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Comorbidities and breast cancer survival: a report from the Shanghai Breast Cancer Survival Study

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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

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide. Lyon, France: International Agency for Research on Cancer. Available from: http://globocan.iarc.fr. Accessed 07 June 2012

  2. American Cancer Society (2012) Breast cancer facts & figures 2011–2012. American Cancer Society, Atlanta

    Google Scholar 

  3. Anderson G, Horvath J (2004) The growing burden of chronic disease in America. Public Health Rep 119:263–270

    Article  PubMed  Google Scholar 

  4. Harlan LC, Klabunde CN, Ambs AH, Gibson T, Bernstein L, McTiernan A, Meeske K, Baumgartner KB, Ballard-Barbash R (2009) Comorbidities, therapy, and newly diagnosed conditions for women with early stage breast cancer. J Cancer Surviv 3:89–98

    Article  PubMed  Google Scholar 

  5. Patnaik JL, Byers T, DiGuiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer I 103:1101–1111

    Article  Google Scholar 

  6. Sheppard AJ, Chiarelli AM, Marrett LD, Nishri ED, Trudeau ME (2011) Stage at diagnosis and comorbidity influence breast cancer survival in first nations women in Ontario, Canada. Cancer Epidem Biomar 20:2160–2167

    Article  Google Scholar 

  7. Land LH, Dalton SO, Jensen MB, Ewertz M (2012) Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008. Breast Cancer Res Treat 131:1013–1020

    Article  PubMed  Google Scholar 

  8. Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast-cancer. Ann Intern Med 120:104–110

    Article  PubMed  CAS  Google Scholar 

  9. Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41:779–785

    Article  PubMed  CAS  Google Scholar 

  10. Patterson RE, Flatt SW, Saquib N, Rock CL, Caan BJ, Parker BA, Laughlin GA, Erickson K, Thomson CA, Bardwell WA et al (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122:859–865

    Article  PubMed  Google Scholar 

  11. Land LH, Dalton SO, Jorgensen TL, Ewertz M (2012) Comorbidity and survival after early breast cancer. A review. Crit Rev Oncol Hematol 81:196–205

    Article  PubMed  Google Scholar 

  12. West DW, Satariano WA, Ragland DR, Hiatt RA (1996) Comorbidity and breast cancer survival: a comparison between black and white women. Ann Epidemiol 6:413–419

    Article  PubMed  CAS  Google Scholar 

  13. Nagel G, Wedding U, Rohrig B, Katenkamp D (2004) The impact of comorbidity on the survival of postmenopausal women with breast cancer. J Cancer Res Clin Oncol 130:664–670

    Article  PubMed  CAS  Google Scholar 

  14. Houterman S, Janssen-Heijnen MLG, Verheij CDGW, Louwman WJ, Vreugdenhil G, van der Sangen MJC, Coebergh JWW (2004) Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Brit J Cancer 90:2332–2337

    PubMed  CAS  Google Scholar 

  15. Maskarinec G, Pagano IS, Yamashiro G, Issell BF (2003) Influences of ethnicity, treatment, and comorbidity on breast cancer survival in Hawaii. J Clin Epidemiol 56:678–685

    Article  PubMed  Google Scholar 

  16. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291:2441–2447

    Article  PubMed  CAS  Google Scholar 

  17. Cronin-Fenton DP, Norgaard M, Jacobsen J, Garne JP, Ewertz M, Lash TL, Sorensen HT (2007) Comorbidity and survival of Danish breast cancer patients from 1995 to 2005. Br J Cancer 96:1462–1468

    PubMed  CAS  Google Scholar 

  18. Dalton SO, Ross L, Duering M, Carlsen K, Mortensen PB, Lynch J, Johansen C (2007) Influence of socioeconomic factors on survival after breast cancer—a nationwide cohort study of women diagnosed with breast cancer in Denmark 1983–1999. Int J Cancer 121:2524–2531

    Article  PubMed  CAS  Google Scholar 

  19. Berglund A, Wigertz A, Adolfsson J, Ahlgren J, Fornander T, Warnberg F, Lambe M (2012) Impact of comorbidity on management and mortality in women diagnosed with breast cancer. Breast Cancer Res Treat 135:281–289

