Risk, Incidence, and Mortality of Breast Cancer in Primary Sjögren’s Syndrome: A Systematic Review and Meta-Analysis

Abstract

BackgroundPrimary Sjögren’s syndrome (pSS) and breast cancer are a highly prevalent autoimmune disease and malignancy, respectively, both occurring predominantly in females. Whether there is a link between these two diseases is uncertain. We conducted a systematic review and meta-analysis to investigate the risk, incidence, and mortality of breast cancer in patients with pSS.MethodsWe systematically searched Embase, PubMed, and Web of Science on January 31, 2022 to identify the study that assessed risk, incidence, or mortality of breast cancer in pSS. The fixed or random-effects models were applied to pool the effect estimates based on heterogeneity measured by Cochran’s Q-test and Higgins’ I2.ResultsTen studies involving 725,805 participants and 64,836 pSS patients were included in our analysis. The pooled result showed that, overall, pSS was not associated with the risk (SIR=0.92, 95%CI: 0.66-1.29, P=0.646) and mortality (HR = 0.78, 95%CI: 0.26-2.34, P = 0.664) of breast cancer; however, when stratified by geographic region, we found that patients with pSS in Asian countries (SIR=1.32, 95%CI: 1.10-1.58, P=0.003) and Argentina (SIR=3.76, 95%CI: 1.04-9.45, P=0.019) had an elevated risk of breast cancer, while pSS in Europe was associated with a reduced risk (SIR=0.61, 95%CI: 0.51-0.73, P<0.001). The pooled result from 28,635 female pSS patients indicated that the incidence of breast cancer was 2.15 (95% CI: 1.33-3.50) per 1000 person/years.ConclusionThis study suggests that there may be geographical differences in the association between pSS and breast cancer risk; patients with pSS in European countries are associated with a lower risk of breast cancer, while Asia and Argentina are the opposite. Future research is needed to further characterize the effect of pSS on breast cancer risk and the pathophysiological mechanisms underlying this association to unravel the complex relationship between the two.

Risk analysis of breast cancer and breast fibrocystic change in female primary Sjögren’s syndrome patients

“…Our results appear to be similar to those in some recent reports and consistent with the increased risk of BC in the Asian population of Sjögren's syndrome. [33,35] In this study, we revealed the strong association of DM with the increased risk of BC with a high OR of 10.4 in pSS. DM itself seems to be not associated with the increased risk of BC in the general population in Taiwan as previously reported in a previous nationwide population study, although the association of DM with BC with low OR had been reported in some studies.…”

“…Indeed, some previous studies reported the different results on the association of autoimmune diseases with the risk of BC, and it seems that there are geographical differences in the association of Sjögren’s syndrome with the risk of BC. [28–33] In this study, we found that the prevalence of BC in pSS patient was 3900 per 100,000 persons, which appears to be much higher than 834.37 per 100,000 persons of the female general population in Taiwan in 2013. [34] The incidence rate of 650 per 100,000 person-years for BC in pSS patients was also higher than that of 93.00 per 100,000 person-years for BC of the female general population in 2013 in Taiwan.…”

Healthy lifestyles, systemic inflammation and breast cancer risk: a mediation analysis

“…However, we also found an inverted U-shaped relationship between CRP and breast cancer. The inverse association between CRP and breast cancer in the extremely high group could possibly be explained by the inverse association between breast cancer and autoimmune disease [ 33 , 34 ], as these patients were characterized by high levels of CRP.…”

Causal effects of Sjögren's syndrome on cancer risk: A Mendelian Randomization Study

“…Sjögren's syndrome (SS) is a chronic systemic autoimmune disease, which has been reported associated with various cancers, such as lymphoma [49,50], B-cell non-Hodgkin lymphoma [51], extranodal marginal zone lymphoma [52][53][54], follicular dendritic cell sarcoma [55], breast cancer [32], diffuse large B-Cell lymphoma[56, 57], ovarian cancer [34], multiple myeloma [35], tongue cancer [35], thyroid cancer[58], cancers of the lip and oral cavity[58], and stomach cancer[58], etc. Although several epidemiological researchers have mentioned the link between SS and cancer risks, it was di cult to certify the causality of SS on cancer risks based purely on epidemiological or association studies.…”

“…Krishna C Thandra et al revealed that Non-Hodgins's lymphoma is strongly associated with SS [31]. Previous researchers found that patients with SS had an elevated risk of breast cancer in Asian countries and Argentina [32]. Radjiv Goulabchand et al [33] found that there was an increased risk of hematological malignancies and thyroid tumors in patients with SS.…”