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Cardiovascular Disease Mortality Among Breast Cancer Survivors
Patrick T Bradshaw1, June Stevens, Nikhil Khankari
1From the Departments of aNutrition and bEpidemiology, University of North Carolina, Chapel Hill, NC; cDepartment of Preventive Medicine, Mount Sinai School of Medicine, New York, NY; and dDepartments of Medicine and Epidemiology, Columbia University, New York, NY.
Insights
Breast cancer survivors face higher cardiovascular disease (CVD) mortality risk, particularly after 7 years post-diagnosis. Early identification of risk factors and interventions are crucial for this vulnerable population.
Area of Science:
- Oncology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) poses a growing concern for breast cancer survivors.
- The comparative burden and timing of CVD in survivors versus the general population are not well understood.
Purpose of the Study:
- To investigate the risk and temporal patterns of cardiovascular disease (CVD) mortality in breast cancer survivors compared to women without breast cancer.
Main Methods:
- A population-based cohort study compared 1,413 breast cancer survivors with 1,411 age-matched controls.
- Data on mortality causes and covariates were collected through the national death index and medical records.
- Cox regression and Fine-Gray models were used to calculate hazard ratios (HR) for overall and CVD-specific mortality.
Main Results:
- Breast cancer survivors had a significantly higher risk of death (HR: 1.8).
- Increased CVD mortality was observed approximately 7 years after diagnosis (cause-specific HR: 1.8, subdistribution HR: 1.9).
- Chemotherapy use was associated with increased CVD mortality in survivors.
Conclusions:
- Breast cancer survivors exhibit a heightened risk of CVD-related mortality, emerging around 7 years post-diagnosis.
- Targeted interventions during this critical window are needed to mitigate the excess CVD burden in this population.
Background:
Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown.
Methods:
We compared deaths due to CVD in a population-based sample of 1,413 women with incident breast cancer diagnosed in 1996-1997, and 1,411 age-matched women without breast cancer. Date and cause of death through December 31, 2009 were assessed through the national death index and covariate data was gathered through structured interviews and medical record abstraction. Hazard ratios (HR) and 95% confidence intervals were calculated using Cox regression for overall mortality (HR) and CVD-specific death (cause-specific HR). Subdistribution HRs for CVD death were estimated from the Fine-Gray model.
Results:
Risk of death was greater among breast cancer survivors compared with women without breast cancer (HR: 1.8 [1.5, 2.1]). An increase in CVD-related death among breast cancer survivors was evident only 7 years after diagnosis (years 0-7, cause-specific HR: 0.80 [0.53, 1.2], subdistribution HR: 0.59 [0.40, 0.87]); years 7+, cause-specific HR: 1.8 [1.3, 2.5], subdistribution HR: 1.9 [1.4, 2.7]; P interaction: 0.001). An increase in CVD-related mortality was observed among breast cancer survivors receiving chemotherapy.
Conclusions:
Breast cancer survivors are at greater risk for CVD-related mortality compared with women without breast cancer and this increase in risk is manifested approximately 7 years after diagnosis. Efforts should be made to identify risk factors and interventions that can be employed during this brief window to reduce the excess burden of CVD in this vulnerable population.
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