medwireNews: Cardiovascular (CV) mortality is a major competing risk in women with early-stage breast cancer, find Canadian researchers who note the particular risk for older long-term survivors and those with a history of CV mortality.
“Given the effectiveness of both primary and secondary prevention interventions for cardiovascular disease, appropriate care for women with [early-stage breast cancer] should involve counseling and preventive interventions that are proportionate to their expected cardiovascular risk”, they write.
Of 98,999 women diagnosed with early-stage breast cancer between 1998 and 2012, 21.3% died during a median follow-up of 6.6 years. Half (49.9%) of the deaths were attributed to breast cancer and 16.3% to CV causes.
Stratification by age showed that breast cancer remained the main cause of death regardless of age. But when the analysis was limited to women who survived for 5 years or more after breast cancer diagnosis, those aged at least 66 years at diagnosis were more likely to die from CV causes than breast cancer.
Moreover, among patients with established CV disease (CVD), the risks of death from breast cancer and CVD were comparable up to 5 years post-diagnosis, after which CV causes surpassed breast cancer as the leading cause of mortality. The corresponding 10-year cumulative incidence rates were 16.9% and 14.6%.
Conversely, women younger than 66 years at diagnosis with no history of CVD, hypertension or diabetes had a “negligible” risk of CV mortality in the initial 10 years following a breast cancer diagnosis, report Geoffrey Anderson (University of Toronto, Ontario) and co-investigators.
Noting that the “traditional risk factors” of age and CVD history are also strong predictors in women with early-stage breast cancer, they suggest using these “as an inexpensive initial screening tool to identify women who could most benefit from preventive interventions.”
They could also be used to “inform decisions about adjuvant endocrine therapy beyond 5 years”, Anderson et al write in JAMA Cardiology. “These agents have adverse cardiovascular effects and may not be of benefit among groups in which breast cancer carries a smaller effect on overall survival.”
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