Abstract
We investigated the association of major comorbidities with breast cancer outcomes using the Shanghai Breast Cancer Survival Study, a population-based, prospective cohort study of Chinese women diagnosed with breast cancer. Analyses included 4,664 women diagnosed with stage I–III incident breast cancer aged 20–75 years (median age = 51) during 2002–2006. Women were interviewed at 3–11 months post-diagnosis (median = 6.4) and followed up by in-person interviews and linkage with the vital statistics registry. Multivariable hazard ratios (HRs) and (95 % confidence intervals (CIs)) for the associations of comorbidities with breast cancer outcomes were estimated using Cox regression models. After a median follow-up of 5.3 years (range: 0.64–8.9), 647 women died (516 from breast cancer) and 632 recurrence/metastases were documented. The main comorbidities reported included: hypertension (22.4 %), chronic gastritis (14.3 %), diabetes mellitus (6.2 %), chronic bronchitis/asthma (5.8 %), coronary heart disease (5.0 %), and stroke (2.2 %). Diabetes was associated with increased risk of total mortality (adjusted HR: 1.40 (1.06–1.85)) and non-breast cancer mortality (adjusted HR: 2.64 (1.63–4.27)), but not breast cancer-specific mortality (adjusted HR: 0.98 (0.68–1.41)), adjusting for socio-demographics, clinical characteristics, selected lifestyle factors, and other comorbidities. Women with a history of stroke had a non-significant increased risk of total mortality (adjusted HR: 1.42 (0.91–2.22)) and a significant increased risk of non-breast cancer mortality (adjusted HR: 2.52 (1.33–4.78)), but not breast cancer-specific mortality (adjusted HR: 0.78 (0.38–1.62)). Overall, none of the comorbidities investigated were significantly associated with recurrence. In this large prospective cohort of breast cancer survivors, diabetes was significantly associated with increased risk of total and non-breast cancer mortality, and history of stroke was associated with increased risk of non-breast cancer mortality.
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Abbreviations
- BMI:
-
Body mass index
- CVD:
-
Cardiovascular disease
- CCI:
-
Charlson comorbidity index
- CIs:
-
Confidence intervals
- CHD:
-
Coronary heart disease
- ER:
-
Estrogen receptor
- LACE:
-
Life After Cancer Epidemiology
- HRs:
-
Hazard ratios
- PR:
-
Progesterone receptor
- SBCSS:
-
Shanghai Breast Cancer Survival Study
- WHEL:
-
Women’s Healthy Eating & Living
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Acknowledgments
The authors wish to thank the participants and research staff of the Shanghai Breast Cancer Survival Study. This study was supported by grants from the Department of Defense Breast Cancer Research Program (DAMD 17-02-1-0607) and the National Cancer Institute (R01 CA118229). SN was partly supported by grant 5K12ES015855 from the National Institute of Environmental Health Sciences.
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The authors declare that they have no conflicts of interest.
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Nechuta, S., Lu, W., Zheng, Y. et al. Comorbidities and breast cancer survival: a report from the Shanghai Breast Cancer Survival Study. Breast Cancer Res Treat 139, 227–235 (2013). https://doi.org/10.1007/s10549-013-2521-2
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DOI: https://doi.org/10.1007/s10549-013-2521-2