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Breast Cancer Research and Treatment

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01-04-2018 | Epidemiology

Worse survival after breast cancer in women with anorexia nervosa

Authors: Annet Bens, Fotios C. Papadopoulos, Eero Pukkala, Anders Ekbom, Mika Gissler, Lene Mellemkjær

Published in: Breast Cancer Research and Treatment | Issue 2/2018

Abstract

Purpose

A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group.

Methods

This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women.

Results

We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6–3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4–3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3–3.6) among Swedish and Danish women.

Conclusions

We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.

Cao S-S, Lu C-T (2016) Recent perspectives of breast cancer prognosis and predictive factors. Oncol Lett 12(5):3674–3678. https://doi.org/10.3892/ol.2016.5149 CrossRefPubMedPubMedCentral

Biganzoli L (2009) Prognostic and predictive factors. In: Castiglione M, Piccart MJ (eds) Adjuvant therapy for breast cancer. Springer, Boston, pp 13–30. https://doi.org/10.1007/978-0-387-75115-3_2 CrossRef

Brenner DR, Brockton NT, Kotsopoulos J, Cotterchio M, Boucher BA, Courneya KS, Knight JA, Olivotto IA, Quan ML, Friedenreich CM (2016) Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control 27(4):459–472. https://doi.org/10.1007/s10552-016-0726-5 CrossRefPubMedPubMedCentral

Kushi LH, Kwan ML, Lee MM, Ambrosone CB (2007) Lifestyle factors and survival in women with breast cancer. J Nutr 137(1 Suppl):236s–242sCrossRefPubMed

Chan DS, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, Navarro Rosenblatt D, Thune I, Vieira R, Norat T (2014) Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25(10):1901–1914. https://doi.org/10.1093/annonc/mdu042 CrossRefPubMedPubMedCentral

Harrington BC, Jimerson M, Haxton C, Jimerson DC (2015) Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician 91(1):46–52PubMed

Mellemkjaer L, Papadopoulos FC, Pukkala E, Ekbom A, Gissler M, Christensen J, Olsen JH (2015) Cancer incidence among patients with anorexia nervosa from Sweden, Denmark and Finland. PLoS ONE 10(5):e0128018. https://doi.org/10.1371/journal.pone.0128018 CrossRefPubMedPubMedCentral

O’Brien KM, Whelan DR, Sandler DP, Weinberg CR (2017) Eating disorders and breast cancer. Cancer Epidemiol Biomarkers Prev 26(2):206–211. https://doi.org/10.1158/1055-9965.epi-16-0587 CrossRefPubMed

Moller S, Jensen MB, Ejlertsen B, Bjerre KD, Larsen M, Hansen HB, Christiansen P, Mouridsen HT (2008) The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise. Acta Oncol 47(4):506–524. https://doi.org/10.1080/02841860802059259 CrossRefPubMed

10.

Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry 68(7):724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74 CrossRefPubMed

11.

Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schäfer P, Kurtz J, Sappino A-P, Vlastos G (2003) Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 21(19):3580–3587. https://doi.org/10.1200/jco.2003.02.046 CrossRefPubMed

12.

Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41(5):779–785. https://doi.org/10.1016/j.ejca.2004.12.025 CrossRefPubMed

13.

Aggarwal A, Pandurangi A, Smith W (2013) Disparities in breast and cervical cancer screening in women with mental illness: a systematic literature review. Am J Prev Med 44(4):392–398. https://doi.org/10.1016/j.amepre.2012.12.006 CrossRefPubMed

14.

Mitchell AJ, Pereira IE, Yadegarfar M, Pepereke S, Mugadza V, Stubbs B (2014) Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. Br J Psychiatry 205(6):428–435. https://doi.org/10.1192/bjp.bp.114.147629 CrossRefPubMed

15.

Ludman EJ, Ichikawa LE, Simon GE, Rohde P, Arterburn D, Operskalski BH, Linde JA, Jeffery RW (2010) Breast and cervical cancer screening: specific effects of depression and obesity. Am J Prev Med 38(3):303–310. https://doi.org/10.1016/j.amepre.2009.10.039 CrossRefPubMedPubMedCentral

16.

Buhren K, Schwarte R, Fluck F, Timmesfeld N, Krei M, Egberts K, Pfeiffer E, Fleischhaker C, Wewetzer C, Herpertz-Dahlmann B (2014) Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa. Eur Eat Disord Rev 22(1):39–44. https://doi.org/10.1002/erv.2254 CrossRefPubMed

17.

Calugi S, El Ghoch M, Conti M, Dalle Grave R (2014) Depression and treatment outcome in anorexia nervosa. Psychiatry Res 218(1–2):195–200. https://doi.org/10.1016/j.psychres.2014.04.024 CrossRefPubMed

18.

