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IntroductionBreast cancer (BC) is one of the leading causes of death among women worldwide. Immunostimulatory treatment has increasingly been used as adjuvant therapy in the last few years, in patients with melanoma and other cancer forms, often with an induction of autoimmunity as a consequence of a successful treatment. We aimed at investigating if coexisting autoimmune diseases (AD) or hypersensitivities (HS) similarly to the side effects of immunostimulatory treatment resulted in a better overall survival, compared to patients without these disorders.Material and methodsThe patient material used was a consecutive clinical material consisting of 1705 patients diagnosed with BC between 1980 and 2010 in Sweden. The patients were stratified according to coexisting AD, HS or lack of both. Overall survival was calculated using Kaplan-Meier and the Cox proportional hazard model.ResultsOur main finding was that BC patients with estrogen receptor (ER) negative tumors together with preexisting AD or HS had a statistically significant better overall survival (HR=0.53; 95% CI= 0.30-0.96) compared to patients without. Premenopausal BC patients with a coexistence of AD or HS had a better overall survival, but this was not statistically significant.DiscussionFor patients with premenopausal or ER-negative BC, coexistence with AD or HS was associated with a better overall survival. Although these findings require validation, and the mechanisms responsible need to be found, they hint to possible new treatment strategies for BC, especially for those with ER-negative tumors and potentially for premenopausal patients.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-357) contains supplementary material, which is available to authorized users.

1594 Background: Antibody therapy of malignant melanoma with ipilimumab is associated with the development of an autoimmune disease. The aim was to investigate if preexisting autoimmune disorders or hypersensitivities, similar to the side effects of immunotherapy in malignant melanoma, gave a better overall survival for breast cancer (BC) patients, compared with patients without these disorders. Methods: A consecutive clinical material consisting of 1,705 breast cancer patients diagnosed between 1980 and 2010 was used. The patients were grouped according to preexisting autoimmune disease or hypersensitivities. The remaining BC patients were used as a reference group. All analyses were adjusted for age at diagnosis, T, N, M-status of the tumor, and ever-use of HRT simultaneously. A p value of less than 0.05 was considered significant. Results: One hundred and twenty-five (7.3%) patients had a history of autoimmunity and 72 (4.2%) patients had a history of hypersensitivity prior to BC diagnosis. Our main finding was that BC patients with a preexisting autoimmune disease or hypersensitivities with ER-negative tumors had a longer overall survival compared to patients without, HR 0.55, 95% CI 0.31-0.97. The risk was specifically low in BC patients with hypersensitivity and ER-negative tumors, HR 0.39, 95% CI 0.16-0.96. The risk was nonsignificantly lower in the autoimmune group, HR 0.78, 95% CI 0.37-1.61. Stratifying both on ER-status and menopausal status, similar results were seen in premenopausal BC patients with hypersensitivity. Postmenopausal BC patients with an ER-negative tumor and an autoimmune disease had a longer nonsignificant overall survival, HR 0.3, 95% CI 0.07-1.26. Conclusions: BC patients with an ER-negative tumor and/or diagnosed before menopause had a longer overall survival when previously diagnosed with hypersensitivity. For BC patients with an autoimmune disease, the prognostic benefit was seen when diagnosed postmenopausally with an ER-negative BC. Preexisting or induced autoimmunity or hypersensitivity may prolong life in breast cancer especially in young patients and those with ER-negative tumors.

Background. Diabetes may be linked to incidence of different tumor diseases and prognosis through various mechanisms such as the disease itself, hyperglycemia, obesity and anti-diabetes therapy. Material and methods. The study includes all women with BC diagnosed in Sweden between 2000 through 2008 (n=54406). The women had no previous cancer diagnosis during the period of 1958-1999. Dates of birth, BC diagnosis and TNM-stage where directly extracted from the cancer registry. The women’s anti-diabetes therapy was gathered from the Swedish Prescribed Drug Registry. Information regarding the cause of death and date of death was obtained from the Cause of Death Registry and tbe Swedish Population Register up until the 31st of December 2012 and 31st of December 2013 respectively. Analyses have been restricted to patients receiving insulin therapy (n=2463) and their breast cancer prognosis has been calculated in comparison with breast cancer patients without diabetes. All analyses were adjusted for TNM-stage and age at diagnosis. Results. Patients with insulin treated diabetes had a worse prognosis compared with other women with breast cancer (HR 1.7, 95%CI 1.5-2.0). The worse prognosis could be seen both for patients with ER+ and ER- tumors. The worst prognosis was seen for patients treated with NPH insulins (HR 2.8, 95% CI 2.4-3.3) while patients treated with long-acting insulin analogs had an intermediate prognosis (HR 1.6, 95% CI 1.2-2.2). Those women treated with NPH insulins and metformin had a slightly worse prognosis (HR 1.4, 95% CI 1.0-1.8). The results for breast cancer specific survival and total survival were similar. Conclusion. Our results imply that insulin treated breast cancer patients have a worse survival compared with other women with breast cancer regardless of tumor stage. Metformin therapy may partially counteract the association. Citation Format: Håkan Olsson, Rickard Einefors, Per Broberg, Mona Landin Olsson. Worse breast cancer prognosis in insulin treated diabetic patients - A population based registry study in Sweden [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-11-02.