Diabetes and other comorbidities in breast cancer survival by race/ethnicity: The California Breast Cancer Survivorship Consortium (CBCSC)
Published Date:Nov 25 2014
Source:Cancer Epidemiol Biomarkers Prev. 24(2):361-368.
Pubmed Central ID:PMC4523272
Funding:1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
HHSN261201000140C/PHS HHS/United States
HHSN26120100034C/PHS HHS/United States
HHSN26120100035C/PHS HHS/United States
K05 CA136967/CA/NCI NIH HHS/United States
N01-HD-3-3175/HD/NICHD NIH HHS/United States
N01CN25403/CN/NCI NIH HHS/United States
R01 CA077398/CA/NCI NIH HHS/United States
R01 CA129059/CA/NCI NIH HHS/United States
R01 CA54281/CA/NCI NIH HHS/United States
R01 CA63446/CA/NCI NIH HHS/United States
R01 CA77305/CA/NCI NIH HHS/United States
R01 CA77398/CA/NCI NIH HHS/United States
R37CA54281/CA/NCI NIH HHS/United States
UM1 CA164973/CA/NCI NIH HHS/United States
The role of comorbidities in survival of breast cancer patients has not been well studied, particularly in non-white populations.
We investigated the association of specific comorbidities with mortality in a multiethnic cohort of 8,952 breast cancer cases within the California Breast Cancer Survivorship Consortium (CBCSC), which pooled questionnaire and cancer registry data from five California-based studies. In total, 2,187 deaths (1,122 from breast cancer) were observed through December 31, 2010. Using multivariable Cox proportional hazards regression, we estimated hazards ratios (HR) and 95% confidence intervals (CI) for overall and breast cancer-specific mortality associated with previous cancer, diabetes, high blood pressure (HBP), and myocardial infarction (MI).
Risk of breast cancer-specific mortality increased among breast cancer cases with a history of diabetes (HR=1.48, 95% CI=1.18, 1.87) or MI (HR=1.94, 95% CI=1.27–2.97). Risk patterns were similar across race/ethnicity (non-Latina White, Latina, African American and Asian American), body size, menopausal status, and stage at diagnosis. In subgroup analyses, risk of breast cancer-specific mortality was significantly elevated among cases with diabetes who received neither radiation nor chemotherapy (HR=2.11, 95% CI=1.32–3.36); no increased risk was observed among those who received both treatments (HR=1.13, 95% CI= 0.70–1.84) (P interaction= 0.03). A similar pattern was found for MI by radiation and chemotherapy (P interaction=0.09).
These results may inform future treatment guidelines for breast cancer patients with a history of diabetes or MI.
Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome.
You May Also Like: