Katuwal Sushmita, Jousilahti Pekka, Pukkala Eero
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Department of Public Health Solutions, Finnish Institute of Health and Welfare, Helsinki, Finland.
Int J Cancer. 2021 Apr 22. doi: 10.1002/ijc.33607.
Our study aims to assess mortality from causes other than breast cancer among women with breast cancer with focus on indications of joint aetiology. Data on female breast cancer patients were obtained from the Finnish Cancer Registry and their underlying causes of death in 54 categories from the Statistics Finland. Standardised mortality ratios (SMR) and their 95% confidence intervals (CIs) were calculated for 50 481 patients diagnosed between 1971 and 2000 and followed until December 2012, stratified by histology, age at diagnosis and time since diagnosis. The expected numbers of deaths were based on respective mortality rates among the Finnish general population. Hazard ratio (HR) was estimated from Poisson regression model to compare risks of cause of death by histology. 41% of 30 841 deaths were due to causes other than breast cancer. Significant excess mortality was observed for stomach cancer (SMR 1.43, 95% CI 1.26-1.62), circulatory system diseases (SMR 1.17, 95% CI 1.14-1.20) and suicide (SMR 1.51, 95% CI 1.28-1.78). In an age-adjusted analysis, significantly higher relative risk of stomach cancer mortality was observed for lobular vs ductal subtype (HR 2.00, 95% CI 1.32-3.02). Significantly increased SMRs were observed for cancers of respiratory organs among premenopausal women, and for other respiratory system diseases, dementia and Alzheimer disease among postmenopausal women. We conclude that female breast cancer patients are at increased risk of death from causes other than the breast cancer diagnosis including circulatory and respiratory system diseases and cancer of stomach, ovary and respiratory systems. The excess mortality because of different causes varies based on menopausal status and histology. There might be shared aetiological factors between the diagnosis of breast cancer and the causes of death among these patients.
我们的研究旨在评估乳腺癌女性患者中除乳腺癌以外其他病因导致的死亡率，重点关注共同病因的指征。女性乳腺癌患者的数据来自芬兰癌症登记处，其潜在死因来自芬兰统计局的54个类别。计算了1971年至2000年间诊断出的50481名患者的标准化死亡率（SMR）及其95%置信区间（CI），并随访至2012年12月，按组织学、诊断时年龄和诊断后时间进行分层。预期死亡人数基于芬兰普通人群的相应死亡率。通过泊松回归模型估计风险比（HR），以比较不同组织学类型的死因风险。30841例死亡中有41%是由乳腺癌以外的原因导致的。观察到胃癌（SMR 1.43，95% CI 1.26 - 1.62）、循环系统疾病（SMR 1.17，95% CI 1.14 - 1.20）和自杀（SMR 1.51，95% CI 1.28 - 1.78）的死亡率显著过高。在年龄调整分析中，小叶型与导管型亚型相比，胃癌死亡的相对风险显著更高（HR 2.00，95% CI 1.32 - 3.02）。绝经前女性的呼吸器官癌症以及绝经后女性的其他呼吸系统疾病、痴呆和阿尔茨海默病的SMR显著升高。我们得出结论，女性乳腺癌患者死于乳腺癌诊断以外原因的风险增加，包括循环和呼吸系统疾病以及胃癌、卵巢癌和呼吸系统癌症。不同原因导致的额外死亡率因绝经状态和组织学类型而异。这些患者中乳腺癌诊断与死因之间可能存在共同的病因因素。
