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Cancer Epidemiol Biomarkers Prev. 2018 Feb;27(2):165-173. doi: 10.1158/1055-9965.EPI-17-0556. Epub 2017 Dec 18.

Bisphosphonate Use and Risk of Recurrence, Second Primary Breast Cancer, and Breast Cancer Mortality in a Population-Based Cohort of Breast Cancer Patients.

Author information

1
School of Medicine, University of Washington, Seattle, Washington.
2
Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
3
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
4
Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
5
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. kmalone@fredhutch.org.

Abstract

Background: Studies of bisphosphonate use and breast cancer recurrence have produced conflicting results. Analyses of large adjuvant trials suggest that bisphosphonates reduce recurrence risk only in postmenopausal women.Methods: We assessed the effect of noncancer treatment-related bisphosphonate use on breast cancer outcomes in a population-based prognostic cohort of women with early-stage invasive breast cancer (n = 1,813; median follow-up = 11.8 years). Using medical record, interview, and cancer registry data, information was assembled on risk factors, cancer treatment, medication use, and outcomes. Statistical analyses used Cox proportional hazards regression models.Results: Bisphosphonate use was associated with a significantly decreased risk of a breast cancer event [locoregional/distant recurrence or second primary breast cancer; HR ever use, 0.65; 95% confidence interval (CI), 0.47-0.90]. Reduced risks were observed in both pre/peri and postmenopausal women, in both ER-negative and ER-positive breast cancers, and for both earlier and later recurrences. Bisphosphonate use was also associated with a significantly decreased risk of breast cancer mortality (HR, 0.40; 95% CI, 0.23-0.69).Conclusions: Bisphosphonate use was associated with a reduction in risk of breast cancer events and improved breast cancer-specific survival in women with early-stage breast cancer. We hypothesize that the benefit of bisphosphonates on breast cancer outcomes may be present primarily in women with low bone density and regardless of menopausal status.Impact: Our findings suggest further consideration of bone density status as a modifier of bisphosphonate's potential beneficial benefits on breast cancer outcomes is warranted. Cancer Epidemiol Biomarkers Prev; 27(2); 165-73. ©2017 AACR.

PMID:
29254937
PMCID:
PMC6021196
[Available on 2019-02-01]
DOI:
10.1158/1055-9965.EPI-17-0556

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