Drug use disorder and risk of incident and fatal breast cancer: a nationwide epidemiological study

Abstract

Purpose 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. Methods 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. Results 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). Conclusions 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.

Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study

“…The broad definition of DUD applied in this study, ranging from a diagnosis in the NPR to a registration of drug possession in the Suspicion Register, has been used in several previous studies [ 7 , 58 ]. Although this definition may include some men with sporadic drug use rather than DUD, our intention was to include men with DUD that had not been noted by the healthcare system and registered in the NPR.…”

“…Men with drug use disorder (DUD) may have a higher risk of prostate cancer incidence and mortality because of delayed diagnosis and/or undertreatment. This issue has rarely been examined and is important because DUD has been associated with a range of adverse health outcomes including drug-related [3,4] and non-drug-related mortality [4][5][6][7], breast cancer incidence and mortality [7], blood-borne infections [8,9], and liver disease [10]. The substantial physical morbidity associated with DUD may be partially related to healthcare seeking barriers [11][12][13], poor health literacy [14], psychiatric comorbidity [15][16][17], and under-utilization of cancer screening [18][19][20][21].…”

Screening for breast and cervical cancer among OST patients: a qualitative study of barriers and suggested interventions to increase participation

“…Recent research suggests that the risks of developing breast and cervical cancer are not evenly distributed throughout the population, and studies show that Swedish women with current or previous drug use—here abbreviated as WWUD (women who use/have used drugs) – are particularly vulnerable. Compared to the general population, Swedish WWUD not only suffer an increased risk to develop and die from breast cancer (Dahlman, Magnusson, et al, 2021 ), but also display a greater incidence of cervical cancer (Dahlman, Li, et al, 2021 ). Internationally, studies have made similar findings regarding the increased vulnerability of women with different forms of substance use.…”

Cancer Association in Drug Abuse Disorders: A latest Update

“…Women with DUD were identified as a risk group for incident, fatal and metastasized breast cancer. Cancer screening attendance and other healthcare seeking barriers are likely to affect the risk increase among women who use drugs [7]. Opioid dependence was associated with lower breast cancer mortality compared to the general female population in Australia [4].…”