Bisphosphonate Use and Breast Cancer Risk among Women with Ductal Carcinoma In Situ.
Bisphosphonate Use and Breast Cancer Risk among Women with Ductal Carcinoma In Situ.
复制标题
DOI：
10.1158/0008-5472.can-20-4100
复制
发表时间：
2021-05-15
期刊：
影响因子：
11.2
通讯作者：
Malone KE
中科院分区：
文献类型：
--
作者：
Li CI;Flanagan MR;Tang MC;Porter PL;Malone KE
有导管原位癌（DCIS）病史的女性患浸润性乳腺癌的风险较高，但很少有已知的潜在可改变因素可以降低这种风险。双膦酸盐是骨质疏松症患者的常用治疗方法，已被证明可降低浸润性乳腺癌患者的复发风险和死亡率;然而，之前尚未在DCIS背景下研究过双膦酸盐的使用。利用基于人群的巢式病例对照设计，我们比较了301例诊断为DCIS和随后的乳腺癌的妇女和587例单独匹配的对照（年龄，DCIS诊断年，主要治疗，组织学，分级和无病生存时间），这些妇女被诊断为DCIS但从未发生随后的乳腺癌。通过患者访谈和病历审查，确定了双膦酸盐使用的近期和持续时间。与从未使用过的患者相比，目前使用双膦酸盐的患者发生浸润性乳腺癌的风险降低（OR=0.50，95% CI：0.26-0.99）。使用双膦酸盐≥48个月的患者风险降低相似（OR=0.45，95% CI：0.24-1.06）。这是第一项研究证明，在有DCIS病史的女性中，使用双膦酸盐与随后发生浸润性乳腺癌的风险降低相关。这一发现与在其他乳腺癌环境中观察到的双膦酸盐的保护作用一致。如果得到其他人的验证，双膦酸盐可能是一种有效的降低风险的方法，其对骨骼健康和骨折风险的积极影响具有潜在的额外益处。
Women with a history of ductal carcinoma in situ (DCIS) have an elevated risk of a subsequent invasive breast cancer, but there are few established potentially modifiable factors known to lower this risk. Bisphosphonates are a commonly used treatment for patients with osteoporosis and have been shown to lower risks of recurrence and mortality in patients with invasive breast cancer; however, their use has not previously been investigated within the context of DCIS. Utilizing a population-based nested case-control design, we compared 301 cases of women diagnosed with DCIS and a subsequent breast cancer and 587 individually matched controls (on age, DCIS diagnosis year, primary treatment, histology, grade, and disease-free survival time) who were diagnosed with DCIS but never a subsequent breast cancer. Information on recency and duration of bisphosphonate use was ascertained from patient interviews and medical record reviews. Current users of bisphosphonates had a reduced risk of developing an invasive breast cancer compared to never users (OR=0.50, 95% CI: 0.26–0.99). Users of bisphosphonates for ≥48 months had a similar reduction in risk (OR=0.45, 95% CI: 0.24–1.06). This is the first study to document that bisphosphonate use is associated with a lower risk of subsequent invasive breast cancer among women with a history of DCIS. This finding is consistent with the protective effect of bisphosphonates observed in other breast cancer settings. If validated by others, bisphosphonates may be an effective risk-reducing approach with the potential added benefits of its positive impacts on bone health and fracture risk.