Laboratory of Molecular Diagnosis of Cancer, and Department of Medical Oncology, Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Br J Cancer. 2021 Nov;125(10):1450-1458. doi: 10.1038/s41416-021-01549-w. Epub 2021 Sep 27.
To assess the risk of cardiovascular mortality among cancer survivors who developed breast cancer as a second malignancy (BCa-2) compared with patients with first primary breast cancer (BCa-1) and the general population.
Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 1,024,047 BCa-1 and 41,744 BCa-2 patients diagnosed from the age 30 between 1975 and 2016, and the corresponding US female population (994,415,911 person-years; 5,403,551 cardiovascular deaths). Compared with the general population and BCa-1 patients, we calculated incidence rate ratios (IRRs) of cardiovascular deaths among BCa-2 patients using Poisson regression. To adjust for unmeasured confounders, we performed a nested, case-crossover analysis among BCa-2 patients who died from cardiovascular disease.
Although BCa-2 patients had a mildly increased risk of cardiovascular mortality compared with the population (IRR 1.08) and BCa-1 patients (IRR 1.15), the association was pronounced among individuals aged 30-49 years (BCa-2 vs. population: IRR 6.61; BCa-2 vs. BCa-1: IRR 3.03). The risk elevation was greatest within the first month after diagnosis, compared with the population, but comparable with BCa-1 patients. The case-crossover analysis confirmed these results.
Our findings suggest that patients with BCa-2 are at increased risk of cardiovascular mortality.
评估作为第二恶性肿瘤（BCa-2）发生乳腺癌的癌症幸存者与首次原发性乳腺癌（BCa-1）患者和普通人群相比发生心血管死亡率的风险。
使用监测、流行病学和最终结果数据库，我们进行了一项基于人群的队列研究，纳入了 1024047 例 BCa-1 和 41744 例 BCa-2 患者，诊断年龄为 30 岁，诊断时间为 1975 年至 2016 年，以及相应的美国女性人群（994415911 人年；5403551 例心血管死亡）。与普通人群和 BCa-1 患者相比，我们使用泊松回归计算了 BCa-2 患者心血管死亡的发病率比（IRR）。为了调整未测量的混杂因素，我们对死于心血管疾病的 BCa-2 患者进行了嵌套病例交叉分析。
尽管与人群（IRR1.08）和 BCa-1 患者（IRR1.15）相比，BCa-2 患者的心血管死亡风险略有增加，但在 30-49 岁的个体中，这种关联更为明显（BCa-2 与人群：IRR6.61；BCa-2 与 BCa-1：IRR3.03）。与人群相比，BCa-2 患者的风险升高最大发生在诊断后的第一个月，但与 BCa-1 患者相当。病例交叉分析证实了这些结果。
我们的研究结果表明，BCa-2 患者发生心血管死亡率的风险增加。
