Abstract
Several studies have suggested that estrogens have a protective function against lymphomagenesis. The treatment of breast cancer is driven by subtype classification, and the assessment of hormone receptor status is important for treatment selection. Thus, we evaluated the association between breast cancer and the incidence of NHL. We conducted a retrospective cohort study using a population-based nationwide registry in South Korea. We selected all women with newly diagnosed breast cancer between January 1st, 2002 and December 31st, 2016 who received curative treatment (N = 84,969) and a 1:10 sample of age-matched non-breast cancer controls (N = 1,057,674). Incident breast cancer (time-varying exposure) was the exposure and development of any type of NHL, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mature T/NK-cell lymphomas, anaplastic large cell lymphoma (ALCL), and unspecified types of NHL, was the outcome. During follow-up, 1564 incident cases of NHL occurred. The fully adjusted Hazard Ratio (HR) for NHL associated with the development of breast cancer was 1.64 (95% CI = 1.34–2.00) after adjusting for body mass index, alcohol intake, physical activity, smoking, income, and comorbidity. The adjusted HR for NHL was much higher in participants who were aged <50 years and who received hormone therapy (either tamoxifen or aromatase inhibitors) than in those ≥50 years or who did not receive hormone therapy, respectively. The development of breast cancer was associated with a significantly increased risk of NHL, particularly follicular lymphoma and mature T/NK-cell lymphoma. In particular, the risk of NHL was higher in patients receiving hormone therapy and in younger patients.
Highlights
Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy worldwide [1, 2]
The Hazard Ratio (HR) for NHL associated with the development of breast cancer was 1.64
The association did not change significantly after adjusting for confounding factors
Summary
Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy worldwide [1, 2]. The overall 5-year survival rate for people with NHL is 73%. For stage IV NHL, the 5-year survival rate is around 63%. Long-term immune suppression could induce NHL in patients receiving immunosuppressive agents after organ transplantation and those with human immunodeficiency virus infection [4, 5]. As these cases account for an extremely small proportion of NHL patients, the identification of people at risk of NHL remains a challenge
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