Database before 25 October 2010 were matched to national cancer records in July 2010 (linkage complete to 2007). Verified self-reported malignancies occurring between 1 January 2008 and 25 October 2010 were also included in the analysis. Standardised incidence ratios (SIRs) were used to compare malignancy incidence in biologic-naïve and TNFi-exposed ARAD participants to the general population using site-, age- and sex-specific rates by calendar year. Rate ratios (RRs) were used to compare malignancy incidence in TNFi-exposed participants to biologic-naïve RA patients, and a composite RA cohort that included pre-TNFi person years, both adjusted for age, gender, smoking, methotrexate use and prior malignancy. RESULTS Forty-four malignancies were reported after 5752 person-years in the TNFi-exposed group (N = 2145) and 32 malignancies were reported after 1682 person-years in the biologic-naïve group (N = 803). No overall increased risk of malignancy in TNFi-treated RA patients was found when compared with the general population or with biologic-naïve RA patients. Compared to the biologic naïve group, without the inclusion of pre-TNFi years in the comparator group, the relative risk of female breast cancer was reduced in TNFi-treated patients (RR 0.17 (95 % CI 0.03 to 0.95)). It was no longer significant when adding pre-TNFi years in the comparator group. The risk of melanoma was increased for both biologic naïve and TNFi-treated patients when compared with the general population (SIR 2.72 (95 % CI 1.13 to 6.53) and SIR 2.03 (95 % CI 1.09 to 3.78) respectively). The relative risk of melanoma was not increased in the TNFi-exposed group compared with biologic naïve patients (RR 0.54, 95 % CI 0.12, 2.40). Inclusion of pre-TNFi person years in the comparator group did not change these results. CONCLUSIONS Malignancy incidence was low in this RA cohort and biologic exposure did not increase the risk of malignancy. Melanoma risk was increased in both TNFi-treated and biologic-naïve RA patients compared with the general population suggesting that RA status, and possibly methotrexate exposure, may be responsible.
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Affiliation(s)
- Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.
| | - Sharon Van Doornum
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia.
| | - Margaret Staples
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.
| | - Marissa Lassere
- St George Hospital, University of New South Wales, Sydney, Australia.
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Institute of Bone and Joint Research, University of Sydney , Sydney, Australia.
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22
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Autoimmune diseases and breast cancer recurrence: a Danish nationwide cohort study. Breast Cancer Res Treat 2015; 149:497-504. [DOI: 10.1007/s10549-014-3258-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/21/2014] [Indexed: 12/11/2022]
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23
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Mandal S, Pile K, Chacko RT, Danda D. Malignancy and autoimmunity: causally or casually related? Int J Rheum Dis 2014; 17:601-5. [DOI: 10.1111/1756-185x.12536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Santoshkumar Mandal
- Department of Clinical Immunology and Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Kevin Pile
- Department of Medicine; University of Western Sydney; Sydney Australia
| | - Raju Titus Chacko
- Department of Medical Oncology; Christian Medical College and Hospital; Vellore India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology; Christian Medical College and Hospital; Vellore India
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24
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Relative risk of myelodysplastic syndromes in patients with autoimmune disorders in the General Practice Research Database. Cancer Epidemiol 2014; 38:544-9. [DOI: 10.1016/j.canep.2014.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 12/17/2022]
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25
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Chung CP, Rohan P, Krishnaswami S, McPheeters ML. A systematic review of validated methods for identifying patients with rheumatoid arthritis using administrative or claims data. Vaccine 2014; 31 Suppl 10:K41-61. [PMID: 24331074 DOI: 10.1016/j.vaccine.2013.03.075] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/15/2013] [Accepted: 03/26/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To review the evidence supporting the validity of billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify patients with rheumatoid arthritis (RA) in administrative and claim databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to RA and reference lists of included studies were searched. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria and extracted the data. Data collected included participant and algorithm characteristics. RESULTS Nine studies reported validation of computer algorithms based on International Classification of Diseases (ICD) codes with or without free-text, medication use, laboratory data and the need for a diagnosis by a rheumatologist. These studies yielded positive predictive values (PPV) ranging from 34 to 97% to identify patients with RA. Higher PPVs were obtained with the use of at least two ICD and/or procedure codes (ICD-9 code 714 and others), the requirement of a prescription of a medication used to treat RA, or requirement of participation of a rheumatologist in patient care. For example, the PPV increased from 66 to 97% when the use of disease-modifying antirheumatic drugs and the presence of a positive rheumatoid factor were required. CONCLUSIONS There have been substantial efforts to propose and validate algorithms to identify patients with RA in automated databases. Algorithms that include more than one code and incorporate medications or laboratory data and/or required a diagnosis by a rheumatologist may increase the PPV.
