Dahlman Disa, Magnusson Hedvig, Li Xinjun, Sundquist Jan, Sundquist Kristina
Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.
Department of Family Medicine and Community Health, Icahn School of Medicine At Mount Sinai, New York, USA.
Breast Cancer Res Treat. 2021 Feb;186(1):199-207. doi: 10.1007/s10549-020-05998-4. Epub 2020 Nov 6.
Breast cancer is one of the most common cancer forms in women and it is often detected by screening. However, women with drug use disorders (DUD) are less likely to be reached by screening programs. In this study, we aimed to investigate breast cancer incidence, mortality and stage at time of diagnosis among women with DUD compared to the general female population in Sweden.
We performed a follow-up study based on Swedish national register data for the period January 1997-December 2015. The study was based on 3,838,248 women aged 15-75 years, of whom 50,858 were registered with DUD. Adjusted hazard ratios (HRs) for incident and fatal breast cancer, and cancer stage at time of diagnosis, were calculated for women with and without DUD using Cox regression analysis.
DUD was associated with incident breast cancer (HR 1.08, 95% confidence interval [CI] 1.02-1.14, p = 0.0069), fatal breast cancer (HR 1.60, 95% CI 1.42-1.82, p < 0.001), and stage IV breast cancer, i.e. metastasis at diagnosis (HR 2.06, 95% CI 1.44-2.95, p < 0.001).
Women with DUD were identified as a risk group for incident, fatal and metastasized breast cancer, which calls for attention from clinicians and policy makers. Cancer screening attendance and other healthcare seeking barriers are likely to affect the risk increase among women who use drugs; however, more research is needed on the underlying mechanisms.
乳腺癌是女性中最常见的癌症形式之一，通常通过筛查发现。然而，患有药物使用障碍（DUD）的女性被筛查项目覆盖的可能性较小。在本研究中，我们旨在调查与瑞典普通女性人群相比，患有DUD的女性乳腺癌的发病率、死亡率及诊断时的分期。
我们基于1997年1月至2015年12月期间瑞典国家登记数据进行了一项随访研究。该研究基于3838248名年龄在15 - 75岁的女性，其中50858名登记患有DUD。使用Cox回归分析计算了患有和未患有DUD的女性发生乳腺癌和致命性乳腺癌的校正风险比（HRs）以及诊断时的癌症分期。
DUD与发生乳腺癌（HR 1.08，95%置信区间[CI] 1.02 - 1.14，p = 0.0069）、致命性乳腺癌（HR 1.60，95% CI 1.42 - 1.82，p < 0.001）以及IV期乳腺癌（即诊断时发生转移，HR 2.06，95% CI 1.44 - 2.95，p < 0.001）相关。
患有DUD的女性被确定为发生乳腺癌、致命性乳腺癌及转移性乳腺癌的风险群体，这需要临床医生和政策制定者予以关注。癌症筛查参与率及其他寻求医疗保健的障碍可能会影响吸毒女性的风险增加；然而，需要对潜在机制进行更多研究。