Fichter MM, Quadflieg N, Crosby RD, Koch S (2017) Long-term outcome of anorexia nervosa: results from a large clinical longitudinal study. Int J Eat Disord. https://doi.org/10.1002/eat.22736 PubMed

19.

Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, Franko DL (2017) Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry 78(2):184–189. https://doi.org/10.4088/JCP.15m10393 CrossRefPubMed

20.

Lowe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W (2001) Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med 31(5):881–890CrossRefPubMed

21.

Schorr M, Miller KK (2017) The endocrine manifestations of anorexia nervosa: mechanisms and management. Nat Rev Endocrinol 13(3):174–186. https://doi.org/10.1038/nrendo.2016.175 CrossRefPubMed

22.

Usdan LS, Khaodhiar L, Apovian CM (2008) The endocrinopathies of anorexia nervosa. Endocr Pract 14(8):1055–1063. https://doi.org/10.4158/EP.14.8.1055 CrossRefPubMedPubMedCentral

23.

Putti TC, El-Rehim DM, Rakha EA, Paish CE, Lee AH, Pinder SE, Ellis IO (2005) Estrogen receptor-negative breast carcinomas: a review of morphology and immunophenotypical analysis. Mod Pathol 18(1):26–35. https://doi.org/10.1038/modpathol.3800255 CrossRefPubMed

24.

Andreopoulou E, Schweber SJ, Sparano JA, McDaid HM (2015) Therapies for triple negative breast cancer. Expert Opin Pharmacother 16(7):983–998. https://doi.org/10.1517/14656566.2015.1032246 CrossRefPubMed

25.

Karamanis G, Skalkidou A, Tsakonas G, Brandt L, Ekbom A, Ekselius L, Papadopoulos FC (2014) Cancer incidence and mortality patterns in women with anorexia nervosa. Int J Cancer 134(7):1751–1757. https://doi.org/10.1002/ijc.28495 CrossRefPubMed

26.

Wyshak G, Frisch RE (2000) Breast cancer among former college athletes compared to non-athletes: a 15-year follow-up. Br J Cancer 82(3):726–730. https://doi.org/10.1054/bjoc.1999.0987 CrossRefPubMedPubMedCentral

27.

Schoemaker MJ, Swerdlow AJ, Higgins CD, Wright AF, Jacobs PA (2008) Cancer incidence in women with Turner syndrome in Great Britain: a national cohort study. Lancet Oncol 9(3):239–246. https://doi.org/10.1016/s1470-2045(08)70033-0 CrossRefPubMed

28.

Ji J, Zoller B, Sundquist J, Sundquist K (2016) Risk of solid tumors and hematological malignancy in persons with Turner and Klinefelter syndromes: a national cohort study. Int J Cancer 139(4):754–758. https://doi.org/10.1002/ijc.30126 CrossRefPubMed

29.

Kwan ML, Chen WY, Kroenke CH, Weltzien EK, Beasley JM, Nechuta SJ, Poole EM, Lu W, Holmes MD, Quesenberry CP, Pierce JP, Shu XO, Caan BJ (2012) Pre-diagnosis body mass index and survival after breast cancer in the after breast cancer pooling project. Breast Cancer Res Treat 132(2):729–739. https://doi.org/10.1007/s10549-011-1914-3 CrossRefPubMed

30.

Moon HG, Han W, Noh DY (2009) Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol 27(35):5899–5905. https://doi.org/10.1200/jco.2009.22.4436 CrossRefPubMed

31.

Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MA, Singer P (2015) Diagnostic criteria for malnutrition—an ESPEN consensus statement. Clin Nutr 34(3):335–340. https://doi.org/10.1016/j.clnu.2015.03.001 CrossRefPubMed

32.

Wintergerst ES, Maggini S, Hornig DH (2007) Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 51(4):301–323. https://doi.org/10.1159/000107673 CrossRefPubMed

33.

Achamrah N, Coëffier M, Déchelotte P (2016) Physical activity in patients with anorexia nervosa. Nutr Rev 74(5):301–311. https://doi.org/10.1093/nutrit/nuw001 CrossRefPubMed

34.

Schmid D, Leitzmann MF (2014) Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol 25(7):1293–1311. https://doi.org/10.1093/annonc/mdu012 CrossRefPubMed

Title: Worse survival after breast cancer in women with anorexia nervosa
Authors: Annet Bens
Fotios C. Papadopoulos
Eero Pukkala
Anders Ekbom
Mika Gissler
Lene Mellemkjær
Publication date: 01-04-2018
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4618-5

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