Cancer Res Treat.  2023 Apr;55(2):551-561. 10.4143/crt.2022.272.

Marked Reduction in the Risk of Dementia in Patients with Breast Cancer: A Nationwide Population-Based Cohort Study

Affiliations
  • 1Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 3Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
  • 4Division of Breast Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Purpose
An inverse relationship between cancer and neurodegenerative disease, which presents the possibility of a reduced risk of dementia in cancer patients, has been suggested previously. However, a nationwide longitudinal population-based study of specific types of cancer with due consideration of treatment effects has not been conducted.
Materials and Methods
This nationwide population-based cohort study used data obtained in a 12-year period (January 2007- December 2018) in the Korean National Health Insurance claims database. All female breast cancer patients (age ≥ 50 years) diagnosed between 2009 and 2010 were included after excluding those with physician visits for any cancer during a 2-year period (2007-2008). Patients with senile cataract constituted the control group. The main study outcome was the risk of developing dementia.
Results
From a total of 90,396 and 85,906 patients with breast cancer and cataract, respectively, patients without behavior codes were excluded. Data for 15,407 breast cancer patients and 7,020 controls were analyzed before matching. After matching for comorbidities and age, either group comprised 2,252 patients. The median follow-up time was 104.1±24.0 months after matching. After matching, breast cancer was a predictor of a lower risk of for dementia (hazard ratio, 0.091; 95% confidence interval, 0.075 to 0.111; p < 0.001). In breast cancer patients, receiving chemotherapy and endocrine therapy did not significantly affect the incidence of dementia.
Conclusion
Breast cancer was associated with a remarkably decreased risk of dementia. The findings strongly suggest an inverse relationship between cancer and neurodegeneration, regardless of the adverse effects of cancer treatment on cognitive function.

Keyword

Breast neoplasms; Neurodegenerative diseases; Dementia; Risk; Incidence

Figure

  • Fig. 1 Patient flow diagram for the selection and enrollment of eligible participants in this study.

  • Fig. 2 Kaplan-Meier analysis of incidence of dementia between patients with or without breast cancer. (A) Before matching, patients with breast cancer exhibited a low incidence of dementia than those without breast cancer (p < 0.001, log-rank test). (B) After matching, patients with breast cancer still had a low incidence of dementia (p < 0.001, log-rank test).

  • Fig. 3 Subgroup analysis of incidence of dementia with stratification by treatment modalities, comorbidities, and age. (A) Before matching, receiving chemotherapy and endocrine therapy were related to the occurrence of dementia in univarate analysis (p=0.002 and p=0.036, respectively). (B) In multivariable model 1 (including receiving chemotherapy, but not endocrine therapy), the administration of chemotherapy was not a significant factor for dementia (p=0.070). (C) In multivariable model 2 (including receiving endocrine therapy, but not chemotherapy), receiving endocrine therapy was not a significant factor for dementia (p=0.321). (D) After matching, chemotherapy, endocrine therapy, and use of aromatase inhibitors did not significantly affected the incidence of dementia (p=0.337, p=0.263, and p=0.987, respectively). CI, confidence interval; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; HR, hazard ratio; LC, liver cirrhosis.


Reference

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