Risk of primary haematologic cancers following incident non-metastatic breast cancer: A Danish population-based cohort study

ElsevierVolume 82, February 2023, 102311Cancer EpidemiologyAuthor links open overlay panelHighlights•

Women undergoing contemporary breast cancer treatments are at risk of developing AML and ALL.

AML and ALL after breast cancer may be partly explained by chemotherapy. Shared risk factors may also contribute to this association.

Previous findings of decreased risk of CLL might be influenced by surveillance bias.

AbstractBackground

Breast cancer survivors may have increased risk of subsequent haematologic cancer. We compared their risk of haematologic cancers with the general population during 38 years of follow-up.

Methods

Using population-based Danish medical registries, we assembled a nationwide cohort of women diagnosed with incident non-metastatic breast cancer during 1980–2017, with follow-up through 2018. We compared breast cancer survivors with the general population by computing standardised incidence ratios (SIR) and 95% confidence intervals (CI).

Results

Among 101,117 breast cancer survivors, we observed 815 incident haematologic cancers (median follow-up: 7.9 years). We observed excess risk of acute myeloid leukaemia (AML) (SIR: 1.65, 95%CI: 1.33–2.01), particularly in women who received chemotherapy (SIR: 3.33, 95%CI: 2.24–4.75) and premenopausal women (SIR: 3.23, 95%CI: 2.41–4.25). The risk of acute lymphoid leukaemia (ALL) was increased (SIR: 2.25, 95%CI: 1.29–3.66), whereas the risk of chronic lymphoid leukaemia (CLL) was decreased (SIR: 0.66, 95%CI: 0.53–0.82). An additional analysis showed elevated risk of CLL 0–6 months after breast cancer diagnosis (SIR: 3.00 95%CI: 1.75–4.80).

Conclusion

Compared to the general population, breast cancer survivors had elevated risk of AML, particularly when treated with chemotherapy. The risk of ALL was elevated, whereas the risk of CLL was lower. The higher risk of CLL in the first six months after diagnosis likely reflects surveillance bias—due to intensified diagnostic efforts at breast cancer diagnosis and treatment—prompting earlier detection. This has likely reduced the long-term risk of CLL in breast cancer survivors.

Keywords

Breast neoplasm. Neoplasms. Second Primary. Haematologic diseases. Chemically-induced disorders

© 2022 The Author(s). Published by Elsevier Ltd.

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