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Affiliation(s)
- Cecilia P Chung
- Division of Rheumatology, Vanderbilt University School of Medicine, 1161 21st Avenue South, D-3100, Medical Center North, Nashville, TN 37232-2358, USA.
| | - Patricia Rohan
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, WOC1 Building, Room 454S, 1401 Rockville Pike, Rockville, MD 20852-1428, USA
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
| | - Melissa L McPheeters
- Vanderbilt Evidence-based Practice Center and Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
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A systematic review of validated methods for identifying systemic lupus erythematosus (SLE) using administrative or claims data. Vaccine 2014; 31 Suppl 10:K62-73. [PMID: 24331075 DOI: 10.1016/j.vaccine.2013.06.104] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/30/2013] [Accepted: 06/25/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE To examine the validity of billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify patients with systemic lupus erythematosus (SLE) in administrative and claims databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to SLE. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. The two reviewers independently extracted data regarding participant and algorithm characteristics and assessed a study's methodologic rigor using a pre-defined approach. RESULTS Twelve studies included validation statistics for the identification of SLE in administrative and claims databases. Seven of these studies used the ICD-9 code of 710.0 in selected populations of patients seen by a rheumatologist or patients who had experienced the complication of SLE-associated nephritis, other kidney disease, or pregnancy. The other studies looked at limited data in general populations. The algorithm in the selected populations had a positive predictive value (PPV) in the range of 70-90% and of the limited data in general populations it was in the range of 50-60%. CONCLUSIONS Few studies use rigorous methods to validate an algorithm for the identification of SLE in general populations. Algorithms including ICD-9 code of 710.0 in physician billing and hospitalization records have a PPV of approximately 60%. A requirement that the code is obtained from a record based on treatment by a rheumatologist increases the PPV of the algorithm but limits the generalizability in the general population.
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Onishi A, Sugiyama D, Kumagai S, Morinobu A. Cancer incidence in systemic sclerosis: meta-analysis of population-based cohort studies. ACTA ACUST UNITED AC 2013; 65:1913-21. [PMID: 23576072 DOI: 10.1002/art.37969] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 04/04/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine cancer incidence in patients with systemic sclerosis (SSc) through a meta-analysis of population-based cohort studies. METHODS Five different databases (Medline, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and Cochrane Collaboration) were searched for articles published between January 1966 and May 2012; review articles and the reference lists from the articles that resulted from the search were also evaluated. Population-based cohort studies with data relevant to the determination of cancer risk in patients with SSc were included. All articles that met strict inclusion criteria were analyzed for data on population size, time of followup, and observed-to-expected cancer ratios, also known as standardized incidence ratios (SIRs). RESULTS Six articles met criteria and were included in the meta-analysis. The pooled SIR for the incidence of cancer overall was 1.41 (95% confidence interval [95% CI] 1.18-1.68), and significant heterogeneity was observed as a consequence of variability in the participants, outcome, study design, and risk of bias among the studies. Men had a significantly higher pooled SIR (1.85 [95% CI 1.49-2.31]) than women (SIR 1.33 [95% CI 1.18-1.49]) (P < 0.01), and stratification for sex eliminated heterogeneity, which indicates that variability among the studies greatly contributed to differences between the sexes. There were no differences between limited cutaneous SSc and diffuse cutaneous SSc (P = 0.77). Significant increases were observed in the risk of cancer of the lung, liver, hematologic system, and bladder, as well as of non-Hodgkin's lymphoma and leukemia. CONCLUSION SSc is associated with an increased risk of cancer, particularly lung, liver, hematologic, and bladder cancers, although absolute risk is relatively low. Men with SSc have a higher risk of developing cancer than women.
