Background Establishing whether women with major depressive disorder (MDD) who develop breast cancer (BC) have poor outcomes is key to optimizing care for this population. To address this, we examined associations between MDD and BC recurrence and mortality. Methods Using medical record data from the Veterans Affairs Healthcare System, we established a retrospective cohort of women with local or regional stage invasive BC between 2010 and 2019 and followed through 2022. We used a two-year window to identify women diagnosed with MDD prior to BC diagnosis. We used multivariable Cox-proportional hazards regression to estimate associations between MDD and BC recurrence and mortality while accounting for competing-risks and adjusting for sociodemographic, clinical, lifestyle, and tumor characteristics. Results We identified 6,051 women with BC, of whom 1,754 (29%) had MDD. The mean age at BC diagnosis was 57 years (standard deviation = 11). In multivariable analyses, women with MDD had a 37% (hazard ratio (HR)=1.37; 95% confidence interval (CI): 1.19-1.57) higher risk of recurrence and a 30% (HR = 1.30; 95% CI: 1.02-1.64) higher risk of BC mortality. The association between MDD and recurrence was stronger among women with estrogen receptor-positive BC. In secondary analyses, there were significant interactions between MDD and multiple exposures with respect to recurrence, including current smoking, substance abuse, and non-receipt of screening mammography. Conclusions Women with MDD had inferior BC outcomes compared to women without a history of MDD. Research is needed to investigate underlying mechanisms linking depression to BC progression and evaluate interventions to improve outcomes in this high-risk population.

中文翻译：

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重度抑郁症对乳腺癌结局的影响：一项全国回顾性队列研究


背景 确定患有重度抑郁症 （MDD） 且患乳腺癌 （BC） 的女性预后是否不佳是优化该人群护理的关键。为了解决这个问题，我们检查了 MDD 和 BC 复发与死亡率之间的关联。方法 使用来自退伍军人事务医疗保健系统的病历数据，我们建立了一个回顾性队列，纳入了 2010 年至 2019 年间患有局部或区域阶段侵袭性 BC 的女性，并随访至 2022 年。我们使用两年的窗口来识别在 BC 诊断之前被诊断患有 MDD 的女性。我们使用多变量 Cox 比例风险回归来估计 MDD 和 BC 复发与死亡率之间的关联，同时考虑竞争风险并调整社会人口学、临床、生活方式和肿瘤特征。结果 我们确定了 6,051 例 BC 女性，其中 1,754 例 （29%） 患有 MDD。BC 诊断时的平均年龄为 57 岁 （标准差 = 11）。在多变量分析中，患有 MDD 的女性复发风险高 37% （风险比 （HR）=1.37;95% 置信区间 （CI）：1.19-1.57），BC 死亡风险高 30% （HR = 1.30;95% CI： 1.02-1.64）。MDD 与复发之间的相关性在雌激素受体阳性 BC 女性中更强。在二次分析中，MDD 与多次暴露在复发方面存在显着的相互作用，包括当前吸烟、药物滥用和未接受乳腺 X 线摄影筛查。结论 与无 MDD 病史的女性相比，患有 MDD 的女性的 BC 结局较差。需要研究来调查将抑郁症与 BC 进展联系起来的潜在机制，并评估改善这一高危人群预后的干预措施。