Diabetes and other comorbidities in breast cancer survival by race/ethnicity: The California Breast Cancer Survivorship Consortium (CBCSC)

Details

• Alternative Title:
  Cancer Epidemiol Biomarkers Prev
• Personal Author:
  Wu, Anna H. ; Kurian, Allison W. ; Kwan, Marilyn L. ; John, Esther M. ; Lu, Yani ; Keegan, Theresa H.M. ; Gomez, Scarlett Lin ; Cheng, Iona ; Shariff-Marco, Salma ; Caan, Bette J. ; Lee, Valerie S. ; Sullivan-Halley, Jane ; Tseng, Chiu-Chen ; Bernstein, Leslie ; Sposto, Richard ; Vigen, Cheryl
• Description:
  Background
  
  The role of comorbidities in survival of breast cancer patients has not been well studied, particularly in non-white populations.
  
  Methods
  
  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).
  
  Results
  
  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).
  
  Conclusion
  
  These results may inform future treatment guidelines for breast cancer patients with a history of diabetes or MI.
  
  Impact
  
  Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome.
  
  
• Subjects:
  Adult Aged Breast Neoplasms Cohort Studies Comorbidity Diabetes Mellitus Ethnicity Female Humans Middle Aged Proportional Hazards Models Survival Rate

  More +
• Source:
  Cancer Epidemiol Biomarkers Prev. 24(2):361-368.
• Pubmed ID:
  25425578
• Pubmed Central ID:
  PMC4523272
• Document Type:
  Journal Article
• 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
• Place as Subject:
  California
• Volume:
  24
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:deb76f097763f170a830720162a963e05933a61f4cf95ebd2cb5a8f995390e91
• Download URL:
  https://stacks.cdc.gov/view/cdc/32608/cdc_32608_DS1.pdf
• File Type:
  [PDF - 402.92 KB ]