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Affiliation(s)
- Akira Onishi
- Kobe University Graduate School of Medicine, Kobe, Japan.
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Tessier Cloutier B, Clarke AE, Ramsey-Goldman R, Wang Y, Foulkes W, Gordon C, Hansen JE, Yelin E, Urowitz MB, Gladman D, Fortin PR, Wallace DJ, Petri M, Manzi S, Ginzler EM, Labrecque J, Edworthy S, Dooley MA, Senécal JL, Peschken CA, Bae SC, Isenberg D, Rahman A, Ruiz-Irastorza G, Hanly JG, Jacobsen S, Nived O, Witte T, Criswell LA, Barr SG, Dreyer L, Sturfelt G, Bernatsky S. Breast cancer in systemic lupus erythematosus. Oncology 2013; 85:117-21. [PMID: 23887245 DOI: 10.1159/000353138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/14/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Evidence points to a decreased breast cancer risk in systemic lupus erythematosus (SLE). We analyzed data from a large multisite SLE cohort, linked to cancer registries. METHODS Information on age, SLE duration, cancer date, and histology was available. We analyzed information on histological type and performed multivariate logistic regression analyses of histological types according to age, SLE duration, and calendar year. RESULTS We studied 180 breast cancers in the SLE cohort. Of the 155 cases with histology information, 11 were referred to simply as 'carcinoma not otherwise specified'. In the remaining 144 breast cancers, the most common histological type was ductal carcinoma (n = 95; 66%) followed by lobular adenocarcinoma (n = 11; 8%), 15 cancers were of mixed histology, and the remaining ones were special types. In our regression analyses, the independent risk factors for lobular versus ductal carcinoma was age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14] and for the 'special' subtypes it was age (OR 1.06, 95% CI 1.01-1.10) and SLE duration (OR 1.05, 95% CI 1.00-1.11). CONCLUSIONS Generally, up to 80% of breast cancers are ductal carcinomas. Though our results are not definitive, in the breast cancers that occur in SLE, there may be a slight decrease in the ductal histological type. In our analyses, age and SLE duration were independent predictors of histological status.
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Affiliation(s)
- B Tessier Cloutier
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Que., Canada
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Bonifazi M, Tramacere I, Pomponio G, Gabrielli B, Avvedimento EV, La Vecchia C, Negri E, Gabrielli A. Systemic sclerosis (scleroderma) and cancer risk: systematic review and meta-analysis of observational studies. Rheumatology (Oxford) 2012; 52:143-54. [PMID: 23175568 DOI: 10.1093/rheumatology/kes303] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES A higher incidence of cancer in scleroderma patients compared with the general population has been suggested by several observational studies, reporting, however, different estimates. Therefore, we aimed to perform a systematic review and meta-analysis to definitely assess this association. METHODS We searched MEDLINE and Embase for all original articles of observational studies on cancer incidence in scleroderma patients without language restriction published up to December 2011. Two independent authors reviewed all titles/abstracts and retrieved detailed full-text of potentially relevant articles to identify studies according to predefined selection criteria. Summary estimates were derived using random-effects model and reported as relative risk (RR). Publication bias was evaluated by trim and fill analysis. RESULTS From articles initially identified, 16 original studies, involving more than 7000 patients, were included in the present review. Compared with the general population, the summary RR to develop all invasive cancers in scleroderma patients was 1.75 (95% CI 1.41, 2.18). The results for selected cancer sites indicated a strong association with lung cancer (RR 4.35; 95% CI 2.08, 9.09), and a significant increased risk also for haematological neoplasms (RR 2.24; 95% CI 1.53, 3.29). The relation with breast cancer, suggested in some previous epidemiological studies, was not confirmed (RR 1.05; 95% CI 0.86, 1.29). CONCLUSION The present meta-analysis, the first on scleroderma and cancer risk, provides definite estimates on the association between scleroderma and cancer.
