Urinary Tract Infections in Breast Cancer Survivors: Retrospective Cohort Study

Objectives: Estrogen plays a role in preventing urinary tract infections (UTIs) in women. In patients with estrogen receptor positive (ER+) breast cancers, hormonal therapy can induce a low estrogen state. Previous studies have focused on vaginal dryness and dyspareunia as the primary genitourinary sequelae of breast cancer treatment. However, there is a significant gap in the medical literature regarding the prevalence of UTIs in this patient population. We aimed to determine the incidence of UTIs in a cohort of newly diagnosed patients with breast cancer and to identify demographic and medical risk factors in premenopausal and postmenopausal patients that may contribute to having UTIs.

Methods: After obtaining IRB approval, a retrospective study of all female patients diagnosed with breast cancer at an academic Cancer Center from January 1, 2015 to December 31, 2015 was performed. The electronic medical record was queried for demographic, clinical characteristics, and urinary lab tests until December 2022 and entered into a REDCap database. Patient demographics and clinical characteristics were summarized using descriptive statistics. The odds ratios (OR) were obtained through binary logistic regression analysis.

Results: 334 women were diagnosed with breast cancer in 2015. Most (66.5%) had Stage I or Stage II disease and identified as white (258; 77.7%) and non-Hispanic (308; 92.8%) (Table 1). 94.3% of patients underwent breast surgery, 33.3% received chemotherapy, and 69.7% had hormonal therapy. The overall cumulative incidence of UTIs over the eight years was 9.7%. The average age at UTI diagnosis was 61 years ±12.1.The peak incidence over this period was during the year 2018. Among the patients who were diagnosed with a UTI, 11.4% and 88.6% were premenopausal and postmenopausal women, respectively. Patients who received hormonal therapy as a part of their breast cancer treatment are 1.4 times more likely to develop UTI when compared with patients without hormonal therapy. Additionally, breast cancer survivors with a family history of ovarian cancer (OR:3.4) or who had diabetes (OR:1.61) had an increased risk of having a UTI.

Conclusions: Postmenopausal breast cancer survivors receiving adjuvant hormonal therapy are at higher risk for urinary tract infections. Further studies should be conducted to investigate UTIs in this high-risk patient population to better guide treatment, diagnosis, prevention, and quality of life.