Breast cancer survivors receiving TNF inhibitors for rheumatoid arthritis are not at an increased risk of their cancer recurring compared to those receiving other medicines.
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It is more common in older people, and affects both men and women. TNF inhibitors are a type of medicine known as biologic disease-modifying antirheumatic drugs (bDMARDs or biologics). These work by blocking the action of certain molecules involved in the development of inflammation in the body. Some studies have suggested that biologic medicines may increase the risk of developing some types of cancer as they can also alter the biology of tumours.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors hoped to find out whether TNF inhibitors were associated with a recurrence of breast cancer (disease coming back) in women who had already had breast cancer and were suffering from rheumatoid arthritis.
WHO WAS STUDIED?
The study included 143 women who were taking TNF inhibitors for their rheumatoid arthritis, and had a history of breast cancer. As a control, the authors also looked at 1598 women with rheumatoid arthritis and a history of breast cancer who were not taking TNF inhibitors. All patients were in clinics in Sweden.
HOW WAS THE STUDY CONDUCTED?
This was a retrospective observational study, which means that the authors used databases of patient records to look back and find women in each group. There was no interventional treatment given. The final paper compared 120 women from each group to see if there was a difference in the rate of breast cancer coming back between women starting TNF inhibitors on average a decade after having a breast cancer diagnosis and those on other types of medicines for their rheumatoid arthritis. The women were followed for recurrent cancer for 5 year on average.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The authors found that there was no difference between the groups – breast cancer came back in 9 women in each group. Women taking TNF inhibitors for their rheumatoid arthritis did not experience any increased risk of breast cancer recurrence.
ARE THESE FINDINGS NEW?
Recurrent cancers of all types have been investigated in two previous publications (see reference 1 & 2 at bottom of page), but no study has specifically investigated recurrent breast cancer in patients with rheumatoid arthritis treated with TNF inhibitors.
HOW RELIABLE ARE THE FINDINGS?
The study included all eligible patients with rheumatoid arthritis and a history of breast cancer starting TNF inhibitors in Sweden between 1999 and 2010. This is the largest study on this topic to date, but there are still some limitations, and larger patient numbers would give more reliable results. Additionally, these findings may not apply to people with aggressive or very recent breast cancers, or with cancers of other types.
WHAT DO THE AUTHORS PLAN ON DOING WITH THE INFORMATION?
The authors are currently planning a similar study including patients with rheumatoid arthritis and a history of any solid tumour (i.e. cancer of all types). This will look at more patients and should provide more important information on cancer and biologics.
WHAT DOES THIS MEAN FOR ME?
If you have a history of breast cancer and are now receiving treatment for rheumatoid arthritis, you and your doctor may find these results reassuring. Doctors may be more willing to prescribe biologic treatments to people with a history of cancer. If you are concerned about the risks of any medical treatment, you should talk to your doctor.
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Date prepared: December 2015
Summary based on research article published on: 8 August 2014.
From: Raaschou P, et al. TNF inhibitor therapy and risk of breast cancer recurrence in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis 2015;74:2137–43. doi:10.1136/annrheumdis- 2014-205745
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1 Strangfeld A. Arthritis Res Ther 2010;12:R5.
2 Dixon WG. Arthritis Care Res (Hoboken) 2010;62:755–63.