Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study

Jennifer L Patnaik, Tim Byers, Carolyn DiGuiseppi, Dana Dabelea, Thomas D Denberg, Jennifer L Patnaik, Tim Byers, Carolyn DiGuiseppi, Dana Dabelea, Thomas D Denberg

Abstract

Introduction: Many women who survive breast cancer die of causes unrelated to their cancer diagnosis. This study was undertaken to assess factors that are related to breast cancer mortality versus mortality from other causes and to describe the leading causes of death among older women diagnosed with breast cancer.

Methods: Women diagnosed with breast cancer at age 66 or older between 1992 and 2000 were identified in the Surveillance, Epidemiology and End Results-Medicare linked database and followed through the end of 2005.

Results: A total of 63,566 women diagnosed with breast cancer met the inclusion criteria and were followed for a median of approximately nine years. Almost one-half (48.7%) were alive at the end of follow-up. Ages and comorbidities at the time of diagnosis had the largest effects on mortality from other causes, while tumor stage, tumor grade, estrogen receptor status, age and comorbidities at the time of diagnosis all had effects on breast cancer-specific mortality. Fully adjusted relative hazards of the effects of comorbidities on breast cancer-specific mortality were 1.24 (95% confidence interval (95% CI) 1.13 to 1.26) for cardiovascular disease, 1.13 (95% CI 1.13 to 1.26) for previous cancer, 1.13 (95% CI 1.05 to 1.22) for chronic obstructive pulmonary disease and 1.10 (95% CI 1.03 to 1.16) for diabetes. Among the total study population, cardiovascular disease was the primary cause of death in the study population (15.9% (95% CI 15.6 to 16.2)), followed closely by breast cancer (15.1% (95% CI 14.8 to 15.4)).

Conclusions: Comorbid conditions contribute importantly to both total mortality and breast cancer-specific mortality among breast cancer survivors. Attention to reducing the risk of cardiovascular disease should be a priority for the long-term care of women following the diagnosis and treatment of breast cancer.

Figures

Figure 1
Figure 1
Proportional distribution of leading causes of death among breast cancer patients ages 66 years and older by age at diagnosis and by stage of disease from 1 January 1992 through 31 December 2000. CVD: cardiovascular disease.
Figure 2
Figure 2
Proportional distribution of cumulative leading causes of death by time since breast cancer diagnosis. CVD: cardiovascular disease.

References

    1. Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK, (editors) SEER Cancer Statistics Review, 1975-2006. Bethesda, MD: National Cancer Institute; 2009.
    1. Jatoi I, Chen BE, Anderson WF, Rosenber PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol. 2007;25:1683–1690. doi: 10.1200/JCO.2006.09.2106.
    1. McKenzie F, Jeffreys M. Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival? Epidemiol Rev. 2009;31:52–66. doi: 10.1093/epirev/mxp007.
    1. Dunwald LK, Rossing MA, Li CI. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res. 2007;9:R6. doi: 10.1186/bcr1639.
    1. Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data: an overview. Med Care. 2002;40(8 Suppl):IV26–IV35.
    1. Yancik R, Wesley MN, Ries LAG, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285:885–892. doi: 10.1001/jama.285.7.885.
    1. Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJC, Nieuwenhuijzen GAP, Coeborgh JWW. Less extensive treatment and inferior prognosis for breast cancer patients with comorbidity: a population-based study. Eur J Cancer. 2005;41:779–785. doi: 10.1016/j.ejca.2004.12.025.
    1. National Cancer Institute. Surveillance Epidemiology and End Results.
    1. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV3–IV18.
    1. National Cancer Institute. SEER-Medicare Linked Database.
    1. US Public Health Service. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Hyattsville, MD: National Center for Health Statistics; pp. 92–1260.
    1. American Medical Association. Physicians' Current Procedural Terminology: CPT 95. 5. Chicago: American Medical Association; 1994.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Charlson ME, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–1251. doi: 10.1016/0895-4356(94)90129-5.
    1. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619. doi: 10.1016/0895-4356(92)90133-8.
    1. Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53:1258–1267. doi: 10.1016/S0895-4356(00)00256-0.
    1. United Nations. Handbook of Vital Statistics Systems and Methods: Legal, Organization and Technical Aspects. I. New York: United Nations; 1991. Glossary, Series F, No. 35.
    1. R package NestedCohort.
    1. The State of Aging and Health in America Report. Whitehouse Station, NJ: The Merck Company Foundation; 2007. Centers for Disease Control and Prevention, The Merck Company Foundation.
    1. Centers for Disease Control and Prevention. National Vital Statistics System Mortality Data. Hyattsville, MD: National Center for Health Statistics; 2010.
    1. Azim HA, Jr, de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol. in press .
    1. Fish EB, Chapman JAW, Link MA. Competing causes of death for primary breast cancer. Ann Surg Oncol. 1998;5:368–375. doi: 10.1007/BF02303502.
    1. Chapman JW, Meng D, Shepherd L, Parulekar W, Ingle JN, Muss HB, Palmer M, Yu C, Goss PE. Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. J Natl Cancer Inst. 2008;100:252–260. doi: 10.1093/jnci/djn014.
    1. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–110.
    1. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D. Comorbidity and survival disparities among black and white patients with breast cancer. JAMA. 2005;294:1765–1772. doi: 10.1001/jama.294.14.1765.
    1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) Vol. 2. Geneva: World Health Organization; 1994.
    1. Hoel DG, Ron E, Carter R, Mabuchi K. Influence of death certificate errors on cancer mortality trends. J Natl Cancer Inst. 1993;85:1063–1068. doi: 10.1093/jnci/85.13.1063.
    1. Lenfant C, Friedman L, Thorn T. Fifty years of death certificates: the Framingham Heart Study. Ann Intern Med. 1998;129:1066–1067.
    1. Kirsner RS, Ma F, Fleming L, Federman DG, Trapido E, Duncan R, Wilkinson JD. The effect of Medicare health care delivery systems on survival for patients with breast and colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2006;15:769–773. doi: 10.1158/1055-9965.EPI-05-0838.
    1. Beck SL, Towsley GL, Caserta MS, Lindau K, Dudley WN. Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nurs. 2009;32:359–369. doi: 10.1097/NCC.0b013e3181a52533.
    1. Ganz PA. Survivorship: adult cancer survivors. Prim Care. 2009;36:721–741.
    1. Giordano SH, Hortobagyi GN. Time to remove the subspecialty blinders: breast cancer does not exist in isolation. J Natl Cancer Inst. 2008;100:230–231. doi: 10.1093/jnci/djn015.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere