News and Research
Immune System
Study Shows Link Between Antibiotic Use And Increased
Risk Of Breast Cancer
2-17-2004
A study published today in the Journal of the American Medical
Association (JAMA)* provides evidence that use of antibiotics
is associated with an increased risk of breast cancer. The
authors - from Group Health Cooperative (GHC) in Seattle;
the National Cancer Institute (NCI), a part of the National
Institutes of Health in Bethesda, Md.; the University of
Washington, Seattle; and the Fred Hutchinson Cancer Center,
also in Seattle - concluded that the more antibiotics the
women in the study used, the higher their risk of breast
cancer.
The
results of this study do not mean that antibiotics cause
breast cancer. "These results only show that there
is an association between the two," explained co-author
Stephen H. Taplin, M.D., of NCI's Division of Cancer Control
and Population Sciences and formerly of the GHC. "More
studies must be conducted to determine whether there is
indeed a direct cause-and-effect relationship."
"This
trial suggests another piece in the puzzle of factors that
may potentially be involved in the development of breast
cancer," said NCI Director Andrew C. von Eschenbach,
M.D. "The NCI will continue to support research into
underlying mechanisms of cancer risk."
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The authors of this JAMA study found that women who
took antibiotics for more than 500 days - or had more than 25 prescriptions
- over an average period of 17 years had more than twice the risk
of breast cancer as women who had not taken any antibiotics. The risk
was smaller for women who took antibiotics for fewer days. However,
even women who had between one and 25 prescriptions over an average
period of 17 years had an increased risk; they were about 1.5 times
more likely to be diagnosed with breast cancer than women who didn't
take any antibiotics. The authors found an increased risk in all classes
of antibiotics that they studied.
"Breast cancer is the second leading cause of
cancer deaths among women in the United States - with an estimated
40,000 deaths this year - and is the most common cancer in women worldwide,"
said first author Christine Velicer, Ph.D., of GHC's Center for Health
Studies. "Antibiotics are used extensively in this country and
in many parts of the world. The possible association between breast
cancer and antibiotic use was important to examine."
To gather the necessary data, the researchers used
computerized pharmacy and breast cancer screening databases at GHC,
a large, non-profit health plan in Washington state. They compared
the antibiotic use of 2,266 women with breast cancer to similar information
from 7,953 women without breast cancer. All the women in the study
were age 20 and older, and the researchers examined a wide variety
of the most frequently prescribed antibiotic medications.
The authors offer a few possible explanations for
the observed association between antibiotic use and increased breast
cancer risk. Antibiotics can affect bacteria in the intestine, which
may impact how certain foods that might prevent cancer are broken
down in the body. Another hypothesis focuses on antibiotics' effects
on the body's immune response and response to inflammation, which
could also be related to the development of cancer. It is also possible
that the underlying conditions that led to the antibiotics prescriptions
caused the increased risk, or that a weakened immune system - either
alone, or in combination with the use of antibiotics - is the cause
of this association.
The results of the study are consistent with an earlier
Finnish study of almost 10,000 women. "Further studies must be
conducted, though, for us to know why we see this increased risk and
the full implications of these findings," said Velicer. Studies
are also necessary to clarify whether specific indications for antibiotic
use, such as respiratory infection or urinary tract infection, or
times of use, such as adolescence, pregnancy or menopause, are associated
with increased breast cancer risk. Additionally, breast cancer risks
could differ between women who take low-dose antibiotics for a long
period of time and women who take high-dose antibiotics only once
in a while.
Antibiotics are regularly prescribed for conditions
such as respiratory infections, acne, and urinary tract infections,
in addition to a wide range of other conditions or illnesses. In this
JAMA study, for example, more than 70 percent of women had used between
one and 25 prescriptions for antibiotics to treat various conditions
over an average 17-year period, and only 18 percent of women in the
study had not filled any antibiotic prescriptions during their enrollment
in the health plan.
Over the past decade, overuse of antibiotics has become
a serious problem. According to the Centers for Disease Control and
Prevention (CDC), tens of millions of antibiotics are prescribed for
viral infections that are not treatable with antibiotics, contributing
to the troubling growth of antibiotic resistance. Efforts are underway
such as the "Get Smart: Know When Antibiotics Work" campaign
- unveiled last year by the Department of Health and Human Services'
CDC and the Food and Drug Administration (FDA) and other partners
- to lower the rate of antibiotic overuse.
"These study results do not mean that women should
stop using antibiotics to treat bacterial infections," stressed
Taplin. "Until we understand more about the association between
antibiotics and cancer, people should take into account the substantial
benefits that antibiotics can have, but should continue to use these
medicines wisely."
Questions and Answers about this study can be found
at www.cancer.gov/newscenter/pressreleases/AntibioticsQandA.
To learn more about the "Get Smart: Know When
Antibiotics Work" campaign, go to http://www.cdc.gov/drugresistance/community.
For information about cancer, please visit the NCI
home page at www.cancer.gov or call the NCI's Cancer Information Service
at 1-800-4-CANCER (1-800-422-6237).
This story has been adapted from a news release issued
by NIH/National Cancer Institute, www.cancer.gov.
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