Multiple Sclerosis and the Cancer Diagnosis: Diagnostic Route, Cancer Stage, and the Diagnostic Interval in Breast and Colorectal Cancer.

Breast Neoplasms / diagnosis Colorectal Neoplasms / diagnosis Cross-Sectional Studies Female Humans Multiple Sclerosis / diagnosis Ontario

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
03 05 2022
Historique:
received: 13 07 2021
accepted: 21 01 2022
entrez: 2 5 2022
pubmed: 3 5 2022
medline: 6 5 2022
Statut: ppublish

Résumé

The multiple sclerosis (MS) population's survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in patients with cancer with and without MS. We conducted a matched population-based cross-sectional study of breast cancers (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada, using administrative data. Exclusion criteria included second or concurrent primary cancers, no health care coverage, and, for the patients without MS, those with any demyelinating disease. We based 1:4 matching of MS to non-MS on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected vs symptomatic), stage (stage I vs all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity. We included 351 patients with MS and breast cancer, 1,404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with fewer screen-detected cancers in breast (odds ratio [OR] 0.68 [95% CI 0.52, 0.88]) and possibly colorectal (0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis (stage I cancer, OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast or colorectal cancer cohorts. Controlling for disability status attenuated some findings. Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.

Sections du résumé

BACKGROUND AND OBJECTIVES
The multiple sclerosis (MS) population's survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in patients with cancer with and without MS.
METHODS
We conducted a matched population-based cross-sectional study of breast cancers (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada, using administrative data. Exclusion criteria included second or concurrent primary cancers, no health care coverage, and, for the patients without MS, those with any demyelinating disease. We based 1:4 matching of MS to non-MS on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected vs symptomatic), stage (stage I vs all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity.
RESULTS
We included 351 patients with MS and breast cancer, 1,404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with fewer screen-detected cancers in breast (odds ratio [OR] 0.68 [95% CI 0.52, 0.88]) and possibly colorectal (0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis (stage I cancer, OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast or colorectal cancer cohorts. Controlling for disability status attenuated some findings.
DISCUSSION
Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.

Identifiants

DOI: 10.1212/WNL.0000000000200163 PMID: 35501160
pubmed: 35501160
pii: 98/18/e1798
doi: 10.1212/WNL.0000000000200163
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1798-e1809

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2022 American Academy of Neurology.

Auteurs

Patti A Groome (PA)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
ORCID: 0000-0003-4823-313X

Colleen Webber (C)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Colleen J Maxwell (CJ)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
ORCID: 0000-0002-7988-2899

Chad McClintock (C)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Dallas Seitz (D)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Alyson Mahar (A)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Ruth Ann Marrie (RA)

From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

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Classifications MeSH

questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Maladies du sein › Tumeurs du sein › Multiple Sclerosis and the Cancer Diagnosis:...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Multiple Sclerosis and the Cancer Diagnosis:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Multiple Sclerosis and the Cancer Diagnosis:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Multiple Sclerosis and the Cancer Diagnosis:...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Multiple Sclerosis and the Cancer Diagnosis:...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Multiple Sclerosis and the Cancer Diagnosis:...