美国乳腺癌幸存者中与治疗相关的心脏病死亡的种族和民族差异。
Racial and ethnic disparities in treatment-related heart disease mortality among US breast cancer survivors.
机构信息
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
出版信息
JNCI Cancer Spectr. 2023 Mar 1;7(2). doi: 10.1093/jncics/pkad024.
BACKGROUND
Racial and ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described.
METHODS
We included 739 557 women diagnosed with first primary invasive breast cancer between 2000 and 2017 (aged 18-84 years, received surgery, survived ≥1 year, followed through 2018) in the Surveillance, Epidemiology, and End Results-18 database. Standardized mortality ratios (SMRs; observed over expected) were calculated by race and ethnicity (non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHPI]; non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy with surgery; chemotherapy, radiotherapy, with surgery; and radiotherapy with surgery) compared with the racial- and ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks.
RESULTS
SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy with surgery (SMR range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, with surgery (SMR = 1.29; 95% confidence interval [CI] = 1.11 to 1.48), whereas SMRs were less than 1 for White women (SMR range = 0.70-0.96). SMRs were especially high for women with advanced (regional or distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy with surgery (range = 1.28-3.61). Non-White women diagnosed at younger than age 60 years had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor-positive breast cancers. Black women had the highest 10-year cumulative risk of heart disease mortality: aged younger than 60 years (Black: 1.78%, 95% CI = 1.63% to 1.94%) compared with White, AANHPI, and Latina women (<1%) and aged 60 years and older (Black: 7.92%, 95% CI = 7.53% to 8.33%) compared with White, AANHPI, and Latina women (range = 3.90%-6.48%).
CONCLUSIONS
Our findings illuminated striking racial and ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt.
背景
乳腺癌幸存者中，初始治疗类型的心脏病死亡率存在种族和民族差异，但这一问题尚未得到充分描述。
方法
我们纳入了 Surveillance, Epidemiology, and End Results-18 数据库中 2000 年至 2017 年间诊断为第一原发性浸润性乳腺癌的 739557 名女性（年龄 18-84 岁，接受了手术，存活时间超过 1 年，并随访至 2018 年）。通过种族和民族（非西班牙裔/拉丁裔亚裔美国人、夏威夷原住民和其他太平洋岛民[AANHPI]、非西班牙裔/拉丁裔黑人[黑人]、西班牙裔/拉丁裔[拉丁裔]和非西班牙裔/拉丁裔白人[白人]）和初始治疗（仅手术、手术联合化疗、手术联合放化疗和手术联合放疗）与种族和民族匹配的一般人群相比，计算标准化死亡率比（SMR；观察值与预期值之比），并根据临床特征进行比较。通过竞争风险来估计累积心脏病死亡率。
结果
仅接受手术和化疗联合手术治疗的黑人女性和拉丁裔女性，以及接受化疗、放疗联合手术治疗的 AANHPI 女性的 SMR 较高（SMR 范围为 1.15-1.21），而白人女性的 SMR 则低于 1（SMR 范围为 0.70-0.96）。黑人女性中晚期（局部或远处）疾病患者的 SMR 尤其高（范围为 1.15-2.89），而 AANHPI 和拉丁裔女性中接受化疗联合手术治疗的患者 SMR 也较高（范围为 1.28-3.61）。黑人女性和 AANHPI 女性中诊断为雌激素受体阳性乳腺癌的患者，诊断年龄小于 60 岁的非白人女性，其 SMR 更高。黑人女性的心脏病死亡 10 年累积风险最高：年龄小于 60 岁（黑人：1.78%，95%置信区间[CI]：1.63%-1.94%），与白人、AANHPI 和拉丁裔女性（<1%）相比，年龄大于 60 岁（黑人：7.92%，95%CI：7.53%-8.33%），与白人、AANHPI 和拉丁裔女性（范围为 3.90%-6.48%）相比。
结论
我们的研究结果揭示了黑人、AANHPI 和拉丁裔乳腺癌幸存者中心血管疾病死亡率的显著种族和民族差异，尤其是在初始接受化疗后。
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