Early death from breast cancer linked to worse disease characteristics
MedWire News: Patients who die from breast cancer within a month of diagnosis are more likely to be older, and have more advanced disease and comorbidities than patients who survive beyond this time, UK research shows.
Survival from major epithelial cancers such as breast cancer appears to be lower in the UK than in other European countries, note David Brewster (NHS National Services Scotland, Edinburgh) and colleagues, who add that most of this excess mortality risk occurs during the first month after diagnosis.
To examine the characteristics of patients with breast cancer who die within 30 days of diagnosis, and explore the influence of socioeconomic deprivation, comorbidity, and lifestyle on outcome, Brewster and team reviewed hospital records of patients diagnosed with the disease in Scotland between 2003 and 2007.
They identified 19,409 women with breast cancer, of whom 249 (1.4%) within 30 days of diagnosis. The majority (65.5%) of deaths were attributed to breast cancer, but other causes included other cancers (4.0%), circulatory disease (16.1%), and respiratory disease (6.0%).
Patients over 65 years of age were between 2.7 (for those aged 65-74 years) and 8.7 (for those aged 85 years and older) times more likely to die within 30 days of breast cancer diagnosis than those younger than 65 years.
The women who died within 30 days were more likely to have experienced emergency admission to hospital in the month prior to their diagnosis than those who lived longer (odds ratio [OR]=26.9).
In addition, patients who died shortly after diagnosis were less likely to have microscopically verified tumors, and more likely to have tumors of a high grade (OR=3.2 for grade III vs grade I-II) and advanced stage (OR=5.3 for stage IV vs stage I) than those who survived beyond 30 days postdiagnosis.
Socioecomonic status did not significantly affect mortality risk, which was unexpected, says the team. This finding may reflect the fact that "a high proportion of early deaths occurred in the very elderly, in an age range less commonly attained by people from deprived communities in which life expectancy is lower than average," they add.
"Further research is required to determine the precise explanation for these findings and, in particular, if any potentially avoidable factors such as delays in presentation, referral, or diagnosis exist," conclude Brewster and co-authors in the British Journal of Cancer.
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By Laura Dean