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Risk of breast cancer among patients with bioprosthetic or mechanical valve replacement: a population-based study in Sweden.

Ji, Jianguang LU ; Zöller, Bengt LU ; Giaccia, Amato; Haile, Robert; Sundquist, Jan LU and Sundquist, Kristina LU (2015) In Breast Cancer Research and Treatment 154(2). p.369-375
Abstract
The association between breast cancer and warfarin is inconclusive as most previous studies examined their association using patients with thromboembolism, whereas thromboembolism itself is a risk factor for cancer. We explored this issue using patients received mechanical heart valves replacement as a proxy for warfarin exposure as these patients need a lifelong warfarin treatment, and compared them with patients received bioprosthesis valves replacement (short-term warfarin treatment) in Sweden between 1987 and 2010. Patients who were operated on for valve replacement were identified from the Swedish Hospital Discharge Registry and linked to the Swedish Cancer Registry to examine the hazard ratios of subsequent breast cancer. A total of... (More)
The association between breast cancer and warfarin is inconclusive as most previous studies examined their association using patients with thromboembolism, whereas thromboembolism itself is a risk factor for cancer. We explored this issue using patients received mechanical heart valves replacement as a proxy for warfarin exposure as these patients need a lifelong warfarin treatment, and compared them with patients received bioprosthesis valves replacement (short-term warfarin treatment) in Sweden between 1987 and 2010. Patients who were operated on for valve replacement were identified from the Swedish Hospital Discharge Registry and linked to the Swedish Cancer Registry to examine the hazard ratios of subsequent breast cancer. A total of 12,242 women were operated on for valve replacement (5481 with mechanical valve and 6401 with bioprosthetic valve). For the entire cohort, the HR of breast cancer was 1.49 (95 % CI 1.09-2.02) among patients with mechanical valve replacement compared to those with bioprosthetic valve replacement. After controlling for a number of confounding factors using propensity score weighting, the HR was 1.69 (95 % CI 1.15-2.47). Our study found that patients with mechanical valve replacement have an increased risk of breast cancer compared to those with bioprosthetic valve replacement. If confirmed, this increased risk should be considered when recommending breast cancer screening for women with mechanical valve replacement. Long-term use of warfarin may explain the observed increase. If so, patients who have used warfarin long-term for other reasons should be studied for a possible increased risk of breast cancer. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Breast Cancer Research and Treatment
volume
154
issue
2
pages
369 - 375
publisher
Springer
external identifiers
  • pmid:26476725
  • wos:000365188600015
  • scopus:84947489596
ISSN
1573-7217
DOI
10.1007/s10549-015-3607-9
language
English
LU publication?
yes
id
64c45c68-7033-4607-a976-4d5911956d43 (old id 8149097)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26476725?dopt=Abstract
date added to LUP
2015-11-03 16:01:11
date last changed
2017-01-01 03:56:55
@article{64c45c68-7033-4607-a976-4d5911956d43,
  abstract     = {The association between breast cancer and warfarin is inconclusive as most previous studies examined their association using patients with thromboembolism, whereas thromboembolism itself is a risk factor for cancer. We explored this issue using patients received mechanical heart valves replacement as a proxy for warfarin exposure as these patients need a lifelong warfarin treatment, and compared them with patients received bioprosthesis valves replacement (short-term warfarin treatment) in Sweden between 1987 and 2010. Patients who were operated on for valve replacement were identified from the Swedish Hospital Discharge Registry and linked to the Swedish Cancer Registry to examine the hazard ratios of subsequent breast cancer. A total of 12,242 women were operated on for valve replacement (5481 with mechanical valve and 6401 with bioprosthetic valve). For the entire cohort, the HR of breast cancer was 1.49 (95 % CI 1.09-2.02) among patients with mechanical valve replacement compared to those with bioprosthetic valve replacement. After controlling for a number of confounding factors using propensity score weighting, the HR was 1.69 (95 % CI 1.15-2.47). Our study found that patients with mechanical valve replacement have an increased risk of breast cancer compared to those with bioprosthetic valve replacement. If confirmed, this increased risk should be considered when recommending breast cancer screening for women with mechanical valve replacement. Long-term use of warfarin may explain the observed increase. If so, patients who have used warfarin long-term for other reasons should be studied for a possible increased risk of breast cancer.},
  author       = {Ji, Jianguang and Zöller, Bengt and Giaccia, Amato and Haile, Robert and Sundquist, Jan and Sundquist, Kristina},
  issn         = {1573-7217},
  language     = {eng},
  number       = {2},
  pages        = {369--375},
  publisher    = {Springer},
  series       = {Breast Cancer Research and Treatment},
  title        = {Risk of breast cancer among patients with bioprosthetic or mechanical valve replacement: a population-based study in Sweden.},
  url          = {http://dx.doi.org/10.1007/s10549-015-3607-9},
  volume       = {154},
  year         = {2015},
}