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Worse survival after breast cancer in women with anorexia nervosa

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group.

Methods

This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women.

Results

We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6–3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4–3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3–3.6) among Swedish and Danish women.

Conclusions

We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.

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Acknowledgements

The authors would like to thank Kirsten Frederiksen for statistical assistance.

Funding

This study was supported by funding from the Danish Research Council for Independent Research (Grant No. 11-108395) and the Danish Cancer Society.

Author information

Authors and Affiliations

  1. Danish Cancer Society Research Center, Copenhagen, Denmark

    Annet Bens & Lene Mellemkjær

  2. Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden

    Fotios C. Papadopoulos

  3. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland

    Eero Pukkala

  4. Faculty of Social Sciences, University of Tampere, Tampere, Finland

    Eero Pukkala

  5. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

    Anders Ekbom

  6. THL National Institute for Health and Welfare, Information Services Department, Helsinki, Finland

    Mika Gissler

  7. Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

    Mika Gissler

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  1. Annet Bens
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Corresponding author

Correspondence to Lene Mellemkjær.

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Conflict of interest

All authors declare that they have no conflict of interest.

Research involving human participants and/or animals

In Sweden, the study was approved by the Regional Ethical Review Board in Uppsala. In Denmark, the study was approved by the Data Protection Board and in Finland, by the National Institute for Health and Welfare. Approvals from Ethical Committees are not needed for registry-based research in Denmark and Finland.

Informed consent

Written consent from study participants was not obtained since in all three countries this is not required for register-based studies that do not involve contact with study participants or biological samples.

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Cite this article

Bens, A., Papadopoulos, F.C., Pukkala, E. et al. Worse survival after breast cancer in women with anorexia nervosa. Breast Cancer Res Treat 168, 495–500 (2018). https://doi.org/10.1007/s10549-017-4618-5

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  • DOI: https://doi.org/10.1007/s10549-017-4618-5

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