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Affiliation(s)
- Martina Bonifazi
- Istituto di Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60100, Ancona, Italy
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Breast reconstruction in the high risk patient with systemic connective tissue disease: a case series. J Plast Reconstr Aesthet Surg 2012; 66:61-6. [PMID: 22874636 DOI: 10.1016/j.bjps.2012.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 06/12/2012] [Accepted: 07/22/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The presence of severe underlying connective tissue disease may restrict the reconstructive options offered to a woman in the event of mastectomy. Putative concerns about reconstructive surgery include the effects of connective tissue disease and immunosuppression on wound healing and donor site morbidity, and increased risks of deranged clotting and thrombophilia after free tissue transfer. There is also the possibility of an unpredictable tissue reaction after oncological resection surgery and adjuvant radiotherapy. METHODOLOGY Here we present a review of the current sparse evidence regarding reconstructive breast surgery in this challenging group of patients. In addition we present a series of six consecutive patients with a spectrum of connective tissue disorders including combinations of longstanding Systemic Lupus Erythematosis (SLE), Rheumatoid arthritis and Raynaud's Disease who underwent successful post-mastectomy reconstruction with an extended autologous latissimus dorsi flap, along with subsequent successful correction of asymmetry and/or nipple reconstruction. RESULTS There is a paucity of literature on this subject perhaps suggesting that surgeons are reluctant to offer reconstruction or that uptake is poor in this group. Complications related to radiotherapy and free tissue transfer in patients with severe CTD is less than may be expected. The most common complications experienced by our patients with CTD after extended ALD breast reconstruction were persistent donor site seroma, wound dehiscence and delayed haematoma formation, reflecting the abnormal inflammatory response and deranged haemostatic cascade common to connective tissue disease. However, all six patients made a full recovery from surgery without residual donor site morbidity and with an acceptable aesthetic breast reconstruction. CONCLUSION Careful peri-operative management is crucial in this group of patients, but good outcomes are possible using a variety of reconstructive techniques. This is the first reported series of patients with severe connective tissue disease who have been managed with extended ALD breast reconstruction. The majority of complications relate to the donor site but the favourable outcomes demonstrate that the extended ALD flap remains a reliable reconstructive option for this group.
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Goedert JJ, Pfeiffer R, Zhu M, Yang XR, Garcia-Closas M, Lissowska J, Kopp WC. Peripheral blood immunologic phenotype of population-based breast cancer cases and matched controls. Eur J Clin Invest 2012; 42:572-4. [PMID: 22073930 PMCID: PMC3288213 DOI: 10.1111/j.1365-2362.2011.02610.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
- Corresponding author: James J. Goedert, M.D., 6120 Executive Boulevard, Room 7068, Rockville MD 20852. FAX: 301-402-0817
| | - Ruth Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | - Mingzhu Zhu
- Clinical Support Lab, SAIC-Frederick, Inc., Frederick, MD
| | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | | | - Jolanta Lissowska
- Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
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Franks AL, Slansky JE. Multiple associations between a broad spectrum of autoimmune diseases, chronic inflammatory diseases and cancer. Anticancer Res 2012; 32:1119-36. [PMID: 22493341 PMCID: PMC3349285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Many recent studies suggest the immune system plays a significant role in the pathogenesis of autoimmune diseases, chronic inflammatory diseases, and cancer. MATERIALS AND METHODS Literature published between 2001 and 2011 was reviewed for risk of cancer development in patients with autoimmune and chronic inflammatory diseases. Mode of risk assessment employed did not limit inclusion of studies. Autoimmune conditions developing after diagnosis of a pre-existing cancer were also considered. RESULTS We report a pervasive, largely positive association between 23 autoimmune and inflammatory diseases and subsequent cancer development. We discuss associations for celiac disease, inflammatory bowel disease rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis in detail. We also address the less frequently reported development of some autoimmune conditions within the course of some malignancies, such as vitiligo developing in the course of melanoma. CONCLUSION Evidence demonstrates that chronic inflammation and autoimmunity are associated with the development of malignancy. Additionally, patients with a primary malignancy may develop autoimmune like disease. These relationships imply a need for surveillance of patients on immunomodulatory therapies for potential secondary disease processes.
