Angelov Ivan, Haas Allen M, Brock Elizabeth, Luo Lingfeng, Zhao Jing, Smith Benjamin D, Giordano Sharon H, Leeper Nicholas J, Nead Kevin T
Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston.
School of Medicine, Baylor College of Medicine, Houston, Texas.
JAMA Netw Open. 2025 Jan 2;8(1):e2452890. doi: 10.1001/jamanetworkopen.2024.52890.
Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the US. Large-scale population-based and mechanistic studies support a direct effect of CVD on accelerated tumor growth and spread, specifically in breast cancer.
To assess whether individuals presenting with advanced breast cancers are more likely to have prevalent CVD compared with those with early-stage breast cancers at the time of diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: This population-based case-control study used data from the Surveillance, Epidemiology, and End Results-Medicare linked databases from 2009 to 2020. The analysis was completed from May 2023 to August 2024. Participants were female patients aged at least 66 years diagnosed with invasive breast cancer. Cases were matched with controls by breast cancer stage at diagnosis and propensity scores using factors known to be associated with delayed cancer diagnosis.
Prevalent CVD prior to breast cancer diagnosis.
The outcome of interest was the odds of locally advanced (T3-4 or N+) or metastatic (M+) breast cancer status at diagnosis.
The full analytic cohort included 19 292 matched individuals, with median (IQR) age 73 (70-79) years, of whom 1676 (8.7%) were Black and 16 681 (86.5%) were White; 9478 individuals (49.1%) had prevalent CVD. Propensity score-matched, multivariable-adjusted models found that individuals with locally advanced or metastatic breast cancer at diagnosis had statistically significantly increased odds of prevalent CVD (odds ratio [OR], 1.10; 95% CI, 1.03-1.17; P = .007). This association was observed among hormone receptor-positive (OR, 1.11; 95% CI, 1.03-1.19; P = .006) but not hormone receptor-negative (OR, 1.02; 95% CI, 0.86-1.21; P = .83) breast cancer. ORs were directionally consistent when separately examining locally advanced (OR, 1.09; 95% CI, 1.02-1.17; P = .02) and metastatic (OR, 1.20; 95% CI, 0.94-1.54; P = .15) disease, among all receptor subtypes.
This case-control study found that individuals with more advanced breast cancer at diagnosis were more likely to have prevalent CVD. This finding may be specific to hormone receptor-positive and ERBB2-negative (formerly HER2) disease. Future studies are needed to confirm these findings and investigate interventions to improve patient outcomes, including personalized cancer screening.
心血管疾病（CVD）和癌症是美国主要的死亡原因。大规模的基于人群的研究和机制研究支持心血管疾病对肿瘤加速生长和扩散有直接影响，特别是在乳腺癌中。
评估与诊断时患有早期乳腺癌的个体相比，患有晚期乳腺癌的个体在诊断时是否更有可能患有心血管疾病。
设计、设置和参与者：这项基于人群的病例对照研究使用了2009年至2020年监测、流行病学和最终结果 - 医疗保险链接数据库中的数据。分析于2023年5月至2024年8月完成。参与者为年龄至少66岁、被诊断患有浸润性乳腺癌的女性患者。病例与对照根据诊断时的乳腺癌分期和倾向评分进行匹配，使用已知与癌症诊断延迟相关的因素。
乳腺癌诊断前存在的心血管疾病。
感兴趣的结局是诊断时局部晚期（T3 - 4或N +）或转移性（M +）乳腺癌状态的比值比。
完整的分析队列包括19292名匹配个体，年龄中位数（IQR）为73（70 - 79）岁，其中1676名（8.7%）为黑人，16681名（86.5%）为白人；9478名个体（49.1%）患有心血管疾病。倾向评分匹配的多变量调整模型发现，诊断时患有局部晚期或转移性乳腺癌的个体患心血管疾病的比值比在统计学上显著增加（比值比[OR]，1.10；95%置信区间，1.03 - 1.17；P = 0.007）。这种关联在激素受体阳性（OR，1.11；95%置信区间，1.03 - 1.19；P = 0.006）的乳腺癌中观察到，但在激素受体阴性（OR，1.02；95%置信区间，0.86 - 1.21；P = 0.83）的乳腺癌中未观察到。在分别检查局部晚期（OR，1.09；95%置信区间，
