Introduction Several studies have observed that coeliac disease is associated with more than a 50% reduced risk of breast cancer1–4⇓⇓⇓ though the reasons for this reduction are unclear. We determined the conventional breast cancer risk factors reported by women with coeliac disease in comparison to the general population.
Methods 9000 women who were members of Coeliac UK, the national society for people with coeliac disease in the UK and 1193 women with coeliac disease who had attended Nottingham University Hospital, Royal Hallamshire Hospital, Derbyshire Royal Infirmary between January 2000 and December 2006 were invited to complete a questionnaire relating to known risk factors for breast cancer. Data from British birth cohort studies were used as a general population comparison.5–7⇓⇓
Results 7416 women (mean age 58.7 (SD 12.4) years) with coeliac disease completed the questionnaire. The mean age at adult diagnosis was 44.8 (SD 12.8) years with 424 (6%) being diagnosed in childhood. The higher proportion of women being parous (91% vs 88%, OR 1.39, 95% CI 1.11 to 1.73), having their first full-term pregnancy before 30 years (89% vs 79%, OR 2.00, 95% CI 1.75 to 2.29) and breastfeeding (73% vs 68%, OR 1.29, 95% CI 1.02 to 1.63) in addition to the younger mean age at menopause (47.8 vs 49.0 years, p=0.00001) suggests women with coeliac disease have favourable breast cancer risk profile features in comparison to the general population. However, the higher likelihood of being Caucasian (98% vs 90%, OR 7.22, 95% CI 5.90 to 8.83) and of affluent social class (26% vs 20%, OR 1.40, 95% CI 1.19 to 1.64) together with higher proportion having menarche before 11 years (15% vs 2%, OR 7.87, 95% CI 5.90 to 8.83) and irregular menstrual cycles (22% vs 19%, OR 1.22, 95% CI 1.05 to 1.43) suggests there are also potentially adverse breast cancer risk profile features associated with coeliac disease. Having similar height to the general population (162.8 (SD 7) cm) and BMI within normal range suggests anthropometric exposures may not explain the apparent reduced risk of breast cancer in women with coeliac disease to the general population.
Conclusion The breast cancer risk profile suggests both protective and adverse associations of coeliac disease. Reduced risk of breast cancer in women with coeliac disease may be related to differences in menstrual and reproductive factors.
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