Association of the Risk of Primary Sjögren's Syndrome With Fibrocystic Breast Disease: A Nationwide, Population-Based Study

Abstract

Objective: Primary Sjögren's syndrome (pSS) is characterized by exocrine glandular inflammation; however, the association between preceding mammary-gland-inflammation-related diseases and newly diagnosed pSS remains unexplored.Methods: We used the 2003–2013 data retrieved from Taiwan's National Health Insurance Research Database (NHIRD) to conduct the present population-based study. We identified newly diagnosed pSS female patients during the 2001–2013 period, as well as age-matched (1:20) and propensity-score-matched (1:2) non-SS individuals (as controls). We explored the associations between pSS and a history of mastitis and fibrocystic breast disease by determining adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a conditional logistical regression analysis after controlling for potential confounders.Results: We identified 9,665 patients with pSS and 193,300 age-matched non-SS controls, as well as 9,155 SS cases and 18,310 propensity-score-matched non-SS controls. We found that fibrocystic breast disease (aOR, 1.75; 95% CI, 1.63–1.88) were independently associated with incident SS, whereas mastitis and childbirth-associated breast infections were not associated with incident SS. We also found positive associations between SS and previously reported SS-associated diseases, including cardiovascular diseases, thyroid diseases, pancreatitis, bronchiectasis, infectious diseases, osteoporosis, and ankylosing spondylitis. In the propensity-score-matched populations, the associations between pSS and fibrocystic breast disease (aOR, 1.74; 95% CI, 1.58–1.91) remained consistent.Conclusion: The present population-based study revealed a previously unexplored association between pSS and history of fibrocystic breast disease, and the finding highlights the need to survey pSS in patients with mammary-gland-inflammation-associated diseases.

Risk analysis of breast cancer and breast fibrocystic change in female primary Sjögren’s syndrome patients

“…Indeed, some studies reported that Sjögren’s syndrome was associated with the increased risk of mastitis and fibrocystic breast disease, and that the pathological findings in mammary glands of Sjögren’s syndrome patients with mastitis was found similar to those of salivary glands in Sjögren’s syndrome. [ 17 , 18 , 23 ] In this study, we found that the breast FC in ultrasonography was found to be highly prevalent in pSS patients. It was noticed that results of another study derived from the nationwide database in Taiwan showed the lower prevalence of breast fibrocystic disease in Sjögren’s syndrome patients.…”

“…It was noticed that results of another study derived from the nationwide database in Taiwan showed the lower prevalence of breast fibrocystic disease in Sjögren’s syndrome patients. [ 23 ] This discrepancy may be explained by the possibility that Sjögren’s syndrome patients may tend to have subclinical breast inflammation, leading to tissue scarring and the subsequence of FC, similar to the findings in the inflamed salivary glands. [ 24 ] In addition, it is also interesting to know whether Sjögren’s syndrome is associated with the increased risk of DM, since pancreas with the glandular structure similar to mammary gland is also likely to be affected in Sjögren’s syndrome to cause pancreatic inflammation.…”

Relationship between age at menopause and breast ultrasonography results

“…Post-menopausal women are projected to increase from 467 million to 1,200 million worldwide by 2030, with the most significant increase in developing countries (3). Menopausal age changes usually occur in the age range of 45-55 years and it changes from country to country (4,5). Hormonal changes during this period lead to post-menopausal women being prone to cardiovascular disease (CVD), bone complications, and an increased risk of developing breast cancer and endometriosis (2,6,7).…”

“…The exact prevalence of this disease is not known, but in some studies, this rate has been reported to be more than 50%. Cysts also increase over time until menopause and decrease abruptly (4,6,8). Atypical hyperplasia includes conditions such as intraductal papilloma and fibroadenoma, which slightly increase the risk of breast cancer (7).…”

“…Identifying the factors associated with early and late menopause is important because menopausal age is related to the risk of developing several chronic diseases such as CVD, breast and uterine cancer, and osteoporosis (11). Women with early menopause are at risk for CVD (4,6,8) and osteoporosis (4,6,9), while women with late menopause are at risk for breast (2,4,5) and uterine cancers (3). Socio-demographic factors and reproductive and behavioral characteristics are known as menopausalrelated factors (7)(8)(9).…”