    Article  PubMed  Google Scholar 

  20. Braithwaite D, Tammemagi CM, Moore DH, Ozanne EM, Hiatt RA, Belkora J, West DW, Satariano WA, Liebman M, Esserman L (2009) Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer 124:1213–1219

    Article  PubMed  CAS  Google Scholar 

  21. McCaskill-Stevens W, Abrams JS (2011) Comorbidities in the aging breast cancer population: are current assessments leading to improved outcomes? J Natl Cancer I 103:1072–1073

    Article  Google Scholar 

  22. Yancik R, Wesley MN, Ries LAG, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. J Am Med Assoc 285:885–892

    Article  CAS  Google Scholar 

  23. Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW (2007) Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 43:2179–2193

    Article  PubMed  Google Scholar 

  24. Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13(3):R64

    Article  PubMed  Google Scholar 

  25. Shu XO, Zheng Y, Cai H, Gu K, Chen Z, Zheng W, Lu W (2009) Soy food intake and breast cancer survival. JAMA 302:2437–2443

    Article  PubMed  Google Scholar 

  26. Gupta V, Gu K, Chen Z, Lu W, Shu XO, Zheng Y (2011) Concordance of self-reported and medical chart information on cancer diagnosis and treatment. BMC Med Res Methodol 11:72

    Article  PubMed  Google Scholar 

  27. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S504

    Article  PubMed  CAS  Google Scholar 

  28. Korn EL, Graubard BI, Midthune D (1997) Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 145:72–80

    Article  PubMed  CAS  Google Scholar 

  29. Kleinbaum D, Klien M (2005) Survival analysis: a self-learning text. Springer Science+Business Media, New York

    Google Scholar 

  30. Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, Caan BJ (2012) Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer Epidemiol Biomarkers Prev 21:1115–1125

    Article  PubMed  Google Scholar 

  31. Ganz PA, Habel LA, Weltzien EK, Caan BJ, Cole SW (2011) Examining the influence of beta blockers and ACE inhibitors on the risk for breast cancer recurrence: results from the LACE cohort. Breast Cancer Res Treat 129:549–556

    Article  PubMed  CAS  Google Scholar 

  32. Lipscombe LL, Goodwin PJ, Zinman B, McLaughlin JR, Hux JE (2008) The impact of diabetes on survival following breast cancer. Breast Cancer Res Treat 109:389–395

    Article  PubMed  Google Scholar 

  33. Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108

    Article  PubMed  Google Scholar 

  34. Holmes MD, Chen WY (2012) Hiding in plain view: the potential for commonly used drugs to reduce breast cancer mortality. Breast Cancer Res 14:216

    Article  PubMed  CAS  Google Scholar 

  35. Powe DG, Voss MJ, Zanker KS, Habashy HO, Green AR, Ellis IO, Entschladen F (2010) Beta-blocker drug therapy reduces secondary cancer formation in breast cancer and improves cancer specific survival. Oncotarget 1:628–638

    PubMed  Google Scholar 

  36. Barron TI, Connolly RM, Sharp L, Bennett K, Visvanathan K (2011) Beta blockers and breast cancer mortality: a population-based study. J Clin Oncol 29:2635–2644

    Article  PubMed  CAS  Google Scholar 

  37. Melhem-Bertrandt A, Chavez-MacGregor M, Lei XD, Brown EN, Lee RT, Meric-Bernstam F, Sood AK, Conzen SD, Hortobagyi GN, Gonzalez-Angulo AM (2011) Beta-blocker use is associated with improved relapse-free survival in patients with triple-negative breast cancer. J Clin Oncol 29:2645–2652

    Article  PubMed  CAS  Google Scholar 

  38. Chae YK, Valsecchi ME, Kim J, Bianchi AL, Khemasuwan D, Desai A, Tester W (2011) Reduced risk of breast cancer recurrence in patients using ace inhibitors, ARBs, and/or statins. Cancer Invest 29:585–593

    Article  PubMed  CAS  Google Scholar 

  39. Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34:73–84

    Article  PubMed  CAS  Google Scholar 

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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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Correspondence to Sarah Nechuta.

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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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