The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, 1124 W. Carson Street, Building N-18, Torrance, CA, 90502, USA.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Breast Cancer Res Treat. 2020 Apr;180(3):767-775. doi: 10.1007/s10549-020-05576-8. Epub 2020 Feb 19.
Cross-sectional studies suggest that falls are prevalent among older breast cancer survivors. However, fall risk in this population has not been comprehensively examined. Therefore, we compared fall risk in older women post-breast cancer diagnosis to fall risk before cancer diagnosis and to risk in cancer-free matched controls.
Among 2019 women in the Women's Health Initiative with localized breast cancer diagnosed at age ≥ 60 years with fall assessment data for 3 years pre-diagnosis and 3 years post-diagnosis, recurrent fall risk post-diagnosis was compared to risk in 2019 cancer-free controls matched by age, year of WHI entry, and baseline fall frequency. Generalized estimating equations under a logistic regression model were used to compare fall recurrence in breast cancer survivors and controls. Multi-variable models were adjusted for the matching factors, race/ethnicity, body mass index, and multiple chronic conditions.
In breast cancer survivors aged 70.8 years (mean) at diagnosis, over the 3-year pre-diagnosis interval, recurrent falls were reported by 18.5%. Over the 3-year post-diagnosis interval, recurrent falls were reported by 21.8% of breast cancer survivors and 20.0% of controls over the same time period (P = 0.27). Recurrent fall risk did not differ between breast cancer survivors and control women (OR 1.07, 95% CI 0.92-1.25), even after multi-variable adjustment.
In contrast to prior reports, older breast cancer survivors were not more likely to experience recurrent falls than age-matched counterparts. These findings underscore the need for incorporation of cancer-free control populations in survivorship studies to distinguish cancer sequelae from processes related to aging.
横断面研究表明，跌倒在老年乳腺癌幸存者中较为普遍。然而，该人群的跌倒风险尚未得到全面评估。因此，我们比较了老年乳腺癌患者诊断后与诊断前以及与无癌匹配对照者的跌倒风险。
在年龄≥60 岁且有跌倒评估数据的 2019 名妇女健康倡议（Women's Health Initiative，WHI）局部乳腺癌患者中，有 2019 名患者在诊断前 3 年和诊断后 3 年内有复发性跌倒风险，将诊断后复发性跌倒风险与无癌对照者（按年龄、WHI 入组年份和基线跌倒频率匹配）进行比较。使用逻辑回归模型下的广义估计方程比较乳腺癌幸存者和对照组的跌倒复发情况。多变量模型调整了匹配因素、种族/民族、体重指数和多种慢性疾病。
在诊断时年龄为 70.8 岁（平均）的乳腺癌幸存者中，在 3 年前瞻性间隔期内，有 18.5%的患者报告有复发性跌倒。在诊断后 3 年的间隔期内，有 21.8%的乳腺癌幸存者和 20.0%的对照组在同一时期报告有复发性跌倒（P=0.27）。即使经过多变量调整，乳腺癌幸存者和对照组女性的复发性跌倒风险没有差异（OR 1.07，95%CI 0.92-1.25）。
与之前的报告相反，老年乳腺癌幸存者复发性跌倒的可能性并不高于年龄匹配的对照组。这些发现强调了在生存研究中纳入无癌对照人群的必要性，以区分癌症后遗症与与衰老相关的过程。
