Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
BMC Cancer. 2021 Jun 26;21(1):735. doi: 10.1186/s12885-021-08494-0.
Ductal carcinoma in situ (DCIS) patients are usually diagnosed through cancer screening programs, suggesting a healthy user effect. In this population-based cohort, we assessed the risk of cardiovascular events and mortality in DCIS patients.
Using the Korean National Health Insurance Service database, 13,740 women, who were initially diagnosed with DCIS between 2007 and 2013, were analyzed. A control group was matched according to age and the year of diagnosis at a 3:1 ratio (n = 41,220). Follow-up was performed until 2016. Subgroup analysis was performed according to the subsequent diagnosis of invasive breast cancer within 1 year: pure DCIS and DCIS+Invasive group.
DCIS patients were more likely to have underlying diseases, higher incomes, and to live in urban districts compared to the control group. Women diagnosed of DCIS had lower myocardial infarct risk (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.46-0.90) and lower stroke risk (HR 0.77; 95% CI 0.60-0.98) compared to the control group. This trend of lower risk was sustained after adjusting for age, income, residence and comorbidities. The mortality rate was similar between the control group and pure DCIS patients but was higher in the DCIS+Invasive group (HR 1.63; 95% CI 1.34-1.98). However, after adjusting for age, income, residence and comorbidities, mortality did not differ between the control group and DCIS+Invasive group (HR 0.99; 95% CI 0.78-1.24).
DCIS patients were at lower risk for MI and stroke compared to a control group despite a higher rate of comorbidities, which may reflect changes in health behaviour. The importance of managing pre-existing comorbidities along with DCIS treatment should be emphasized.
导管原位癌（DCIS）患者通常通过癌症筛查计划诊断，提示存在健康使用者效应。在本基于人群的队列中，我们评估了 DCIS 患者发生心血管事件和死亡的风险。
使用韩国国家健康保险服务数据库，分析了 2007 年至 2013 年间首次被诊断为 DCIS 的 13740 名女性。根据年龄和诊断年份，按 3:1 的比例匹配对照组（n=41220）。随访至 2016 年。根据 1 年内随后诊断为浸润性乳腺癌的情况进行亚组分析：单纯 DCIS 和 DCIS+浸润组。
与对照组相比，DCIS 患者更有可能患有基础疾病、收入更高，并居住在市区。与对照组相比，诊断为 DCIS 的女性发生心肌梗死的风险较低（风险比[HR]0.64；95%置信区间[CI]0.46-0.90），发生中风的风险较低（HR 0.77；95%CI 0.60-0.98）。在调整年龄、收入、居住地和合并症后，这种较低风险的趋势仍然存在。对照组和单纯 DCIS 患者的死亡率相似，但 DCIS+浸润组更高（HR 1.63；95%CI 1.34-1.98）。然而，在调整年龄、收入、居住地和合并症后，对照组和 DCIS+浸润组的死亡率没有差异（HR 0.99；95%CI 0.78-1.24）。
尽管 DCIS 患者合并症发生率较高，但与对照组相比，其发生心肌梗死和中风的风险较低，这可能反映了健康行为的变化。在治疗 DCIS 的同时，应强调管理现有合并症的重要性。
