Multiple sclerosis and the cancer diagnosis: diagnostic route, cancer stage, and the diagnostic interval in breast and colorectal cancer

Background and Objectives — The multiple sclerosis (MS) population’s survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in cancer patients with and without MS.

Methods — We conducted a matched population-based cross-sectional study of breast (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada using administrative data. Exclusion criteria included second or concurrent primary cancers, no healthcare coverage, and, for the patients without MS, those with any demyelinating disease. 1:4 matching of MS to non-MS was based on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected versus symptomatic), stage (stage I versus all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity.

Results — We included 351 patients with MS and breast cancer, 1404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with less screen-detected cancers in breast (OR [95%CI] 0.68 [0.52, 0.88]) and possibly colorectal (OR 0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis: stage I cancer (OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast nor colorectal cancer cohorts Controlling for disability status attenuated some findings.

Conclusion — Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.