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Tseng, Chen, Chiang, and Lin: Increased risk of breast cancer in women with uterine myoma: a nationwide, population-based, case-control study
Original Article

J Gynecol Oncol 2017;28(3):e35.

Published online: 4 May 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e35

Increased risk of breast cancer in women with uterine myoma: a nationwide, population-based, case-control study

Jenn-Jhy Tseng1, Yi-Huei Chen2, Hsiu-Yin Chiang2, Ching-Heng Lin2,

1Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan

2Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan

Correspondence to Ching-Heng Lin Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Xitun District, Taichung 40705, Taiwan. E-mail: epid@vghtc.gov.tw

Received 23 November 2016       Revised 23 January 2017       Accepted 7 February 2017

Copyright © 2017 Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate if uterine myoma is associated with breast cancer.

Methods

This case-control study used a nationwide database in Taiwan. We identified 24,315 patients with newly diagnosed breast cancer as cases and matched them with 24,281 patients without breast cancer on age, sex, urbanization, income, and initial diagnosis date. Patients with prior mastectomy were excluded. We used logistic regression analysis to assess the association between uterine myoma and breast cancer while adjusting for confounders. We evaluated the impact of surgical removal of uterine myoma on subsequent breast cancer among patients with uterine myoma.

Results

We found that 2,892 (11.9%) patients with newly diagnosed breast cancer and 2,541 (10.5%) patients without breast cancer had a history of uterine myoma. The association between breast cancer and uterine myoma was significant (adjusted odds ratio [aOR]=1.14; 95% confidence interval [CI]=1.07–1.21; p<0.001). This association remained in patients who used hormone (aOR=1.20; 95% CI=1.08–1.33; p=0.001) or who did not use hormone (aOR=1.11; 95% CI=1.03–1.19; p=0.005) within 5 years prior to the index date. Surgical removal of uterine myoma was not associated with a decreased risk of breast cancer (aOR=0.99; 95% CI=0.88–1.10; p=0.795).

Conclusion

A minor increased risk of breast cancer was found in women with a history of uterine myoma. This association remained in patients with recent hormone use. Removal of uterine myoma was not associated with decreased risk of breast cancer.

Keywords: Uterus, Leiomyoma, Breast Neoplasms, Hormone Replacement Therapy, Case-Control Studies, National Health Programs

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Fig. 1.
Flowchart of selection process of study population. ICD-9-CM, International Classification of Diseases, 9th revision, clinical modification; NHIRD, National Health Insurance Research Database; UM, uterine myoma.
jgo-28-e35f1.tif
Table 1.
Characteristics of patients with breast cancer and matched controls
Variable* All patients (n=48,596) Without breast cancer (n=24,281) With breast cancer (n=24,315) p-value†
No. % No. % No. %
Age (yr) 54.2±12.0 54.1±12.1 54.3±12.0 0.307
Urbanization 1.000
1 (highest) 17,350 36.5 8,675 36.5 8,675 36.5
2 14,924 31.4 7,462 31.4 7,462 31.4
3 6,650 14.0 3,325 14.0 3,325 14.0
4 (lowest) 8,547 18.0 4,273 18.0 4,274 18.0
Family income (NTD) 0.999
0–15,840 16,924 34.9 8,462 34.9 8,462 34.8
15,841–45,800 27,658 57.0 13,829 57.0 13,829 57.0
≥45,801 3,979 8.2 1,988 8.2 1,991 8.2
Comorbidites‡
Hypertension 11,444 23.5 5,599 23.1 5,845 24.0 0.011
Diabetes 5,326 11.0 2,574 10.6 2,752 11.3 0.011
Hyperlipidemia 6,734 13.9 3,329 13.7 3,405 14.0 0.349
Endometriosis 590 1.2 285 1.2 305 1.3 0.417
Hormone therapy§ 9,527 19.6 4,915 20.2 4,612 19.0 <0.001
Cumulative exposure time for hormone use (day) 128.0±237.5 136.7±245.0 0.079
No. of inpatient or outpatient visit 18.2±15.5 16.7±15.5 19.7±15.3 <0.001

NTD, New Taiwan Dollars.

* Data are shown as number (%) or mean±standard deviation;

† We compared continuous variables were analyzed by Student's t-test; categorical variables were analyzed by χ2 test;

‡ Reference group is patients without the corresponding condition;

§ Use of estrogen or progesterone within 5 years prior to the index date.

Table 2.
Association between a history of uterine myoma and subsequent occurrence of breast cancer, stratified by age group and recent hormone use
Stratified group UM All patients (n=48,596) Without breast cancer (n=24,281) With breast cancer (n=24,315) Adjusted OR (95% CI) p-value
No. % No. % No. %
All patients* No UM 43,163 88.8 21,740 89.5 21,423 88.1 Reference <0.001
UM 5,433 11.2 2,541 10.5 2,892 11.9 1.14 (1.07–1.21)
Used of hormone†
Not used No UM 35,534 91.0 17,731 91.6 17,803 90.4 Reference 0.005
UM 3,535 9.0 1,635 8.4 1,900 9.6 1.11 (1.03–1.19)
Used No UM 7,629 80.1 4,009 81.6 3,620 78.5 Reference 0.001
UM 1,898 19.9 906 18.4 992 21.5 1.20 (1.08–1.33)

CI, confidence interval; OR, odds ratio; UM, uterine myoma.

* Adjusted for age, urbanization, family income, hypertension, diabetes, hyperlipidemia, hormone use, endometriosis, and number of hospital inpatient/ outpatient visit;

† Adjusted for urbanization, family income, hypertension, diabetes, hyperlipidemia, hormone use, endometriosis, and number of hospital inpatient/outpatient visit.

Table 3.
Surgical interventions for uterine myoma and subsequent occurrence of breast cancer risk among patients with a history of uterine myoma
Variable Patients with UM (n=5,433) Without breast cancer (n=2,541) With breast cancer (n=2,892) Adjusted OR (95% CI)* p-value
No. % No. % No. %
No operation 3,332 61.3 1,544 60.8 1,788 61.8 Reference –
Operation 2,101 38.7 997 39.2 1,104 38.2 0.99 (0.88–1.10) 0.795
Myomectomy 499 9.2 229 9.0 270 9.3 1.07 (0.88–1.30) 0.474
Hysterectomy 1,602 29.5 768 30.2 834 28.8 0.96 (0.85–1.08) 0.497

CI, confidence interval; OR, odds ratio; UM, uterine myoma.

* Adjusted for age, urbanization, family income, hypertension, diabetes, hyperlipidemia, hormone use, endometriosis, and number of inpatient/outpatient visit.

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