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Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women

BACKGROUND: Glucocorticoids could theoretically decrease breast cancer risk through their anti-inflammatory effects or increase risk through immunosuppression. However, epidemiological evidence is limited regarding the associations between glucocorticoid use and breast cancer risk. METHODS: We inves...

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Autores principales: Cairat, Manon, Al Rahmoun, Marie, Gunter, Marc J., Heudel, Pierre-Etienne, Severi, Gianluca, Dossus, Laure, Fournier, Agnès
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330083/
https://www.ncbi.nlm.nih.gov/pubmed/34340701
http://dx.doi.org/10.1186/s12916-021-02004-6
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author Cairat, Manon
Al Rahmoun, Marie
Gunter, Marc J.
Heudel, Pierre-Etienne
Severi, Gianluca
Dossus, Laure
Fournier, Agnès
author_facet Cairat, Manon
Al Rahmoun, Marie
Gunter, Marc J.
Heudel, Pierre-Etienne
Severi, Gianluca
Dossus, Laure
Fournier, Agnès
author_sort Cairat, Manon
collection PubMed
description BACKGROUND: Glucocorticoids could theoretically decrease breast cancer risk through their anti-inflammatory effects or increase risk through immunosuppression. However, epidemiological evidence is limited regarding the associations between glucocorticoid use and breast cancer risk. METHODS: We investigated the association between systemic glucocorticoid use and breast cancer incidence in the E3N cohort, which includes 98,995 women with information on various characteristics collected from repeated questionnaires complemented with drug reimbursement data available from 2004. Women with at least two reimbursements of systemic glucocorticoids in any previous 3-month period since January 1, 2004, were defined as exposed. We considered exposure as a time-varying parameter, and we used multivariable Cox regression models to estimate hazard ratios (HRs) of breast cancer. We performed a competing risk analysis using a cause-specific hazard approach to study the heterogeneity by tumour subtype/stage/grade. RESULTS: Among 62,512 postmenopausal women (median age at inclusion of 63 years old), 2864 developed breast cancer during a median follow-up of 9 years (between years 2004 and 2014). Compared with non-exposure, glucocorticoid exposure was not associated with overall breast cancer risk [HR = 0.94 (0.85–1.05)]; however, it was associated with a higher risk of in situ breast cancer and a lower risk of invasive breast cancer [HR(insitu) = 1.34 (1.01–1.78); HR(invasive) = 0.86 (0.76–0.97); P(homogeneity) = 0.01]. Regarding the risk of invasive breast cancer, glucocorticoid exposure was inversely associated with oestrogen receptor (ER)-positive breast cancer [HR(ER+) = 0.82 (0.72–0.94); HR(ER−) = 1.21 (0.88–1.66); P(homogeneity) = 0.03]; it was also inversely associated with the risk of stage 1 or stage 2 tumours but positively associated with the risk of stage 3/4 breast cancers [HR(stage1) = 0.87 (0.75–1.01); HR(stage2) = 0.67 (0.52–0.86); HR(stage3/4) = 1.49 (1.02–2.20); P(homogeneity) = 0.01]. CONCLUSION: This study suggests that the association between systemic glucocorticoid use and breast cancer risk may differ by tumour subtype and stage. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-021-02004-6.
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spelling pubmed-83300832021-08-04 Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women Cairat, Manon Al Rahmoun, Marie Gunter, Marc J. Heudel, Pierre-Etienne Severi, Gianluca Dossus, Laure Fournier, Agnès BMC Med Research Article BACKGROUND: Glucocorticoids could theoretically decrease breast cancer risk through their anti-inflammatory effects or increase risk through immunosuppression. However, epidemiological evidence is limited regarding the associations between glucocorticoid use and breast cancer risk. METHODS: We investigated the association between systemic glucocorticoid use and breast cancer incidence in the E3N cohort, which includes 98,995 women with information on various characteristics collected from repeated questionnaires complemented with drug reimbursement data available from 2004. Women with at least two reimbursements of systemic glucocorticoids in any previous 3-month period since January 1, 2004, were defined as exposed. We considered exposure as a time-varying parameter, and we used multivariable Cox regression models to estimate hazard ratios (HRs) of breast cancer. We performed a competing risk analysis using a cause-specific hazard approach to study the heterogeneity by tumour subtype/stage/grade. RESULTS: Among 62,512 postmenopausal women (median age at inclusion of 63 years old), 2864 developed breast cancer during a median follow-up of 9 years (between years 2004 and 2014). Compared with non-exposure, glucocorticoid exposure was not associated with overall breast cancer risk [HR = 0.94 (0.85–1.05)]; however, it was associated with a higher risk of in situ breast cancer and a lower risk of invasive breast cancer [HR(insitu) = 1.34 (1.01–1.78); HR(invasive) = 0.86 (0.76–0.97); P(homogeneity) = 0.01]. Regarding the risk of invasive breast cancer, glucocorticoid exposure was inversely associated with oestrogen receptor (ER)-positive breast cancer [HR(ER+) = 0.82 (0.72–0.94); HR(ER−) = 1.21 (0.88–1.66); P(homogeneity) = 0.03]; it was also inversely associated with the risk of stage 1 or stage 2 tumours but positively associated with the risk of stage 3/4 breast cancers [HR(stage1) = 0.87 (0.75–1.01); HR(stage2) = 0.67 (0.52–0.86); HR(stage3/4) = 1.49 (1.02–2.20); P(homogeneity) = 0.01]. CONCLUSION: This study suggests that the association between systemic glucocorticoid use and breast cancer risk may differ by tumour subtype and stage. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-021-02004-6. BioMed Central 2021-08-02 /pmc/articles/PMC8330083/ /pubmed/34340701 http://dx.doi.org/10.1186/s12916-021-02004-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/3.0/igo/This article is licensed under the terms of the Creative Commons Attribution 3.0 IGO License (https://creativecommons.org/licenses/by/3.0/igo/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the World Health Organization, provide a link to the Creative Commons licence and indicate if changes were made.
spellingShingle Research Article
Cairat, Manon
Al Rahmoun, Marie
Gunter, Marc J.
Heudel, Pierre-Etienne
Severi, Gianluca
Dossus, Laure
Fournier, Agnès
Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title_full Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title_fullStr Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title_full_unstemmed Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title_short Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
title_sort use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330083/
https://www.ncbi.nlm.nih.gov/pubmed/34340701
http://dx.doi.org/10.1186/s12916-021-02004-6
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