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Survival in elderly patients with breast cancer with and without autoimmune disease
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Survival in elderly patients with breast cancer with and without autoimmune disease
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Survival in elderly patients with breast cancer with and without autoimmune disease
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Journal Article
Survival in elderly patients with breast cancer with and without autoimmune disease
2023
Overview
Background Patients with certain autoimmune conditions are at a reduced risk of developing breast cancer compared to the general population. Despite this, little is known about outcomes in patients with breast cancer who have a concurrent autoimmune diagnosis. Methods This study compared differences in outcomes between women with breast cancer who had or did not have an autoimmune diagnosis. The SEER‐Medicare databases (2007–2014) were used to identify patients with breast cancer and diagnosis codes were used to identify those with an autoimmune disorder. Results The studied autoimmune diseases had a prevalence of 27% among the 137,324 patients with breast cancer. Autoimmune disease was associated with significantly longer overall survival (OS) and significantly lower cancer‐specific mortality (CSM) among stage IV breast cancer patients (p < 0.0001). After controlling for the effects of age, race, chronic kideny disease, chemotherapy, and radiation therapy autoimmune disease was still predictive of improved OS (HR: 1.45, 95% CI: 1.35–1.55, p < 0.0001) and CSM (HR: 1.40, 95% CI: 1.29–1.5, p < 0.0001). By contrast, in patients with stage I–III breast cancer, the presence of an autoimmune diagnosis was associated with a lower OS (p < 0.0001, p < 0.0001, and p = 0.026, respectively), compared to patients without autoimmune disease. Conclusions We found a higher prevalence of rheumatoid arthritis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus in patients with breast cancer compared to age matched cohorts in the general population. The presence of an autoimmune diagnosis was associated with a lower OS in stages I–III breast cancer and improved OS and CSM in patients with stage IV disease. These results suggest that anti‐tumor immunity plays an important role in late stage breast cancer and could potentially be exploited to improve the effectiveness of immunotherapy. This study investigated the impact of autoimmune disease on survival in women with breast cancer using a national database of cancer patients. Our analysis showed that women with breast cancer have higher rates of certain autoimmune conditions than previously reported including rheumatoid arthritis and inflammatory bowel disease. Patients with early stage breast cancer and autoimmune disease were found to have slightly worse survival, although this did not seem to be due to their breast cancer but instead may have been due to older age and a higher rate of kidney disease in those with an autoimmune diagnosis. However, we also found that in women with advanced breast cancer, having an autoimmune diagnosis, correlated with longer survival. This study raises the possibility that the immune system plays an important role in late stage breast cancer. More research is needed to clarify why autoimmune disease was linked to improved outcomes.
Publisher
John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
Subject
/ Aged
/ Autoimmune Diseases - complications
/ Autoimmune Diseases - epidemiology
/ Breast Neoplasms - diagnosis
/ Breast Neoplasms - epidemiology
/ Codes
/ Female
/ Health maintenance organizations
/ HMOs
/ Humans
/ Lupus
/ Medicare
/ Medicare; statistics & numerical data
/ Patients
/ SEER program; statistics & numerical data
/ Software
/ Survival
