Department of Medicine, University of Toronto, Toronto, Ontario, Canada2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada4Division of Cardiology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA Cardiol. 2017 Jan 1;2(1):88-93. doi: 10.1001/jamacardio.2016.3841.
There is increasing interest in the effect of cardiovascular disease on cancer survivors. However, there are limited contemporary population-based data on the risk of cardiovascular death after early-stage breast cancer.
To describe the incidence of cardiovascular death in a contemporary population of women with early-stage breast cancer while accounting for competing risks.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study was conducted among 98 999 women diagnosed with early-stage breast cancer between April 1, 1998, and March 31, 2012. Patients were followed up until death or were censored on December 31, 2013. Baseline characteristics were determined from administrative databases and the Ontario Cancer registry. Vital statistics data were used to determine the cause of death. Cumulative incidence functions were used to estimate the incidence of cause-specific mortality. We studied the association between baseline characteristics and rates of cardiovascular death using cause-specific hazard functions. The analyses accounted for competing risks of noncardiovascular death. Statistical analysis was performed from July 16, 2015, to August 4, 2016.
Early-stage breast cancer, age, cardiovascular disease, hypertension, and diabetes.
Cause of death, which was classified as breast cancer, cardiovascular disease, other cancers, or other noncancer causes.
Of the 98 999 women (median age, 60 years [interquartile range, 50-71 years]) in the study, 21 123 (21.3%) died during follow-up. The median time to death was 4.2 years (IQR, 2.2-7.1 years). Breast cancer was the most common cause of death (10 550 deaths [49.9%]); 3444 deaths [16.3%] were from cardiovascular causes. Cardiovascular death was infrequent in women younger than 66 years without prior cardiovascular disease, diabetes, or hypertension. Among women 66 years or older, the risks of breast cancer death and cardiovascular death at 10 years were 11.9% (95% CI, 11.6%-12.3%) and 7.6% (95% CI, 7.3%-7.9%), respectively. Among patients with prior cardiovascular disease, the risk of death from breast cancer and cardiovascular disease were equivalent for the first 5 years, after which death from cardiovascular causes was more frequent (10-year cumulative incidence, 14.6% [95% CI, 13.7%-15.4%] for breast cancer vs 16.9% [95% CI, 16.0%-17.8%] for cardiovascular disease). For women 66 years or older who survived 5 years or more after diagnosis of breast cancer, cardiovascular disease exceeded breast cancer as the leading cause of death at 10 years after diagnosis, when the cumulative incidence of each was 5%.
Cardiovascular death is an important competing risk for older women with early-stage breast cancer. This finding mandates adequate attention to cardiovascular preventive therapy after diagnosis of breast cancer.
心血管疾病对癌症幸存者的影响越来越受到关注。然而，目前关于早期乳腺癌患者心血管死亡风险的当代人群数据有限。
描述在考虑竞争风险的情况下，早期乳腺癌女性中心血管死亡的发生率。
设计、地点和参与者：这是一项基于人群的队列研究，纳入了 98999 名于 1998 年 4 月 1 日至 2012 年 3 月 31 日期间被诊断为早期乳腺癌的女性。患者被随访至死亡或于 2013 年 12 月 31 日被删失。基线特征来自于行政数据库和安大略癌症登记处。使用生命统计数据确定死因。累积发病率函数用于估计特定原因死亡率。我们使用特定原因危害函数研究了基线特征与心血管死亡率之间的关系。分析考虑了非心血管死亡的竞争风险。统计分析于 2015 年 7 月 16 日至 2016 年 8 月 4 日进行。
早期乳腺癌、年龄、心血管疾病、高血压和糖尿病。
死因，分为乳腺癌、心血管疾病、其他癌症或其他非癌症原因。
在这项研究中的 98999 名女性（中位年龄 60 岁[四分位距，50-71 岁]）中，21123 名（21.3%）在随访期间死亡。中位死亡时间为 4.2 年（IQR，2.2-7.1 年）。乳腺癌是最常见的死因（10550 例死亡[49.9%]）；3444 例死亡[16.3%]源于心血管原因。在没有既往心血管疾病、糖尿病或高血压的 66 岁以下女性中，心血管死亡很少见。在 66 岁及以上的女性中，10 年内乳腺癌死亡和心血管死亡的风险分别为 11.9%（95%CI，11.6%-12.3%）和 7.6%（95%CI，7.3%-7.9%）。在有既往心血管疾病的患者中，前 5 年内乳腺癌和心血管疾病死亡风险相当，之后心血管疾病死亡风险更高（10 年累积发病率，乳腺癌为 14.6%[95%CI，13.7%-15.4%]，心血管疾病为 16.9%[95%CI，16.0%-17.8%]）。对于 66 岁及以上、乳腺癌诊断后存活 5 年或以上的女性，心血管疾病在诊断后 10 年成为导致死亡的主要原因，此时每种疾病的累积发生率均为 5%。
心血管死亡是老年早期乳腺癌女性的一个重要竞争风险。这一发现要求在乳腺癌诊断后充分关注心血管预防治疗。
