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July 06, 2021; 97 (1) Research Article

Breast Cancer Survival in Multiple Sclerosis

A Matched Cohort Study

Ruth Ann Marrie, Colleen Maxwell, Alyson Mahar, Okechukwu Ekuma, Chad McClintock, Dallas Seitz, Patti Groome
First published May 19, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012127
Ruth Ann Marrie
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Colleen Maxwell
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Alyson Mahar
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Okechukwu Ekuma
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Chad McClintock
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Dallas Seitz
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Patti Groome
From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen’s University, Kingston, Canada.
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Breast Cancer Survival in Multiple Sclerosis
A Matched Cohort Study
Ruth Ann Marrie, Colleen Maxwell, Alyson Mahar, Okechukwu Ekuma, Chad McClintock, Dallas Seitz, Patti Groome
Neurology Jul 2021, 97 (1) e13-e22; DOI: 10.1212/WNL.0000000000012127

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Abstract

Objective To test the hypotheses that overall survival and cancer-specific survival after breast cancer diagnosis would be lower in persons with multiple sclerosis (MS) as compared to persons without MS using a retrospective matched cohort design.

Methods We applied a validated case definition to population-based administrative data in Manitoba and Ontario, Canada, to identify women with MS. We linked the MS cohorts to cancer registries to identify women with breast cancer. Then we selected 4 breast cancer controls without MS matched on birth year, cancer diagnosis year, and region. We compared all-cause survival between cohorts using Cox proportional hazards regression adjusting for age at cancer diagnosis, cancer diagnosis period, income quintile, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a multivariable cause-specific hazards model. We pooled findings between provinces using meta-analysis.

Results We included 779 patients with MS and 3,116 controls with breast cancer. Most patients with stage data (1,976/2,822 [70.0%]) were diagnosed with stage I or II breast cancer and the mean (SD) age at diagnosis was 57.8 (10.7) years. After adjustment for covariates, MS was associated with a 28% increased hazard for all-cause mortality (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.08–1.53), but was not associated with altered cancer-specific survival (HR 0.98; 95% CI 0.65–1.46).

Conclusion Women with MS have lower all-cause survival after breast cancer diagnosis than women without MS. Future studies should confirm these findings in other populations and identify MS-specific factors associated with worse prognosis.

Glossary

CI=
confidence interval;
DAD=
Discharge Abstract Database;
HR=
hazard ratio;
ICD=
International Classification of Diseases;
ICD-10-CA=
International Classification of Diseases–10-Canada;
ICD-O-3=
International Classification of Diseases for Oncology;
MCHP=
Manitoba Centre for Health Policy;
MS=
multiple sclerosis;
ODB=
Ontario Drug Benefit Program;
OHIP=
Ontario Health Insurance Plan;
SES=
socioeconomic status

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received November 5, 2020.
  • Accepted in final form March 19, 2021.
  • © 2021 American Academy of Neurology
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