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Epidemiology
Risk of primary gastrointestinal cancers following incident non-metastatic breast cancer: a Danish population-based cohort study
  1. Kasper Adelborg1,
  2. Dóra Körmendiné Farkas1,
  3. Jens Sundbøll1,
  4. Lidia Schapira2,
  5. Suzanne Tamang3,
  6. Mark R Cullen3,
  7. Deirdre Cronin-Fenton1,
  8. Henrik Toft Sørensen1
  1. 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Stanford Cancer Institute and Department of Medicine, Stanford University, Stanford, California, USA
  3. 3Stanford Center for Population Health Sciences and Department of Medicine, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Kasper Adelborg; kade{at}clin.au.dk

Abstract

Objective We examined the risk of primary gastrointestinal cancers in women with breast cancer and compared this risk with that of the general population.

Design Using population-based Danish registries, we conducted a cohort study of women with incident non-metastatic breast cancer (1990–2017). We computed cumulative cancer incidences and standardised incidence ratios (SIRs).

Results Among 84 972 patients with breast cancer, we observed 2340 gastrointestinal cancers. After 20 years of follow-up, the cumulative incidence of gastrointestinal cancers was 4%, driven mainly by colon cancers. Only risk of stomach cancer was continually increased beyond 1 year following breast cancer. The SIR for colon cancer was neutral during 2–5 years of follow-up and approximately 1.2-fold increased thereafter. For cancer of the oesophagus, the SIR was increased only during 6–10 years. There was a weak association with pancreas cancer beyond 10 years. Between 1990–2006 and 2007–2017, the 1–10 years SIR estimate decreased and reached unity for upper gastrointestinal cancers (oesophagus, stomach, and small intestine). For lower gastrointestinal cancers (colon, rectum, and anal canal), the SIR estimate was increased only after 2007. No temporal effects were observed for the remaining gastrointestinal cancers. Treatment effects were negligible.

Conclusion Breast cancer survivors were at increased risk of oesophagus and stomach cancer, but only before 2007. The risk of colon cancer was increased, but only after 2007.

  • cancer epidemiology
  • gastrointestinal neoplasia
  • screening
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2020-000413

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    Footnotes

    • Contributors HTS conceived the study idea. KA, JS, DCF, and HTS designed the study. KA and JS reviewed the literature, organised the writing, wrote initial drafts and directed the analyses which were carried out by DKF. All authors participated in the discussion and interpretation of the results. All authors critically revised the manuscript for intellectual content and approved the final version.

    • Funding This work was supported by Program for Clinical Research Infrastructure established by the Lundbeck Foundation and the Novo Nordisk Foundation and administered by the Danish Regions.

    • Disclaimer The funding source had no role in the design, conduct, analysis, or reporting of the study.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Danish Data Protection Agency, record number (2016-051-000001).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Danish law does not allow researchers to share raw data or datasets which include individual-level data points from the registries with third parties.