Abstract
PurposeBreast 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.MethodsWe 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.ResultsDUD 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).ConclusionsWomen 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.
Highlights
Drug use disorders (DUD) are associated with a range of adverse health outcomes including increased mortality rates [1, 2]
We found a significant association between DUD and fatal breast cancer after adjustment for age in Model 1 (HR 1.63, 95% confidence interval (CI) 1.44–1.84) and remained significant after adjustment for age, educational attainment, social welfare, region of residence, marital status and alcohol use disorder in Model 2 (HR 1.60, 95% CI 1.42–1.82)
In additional analyses that adjusted for risk factors for breast cancer [17, 18], the association between DUD and incident breast cancer became statistically non-significant, suggesting that the risk factors listed above are likely to confound our results for incident but not for fatal breast cancer
Summary
Drug use disorders (DUD) are associated with a range of adverse health outcomes including increased mortality rates [1, 2]. Patients in opioid substitution treatment (OST) are shown to have significantly higher non-drugrelated mortality, including in cancer, than the general population [3, 4]. The mortality rates are especially increased in patients older than 55 years [3], which is worrying since the OST populations are aging [5]. The adverse health outcomes associated with DUD could partly be related to unmet health care needs [9,10,11] including non-participation in cancer screening programs, such as for breast cancer [12, 13], cervical cancer [13,14,15] and colorectal cancer [13]. It is likely that women with DUD have higher mortality in common cancers, e.g. breast cancer, and a delayed diagnosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
