Leading Cause of Death for Older Females With Breast Cancer
Leading Cause of Death for Older Females With Breast Cancer
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.
Mortality rates for breast cancer have declined since 1990. In 2006, there were about 2.5 million women in the United States who had survived breast cancer (diagnosed at any point prior to 1 January 2006). The survivorship of breast cancer patients depends on many factors, including age at diagnosis, tumor stage, tumor grade, estrogen receptor (ER) status, progesterone receptor status, socioeconomic factors and other non-cancer-related clinical conditions such as preexisting health status, functional status and social connections. Research has shown that other preexisting chronic conditions, or comorbidities, also have a significant effect on the overall survival of breast cancer patients. The current study assesses the effects of comorbidities on outcomes of breast cancer mortality and mortality from other causes among breast cancer survivors ages 66 and older.
The most commonly used outcome when conducting epidemiologic research on cancer survivorship is all-cause mortality, which, among individuals with breast cancer, is the sum of breast cancer-specific mortality and mortality from other causes. Although assigning a single cause of death is difficult and can be somewhat arbitrary, assessing outcomes for both breast cancer-specific mortality and mortality from other causes can assist healthcare providers and patients with breast cancer in assessing prognostic indicators and other decisions made in primary care. This study describes the effect of select characteristics, including comorbid conditions, on breast cancer-specific mortality compared to mortality from other causes and explores leading causes of death among breast cancer survivors.
Abstract and Introduction
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.
Introduction
Mortality rates for breast cancer have declined since 1990. In 2006, there were about 2.5 million women in the United States who had survived breast cancer (diagnosed at any point prior to 1 January 2006). The survivorship of breast cancer patients depends on many factors, including age at diagnosis, tumor stage, tumor grade, estrogen receptor (ER) status, progesterone receptor status, socioeconomic factors and other non-cancer-related clinical conditions such as preexisting health status, functional status and social connections. Research has shown that other preexisting chronic conditions, or comorbidities, also have a significant effect on the overall survival of breast cancer patients. The current study assesses the effects of comorbidities on outcomes of breast cancer mortality and mortality from other causes among breast cancer survivors ages 66 and older.
The most commonly used outcome when conducting epidemiologic research on cancer survivorship is all-cause mortality, which, among individuals with breast cancer, is the sum of breast cancer-specific mortality and mortality from other causes. Although assigning a single cause of death is difficult and can be somewhat arbitrary, assessing outcomes for both breast cancer-specific mortality and mortality from other causes can assist healthcare providers and patients with breast cancer in assessing prognostic indicators and other decisions made in primary care. This study describes the effect of select characteristics, including comorbid conditions, on breast cancer-specific mortality compared to mortality from other causes and explores leading causes of death among breast cancer survivors.
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