Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Cancer. 2013 Apr 15;119(8):1478-85. doi: 10.1002/cncr.27914. Epub 2012 Dec 26.
Of the approximately 2.4 million American women with a history of breast cancer, 43% are aged ≥ 65 years and are at risk for developing subsequent malignancies.
Women from 6 geographically diverse sites included 5-year breast cancer survivors (N = 1361) who were diagnosed between 1990 and 1994 at age ≥ 65 years with stage I or II disease and a comparison group of women without breast cancer (N = 1361). Women in the comparison group were age-matched and site-matched to breast cancer survivors on the date of breast cancer diagnosis. Follow-up began 5 years after the index date (survivor diagnosis date or comparison enrollment date) until death, disenrollment, or through 15 years after the index date. Data were collected from medical records and electronic sources (cancer registry, administrative, clinical, National Death Index). Analyses included descriptive statistics, crude incidence rates, and Cox proportional hazards regression models for estimating the risk of incident malignancy and were adjusted for death as a competing risk.
Survivors and women in the comparison group were similar: >82% were white, 55% had a Charlson Comorbidity Index of 0, and ≥ 73% had a body mass index ≤ 30 kg/m(2) . Of all 306 women (N = 160 in the survivor group, N = 146 in the comparison group) who developed a first incident malignancy during follow-up, the mean time to malignancy was similar (4.37 ± 2.81 years vs 4.03 ± 2.76 years, respectively; P = .28), whereas unadjusted incidence rates were slightly higher in survivors (1882 vs 1620 per 100,000 person years). The adjusted hazard of developing a first incident malignancy was slightly elevated in survivors in relation to women in the comparison group, but it was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.94-1.47).
Older women who survived 5 years after an early stage breast cancer diagnosis were not at an elevated risk for developing subsequent incident malignancies up to 15 years after their breast cancer diagnosis.
在美国约 240 万有乳腺癌病史的女性中，43%的年龄≥65 岁，有发展为后续恶性肿瘤的风险。
来自 6 个地理位置不同的地点的女性包括 5 年乳腺癌幸存者（N=1361），她们在 1990 年至 1994 年期间被诊断为年龄≥65 岁、疾病分期为 I 期或 II 期的早期乳腺癌，以及无乳腺癌的对照组女性（N=1361）。对照组女性在乳腺癌诊断日期与乳腺癌幸存者年龄匹配和地点匹配。随访从指数日期（幸存者诊断日期或对照登记日期）开始，持续 5 年，直至死亡、退出或指数日期后 15 年。数据来自病历和电子来源（癌症登记处、行政、临床、国家死亡索引）。分析包括描述性统计、粗发病率和 Cox 比例风险回归模型，用于估计新发恶性肿瘤的风险，并调整死亡作为竞争风险。
幸存者和对照组女性相似：>82%为白人，55%Charlson 合并症指数为 0，≥73%的体重指数≤30kg/m²。在所有 306 名（幸存者组 160 名，对照组 146 名）在随访期间发生首次新发恶性肿瘤的女性中，恶性肿瘤的平均时间相似（分别为 4.37±2.81 年和 4.03±2.76 年；P=0.28），但幸存者的未调整发病率略高（每 100000 人年 1882 例和 1620 例）。与对照组女性相比，幸存者新发恶性肿瘤的风险略高，但无统计学意义（危险比，1.17；95%置信区间，0.94-1.47）。
早期乳腺癌诊断后存活 5 年以上的老年女性在乳腺癌诊断后 15 年内发展为新发恶性肿瘤的风险没有升高。