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Affiliation(s)
- Alexis L Franks
- Integrated Department of Immunology, University of Colorado School of Medicine, Aurora, CO, USA
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Lucivero G, Romano C, Ferraraccio F, Sellitto A, De Fanis U, Giunta R, Guarino A, Auriemma PP, Benincasa M, Iovino F. Lupus mastitis in systemic lupus erythematosus: a rare condition requiring a minimally invasive diagnostic approach. Int J Immunopathol Pharmacol 2012; 24:1125-9. [PMID: 22230423 DOI: 10.1177/039463201102400435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.
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Böhm I. Breast cancer in lupus. Breast 2011; 20:288-90. [PMID: 21237645 DOI: 10.1016/j.breast.2010.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/23/2010] [Accepted: 12/18/2010] [Indexed: 11/18/2022] Open
Abstract
The purpose was to evaluate the frequency of breast cancer (BC) in patients with either systemic (SLE) or incomplete lupus erythematosus (ILE), and possibly to find out immunological differences in patients with and without cancer. 133 consecutive female patients with lupus were included. The records were retrospectively analysed with respect to both malignant disease and routine laboratory parameters (e.g. autoantibodies, white blood cell counts). BC was the most common malignancy that was detected in 50% of female lupus patients with concomitant oncological disease. Other malignancies were significantly less (p < 0.001) frequent. Only ILE-patients had BC or other oncological diseases. The proportion of ILE-patients with SSA- and SSB-autoantibodies was significantly higher (p < 1.5 × 10(-10) and 9.1 × 10(-17)) in those with malignancies than without. The presented data suggest that BC is the most common malignancy in patients with ILE. SLE is no prerequisite to acquire an oncological disease. Immunological disturbances (e.g. SSA- and SSB-autoantibodies) could play a role in the oncogensis.
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Affiliation(s)
- Ingrid Böhm
- Department of Radiology, Philipps University of Marburg, Baldingerstrasse, Marburg, Germany.
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Du J, Sun C, Hu Z, Yang Y, Zhu Y, Zheng D, Gu L, Lu X. Lysophosphatidic acid induces MDA-MB-231 breast cancer cells migration through activation of PI3K/PAK1/ERK signaling. PLoS One 2010; 5:e15940. [PMID: 21209852 PMCID: PMC3012724 DOI: 10.1371/journal.pone.0015940] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/30/2010] [Indexed: 01/28/2023] Open
Abstract
Background Enhanced motility of cancer cells is a critical step in promoting tumor metastasis. Lysophosphatidic acid (LPA), representing the major mitogenic activity in serum, stimulates migration in various types of cancer cells. However, the underlying signaling mechanisms for LPA-induced motility of cancer cells remain to be elucidated. Methodology/Principal Findings In this study, we found that LPA dose-dependently stimulated migration of MDA-MB-231 breast cancer cells, with 10 µM being the most effective. LPA also increased ERK activity and the MEK inhibitor U0126 could block LPA-induced ERK activity and cell migration. In addition, LPA induced PAK1 activation while ERK activation and cell migration were inhibited by ectopic expression of an inactive mutant form of PAK1 in MDA-MB-231 cells. Furthermore, LPA increased PI3K activity, and the PI3K inhibitor LY294002 inhibited both LPA-induced PAK1/ERK activation and cell migration. Moreover, in the breast cancer cell, LPA treatment resulted in remarkable production of reactive oxygen species (ROS), while LPA-induced ROS generation, PI3K/PAK1/ERK activation and cell migration could be inhibited by N-acetyl-L-Cysteine, a scavenger of ROS. Conclusions/Significance Taken together, this study identifies a PI3K/PAK1/ERK signaling pathway for LPA-stimulated breast cancer cell migration. These data also suggest that ROS generation plays an essential role in the activation of LPA-stimulated PI3K/PAK1/ERK signaling and breast cancer cell migration. These findings may provide a basis for designing future therapeutic strategy for blocking breast cancer metastasis.
