Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;29(8):967-978.
doi: 10.1177/13524585231175975. Epub 2023 Jun 8.

Clinical course of multiple sclerosis and patient experiences during breast cancer treatment

Alyssa N Nylander  1 , Jessica Singh  1 , Shane Poole  1 , Annika Anderson  1 , Ruth Ann Marrie  2 , Hope Rugo  3 , Riley Bove  1
Affiliations

Clinical course of multiple sclerosis and patient experiences during breast cancer treatment

Alyssa N Nylander et al. Mult Scler. 2023 Jul.

Abstract

Background: Over one-third of multiple sclerosis (MS) patients are post-menopausal women, the primary demographic affected by breast cancer. After breast cancer diagnosis, there is little information about patients' clinical experiences with both diseases.

Objective: Utilize a case series of MS patients diagnosed with breast cancer to characterize oncologic and MS trajectories, and generate novel insights about clinical considerations using qualitative analysis.

Methods: A single-center retrospective review was performed on medical record data of patients with MS and breast cancer. Thematic analysis was used to characterize experiences with the concurrent diagnoses.

Results: For the 43 patients identified, mean age was 56.7 years at cancer diagnosis and MS duration was 16.5 years. Approximately half were treated with MS disease modifying therapy at cancer diagnosis, and half of these subsequently discontinued or changed therapy. Altogether 14% experienced MS relapse(s) during follow-up (with 2 relapses in the first 2 years), with mean annualized relapse rate of 0.03. Cohort Expanded Disability Status Scale (EDSS) scores remained stable during follow-up. Qualitative insights unique to this population were identified regarding immunosuppression use and neurologic symptoms.

Conclusions: MS relapses were infrequent, and there was modest progression during breast cancer treatment. Oncologic outcomes were comparable to non-MS patients with similarly staged cancer.

Keywords: Multiple sclerosis; breast neoplasms; comorbidity; immunosuppression therapy; prognosis; qualitative research; retrospective studies.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AN: AN is funded by a NMSS Clinician Scientist fellowship.

J.S., S.P., A.A.: none.

R.A.M.: RAM receives research funding from: Canadian Institutes of Health Research, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, Consortium of MS Centers, the Arthritis Society, US Department of Defense. She is supported by the Waugh Family Chair in Multiple Sclerosis. She is a co-investigator on a study funded in part by Biogen Idec and Roche (no funds to her or her institution).

H.R.: Research support for clinical trials through the University of California, paid to UCSF: Pfizer, Merck, Novartis, Lilly, Roche, Daiichi, Seattle Genetics, Macrogenics, Sermonix, Polyphor, AstraZeneca, Astellas and Gilead. Honoraria from: Puma, Samsung, Chugai, Blueprint and NAPO.

R.B.: R.B. has received research support from NIH, NSF, DOD, NMSS, as well as Biogen, Novartis, and Roche Genentech. She has received consulting or advisory board fees from Alexion, Biogen, EMD Serono, Genzyme Sanofi, Jansen, Novartis, Roche Genentech, TG Therapeutics.

Figures

Figure 1.
Figure 1.
Retrospective review data extraction flow diagram.
Figure 2.
Figure 2.
Breast cancer treatments were variable and few patients developed metastatic disease by 5-year follow-up. (a) Overview of breast cancer treatment. Intersecting sets of breast cancer treatments are shown by UpSet plot in 43 women with MS and concurrent breast cancer, (b) time to event plot demonstrating probability of metastasis-free survival, with tick marks representing censored data, and (c) lifetime plot demonstrating variable follow-up lengths and time to development of metastatic disease (line capped with black circle), other lines censored. Dotted line represents 5-year follow-up.
Figure 3.
Figure 3.
Overview of MS disease modifying therapy (DMT) at time of breast cancer diagnosis and changes in EDSS over breast cancer treatment. (a) Distribution of DMTs at time of breast cancer diagnosis are shown as a proportion of a whole; (b) change in DMT therapy at time of breast cancer diagnosis are shown as a proportion of a whole; and (c) changes in MS-related disability as assessed by the Expanded Disability Status Scale, EDSS), over the course of treatment for breast cancer in 29 women with at least 2 EDSS scores available in the medical records. For visualization purposes, the mid-point of cancer treatment was selected as the neurological visit between 1 to 2 years after initiation of breast cancer treatment. As defined in the manuscript, patients with EDSS worsening are coded in purple, EDSS stability are in green, and EDSS improvement are in blue.
Figure 4.
Figure 4.
There are multiple novel qualitative themes related to the patient experience with both multiple sclerosis and breast cancer. The green banner and text represents themes novel to the experience of women with neuroinflammatory disease and breast cancer, while the blue banner and text represents themes common to the oncologic literature.
See this image and copyright information in PMC

References

    1. Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 2014; 20(5): 520–526. - PubMed
    1. Wallin MT, Culpepper WJ, Campbell JD, et al.. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology 2019; 92: e1029–e1040. - PMC - PubMed
    1. Fitzmaurice C, Abate D, Abbasi N, et al.. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the global burden of disease study. JAMA Oncol 2019; 5: 1749–1768. - PMC - PubMed
    1. Marrie RA, Maxwell C, Mahar A, et al.. Breast cancer survival in multiple sclerosis: A matched cohort study. Neurology 2021; 97: e13–e22. - PubMed
    1. Nørgaard M, Veres K, Didden EM, et al.. Multiple sclerosis and cancer incidence: A Danish nationwide cohort study. Mult Scler Relat Disord 2019; 28: 81–85. - PubMed

Publication types