Long-Term Risk of Death From Heart Disease Among Breast Cancer Patients

Abstract

BackgroundMost breast cancer patients die of non-cancer causes. The risk of death from heart disease, a leading cause of death, is unknown. The aim of this study is to characterize the long-term risk of fatal heart disease in breast cancer patients.MethodsThis retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database. Standard mortality ratios (SMR) were calculated for breast cancer patients diagnosed from 1992 to 2014. Patients were stratified by receipt of radiotherapy and/or chemotherapy, disease laterality, and diagnosis era. Hazard ratios (HRs) and odds ratios (ORs) were calculated to compare the risk of death from heart disease among other breast cancer patients.ResultsThere were 1,059,048 patients diagnosed with breast cancer from 1992 to 2014, of which 47,872 (4.6%) died from heart disease. The SMR for death from heart disease at 10+ years for patients who received only radiotherapy was 2.92 (95% CI 2.81–3.04, p < 0.001) and in patients who received only chemotherapy was 5.05 (95% CI 4.57–5.55, p < 0.001). There was no statistically significant difference in SMR for death from heart disease for left-sided vs. right-sided disease. At 10+ years, heart disease made up 28% of deaths from non-primary cancer. HRs and ORs showed that the risk of death from heart disease was highest in patients older than 70 years of age and with longer follow-up.ConclusionThe risk of fatal heart disease was highest in older breast cancer patients with longer follow-up (i.e., >5–10 years) and who received chemotherapy. These patients should be referred to cardio-oncology clinics to mitigate this risk.

Ten-Year Probabilities of Death Due to Cancer and Cardiovascular Disease among Breast Cancer Patients Diagnosed in North-Eastern Spain

“…In the 2005-2009 cohort, deaths from acute myocardial infarction (n = 13), other ischaemic diseases of the heart (n = 12), heart failure (n = 23), and other heart diseases (n = 28) were the largest contributing causes to CVD mortality. Our results show that the risk of death from CVD-mainly heart disease-was related to age, since 90% of our cohort who died due to CVD were over 75 years of age when they were diagnosed with BC and had a longer follow-up than the patients who died from the other significant causes of death (see Supplementary Material Figure S2), which is consistent with other studies carried out in the USA [17]. In another recent study in the USA, the time trend of CVD mortality risk increased in regional-advanced BCs treated with chemotherapy and/or RT [60].…”

“…Previous studies evaluating non-BC deaths in BC patients have shown that other cancers, mainly metastases to the liver, lung, and brain, as well as CVD, pulmonary, and gastrointestinal diseases, contributed to the increased risk of death [9][10][11][12][13]17,30,31]. Below, we discuss our results around three categories of causes of death: (i) cancer, (ii) CVD, and (iii) other causes, focusing on the role of CVD as a competing risk of death to cancer.…”

“…CVD emerges as the second competing risk of death among BC survivors after BC. The risk of death from heart diseases in BC patients has been clearly established in a large cohort study carried out in the USA [17]. In the 2005-2009 cohort, deaths from acute myocardial infarction (n = 13), other ischaemic diseases of the heart (n = 12), heart failure (n = 23), and other heart diseases (n = 28) were the largest contributing causes to CVD mortality.…”

“…These studies have shown that cardiovascular, pulmonary, and gastrointestinal diseases; second tumours in the ovary and endometrium; and metastases to the liver and lung are the most common causes of death in BC patients [9][10][11][12][13]. Among the causes of non-BC death, evidence suggests that with longer follow-up, CVD could compete with cancer as the leading cause of death due to potential comorbid conditions in BC patients [13,17]. In a previous study, we analysed the causes of death in BC patients diagnosed from 1985 to 2004 using data from two historical population-based cancer registries in Girona and Tarragona (Spain) [12].…”

Impact of surrogate molecular biological subtype on breast cancer survival: in-depth epidemiological analysis based on the Archangelsk regional cancer registry data

“…и A. Agha и соавт. [31,32,33] было показано, что риск смерти от ССЗ у больных РМЖ в 2-6 раз превышает таковой у женщин сравнимого возраста в общей популяции. Ранее в исследовании Л.Е.…”