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

Abstract

IntroductionMany 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.MethodsWomen 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.ResultsA 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)).ConclusionsComorbid 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.

Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis

“…30 Therefore, modifiable risk factors and poor lifestyle choices can ultimately contribute to an increased cardiovascular disease risk among breast cancer survivors. 4,8,29,42 Additional studies indicated that African American breast cancer survivors were at an increased cardiovascular disease risk compared to other races. 23,31,36 Having a first-degree family history of heart disease also increased the cardiovascular disease risk.…”

“…Cardiovascular disease risk was often conceptually defined as incidence of cardiovascular diseases including ischemic heart disease, congestive heart failure, myocardial infarction, coronary artery disease, stroke, angina, atrial fibrillation, paroxysmal tachycardia, nonrheumatic valve disease, cardiomyopathy, aortic aneurysm, and arteriosclerosis. [3][4]8,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] While one study included angina as a cardiovascular disease risk factor, 15 Darby et al indicated that angina would not be included as a risk factor due to difficulty with clinical identification of angina. 19 Other investigators conceptually defined cardiovascular disease risk as the presence of cardiovascular disease risk factors including smoking and having an overweight or obese body mass index.…”

“…Incidence of cardiovascular diseases using morbidity and mortality was a common measure of cardiovascular disease risk among breast cancer survivors. 4,8,[14][15][16][17][18][19][20][21][22][24][25][26][27]29 Authors of these studies used electronic health records, large databases, and/or linkages to death indexes as data sources. Physical measurements of cardiovascular disease risk are ideal to reduce self-report bias; however, fewer studies conducted physical measurements of cardiovascular disease risk.…”

“…6 Ninety percent of women diagnosed with breast cancer will survive for at least 5 years after diagnosis, 7 shifting the cause of death from breast cancer to other agerelated conditions such as cardiovascular diseases. 8 Breast cancer survivors are at an increased risk of cardiovascular diseases due to adverse effects from cancer treatment, such as cardiotoxicity, which may persist from the time of treatment to survivorship. 9 Despite studies exploring cardiovascular disease risk among breast cancer survivors, guidelines for monitoring and reducing cardiovascular disease risk do not exist currently for patients treated in the US.…”

Cardio-oncology for the 21st Century: Introduction

“…In fact, Patnaik and colleagues reviewed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database and found that breast cancer survivors were as likely to die from cardiovascular disease as from recurrent breast cancer. 3 Additionally, Mertens and colleagues found that cardiovascular events are the leading cause of nonmalignant deaths in survivors of childhood cancers. 4 Because of the ongoing need for recurrent cancer monitoring, the treating oncologist may be the de facto primary care physician for many oncologic patients.…”