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Affiliation(s)
- Jun Du
- Department of Physiology, Nanjing Medical University, Nanjing, China
| | - Chongqi Sun
- Kangda College, Nanjing Medical University, Nanjing, China
| | - Zhenzhen Hu
- Department of Physiology, Nanjing Medical University, Nanjing, China
| | - Yu Yang
- Department of Physiology, Nanjing Medical University, Nanjing, China
| | - Yichao Zhu
- Cancer Center, Nanjing Medical University, Nanjing, China
| | - Datong Zheng
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Luo Gu
- Cancer Center, Nanjing Medical University, Nanjing, China
- * E-mail: (LG); (XL)
| | - Xiang Lu
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (LG); (XL)
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Kermani TA, Schäfer VS, Crowson CS, Hunder GG, Ytterberg SR, Matteson EL, Gabriel SE, Warrington KJ. Cancer preceding giant cell arteritis: a case-control study. ACTA ACUST UNITED AC 2010; 62:1763-9. [PMID: 20191583 DOI: 10.1002/art.27429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To study the association between previous cancer and giant cell arteritis (GCA). METHODS Using the resources of the Rochester Epidemiology Project, we identified incident cases of GCA diagnosed between January 1, 1950 and December 31, 2004. Each GCA patient was matched for age, sex, and length of medical history to 2 subjects without GCA from the same population. Medical records were reviewed. Diagnosis of cancer was confirmed by histopathologic analysis. RESULTS We identified 204 GCA cases and 407 controls. The GCA group included 163 women (80%) and 41 men (20%). Their mean +/- SD age was 76.0 +/- 8.2 years. The non-GCA group consisted of 325 women (80%) and 82 men (20%). Their mean +/- SD age was 75.6 +/- 8.4 years. At the index date, 45 GCA patients (22%) and 125 non-GCA patients (31%) had had a previous cancer. The odds ratio (OR) for previous cancer in cases compared with controls, adjusted for age, sex, and calendar year, was 0.63, and the 95% confidence interval (95% CI) was 0.42-0.94 (P = 0.022). The mean age at diagnosis of the first cancer before the index date was similar in the cases (67.5 +/- 11.9 years) and the controls (64.9 +/- 13.2 years) (P = 0.32). The mean +/- SD duration from the first cancer to the index date was 9.8 +/- 9.9 years in the cases and 11.7 +/- 10.8 years in the controls (P = 0.31). Cancer types were similar in both groups, but fewer gynecologic malignancies were noted in GCA patients (OR 0.39 [95% CI 0.13-1.15], P = 0.09). Colon cancer also appeared less commonly in the cases compared with the controls (OR 0.22 [95% CI 0.03-1.74], P = 0.15). CONCLUSION The findings of this population-based case-control study indicate that GCA patients had significantly fewer malignancies prior to the index date as compared with controls.
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Lin YJ, Lan YC, Wan L, Huang CM, Lin CW, Hsueh KC, Chen DY, Lin TH, Tsai FJ. The NBS1 Genetic Polymorphisms and the Risk of the Systemic Lupus Erythematosus in Taiwanese Patients. J Clin Immunol 2010; 30:643-8. [DOI: 10.1007/s10875-010-9427-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 05/17/2010] [Indexed: 12/19/2022]
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Lysophosphatidic acid production and action: critical new players in breast cancer initiation and progression. Br J Cancer 2010; 102:941-6. [PMID: 20234370 PMCID: PMC2844037 DOI: 10.1038/sj.bjc.6605588] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lysophosphatidic acid (LPA) is a potent lipid mediator that acts on a series of specific G protein-coupled receptors, leading to diverse biological actions. Lysophosphatidic acid induces cell proliferation, survival and migration, which are critically required for tumour formation and metastasis. This bioactive lipid is produced by the ectoenzyme lysophospholipase D or autotaxin (ATX), earlier known as an autocrine motility factor. The ATX-LPA signalling axis has emerged as an important player in many types of cancer. Indeed, aberrant expression of ATX and LPA receptors occurs during the development and progression of breast cancer. Importantly, expression of either ATX or LPA receptors in the mammary gland of transgenic mice is sufficient to induce the development of a high frequency of invasive and metastatic mammary cancers. The focus of research now turns to understanding the mechanisms by which ATX and LPA promote mammary tumourigenesis and metastasis. Targeting the ATX-LPA signalling axis for drug development may further improve outcomes in patients with breast cancer.
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