Breast Cancer Research and Treatment

, Volume 146, Issue 2, pp 401–409 | Cite as

Incident comorbidities and all-cause mortality among 5-year survivors of Stage I and II breast cancer diagnosed at age 65 or older: a prospective-matched cohort study

  • Jennifer H. Jordan
  • Soe Soe Thwin
  • Timothy L. Lash
  • Diana S. M. Buist
  • Terry S. Field
  • Reina Haque
  • Pamala A. Pawloski
  • Hans V. Petersen
  • Marianne N. Prout
  • Virginia P. Quinn
  • Marianne Ulcickas Yood
  • Rebecca A. Silliman
  • Ann M. Geiger


Five-year breast cancer survivors, diagnosed after 65 years of age, may develop more incident comorbidities than similar populations free of cancer. We investigated whether older breast cancer survivors have a similar comorbidity burden 6–15 years after cancer diagnosis to matched women free of breast cancer at start of follow-up and whether incident comorbidities are associated with all-cause mortality. In this prospective cohort study, 1,361 older 5-year early-stage breast cancer survivors diagnosed between 1990 and 1994 and 1,361 age- and health system-matched women were followed for 10 years. Adjudicated medical record review captured prevalent and incident comorbidities during follow-up or until death as collected from the National Death Index. Older 5-year breast cancer survivors did not acquire incident comorbidities more often than matched women free of breast cancer in the subsequent 10 years [hazard ratio (HR) 1.0, 95 % confidence interval (95 % CI) 0.93, 1.1]. Adjusted for cohort membership, women with incident comorbidities had a higher mortality rate than those without incident comorbidities (HR 4.8, 95 % CI 4.1, 5.6). A breast cancer history continued to be a hazard for mortality 6–15 years after diagnosis (HR 1.3, 95 % CI 1.1, 1.4). We found that older breast cancer survivors who developed comorbidities had an increased all-cause mortality rate even after adjusting for age and prevalent comorbidity burden. Additionally, survivors acquire comorbidities at a rate similar to older women free of breast cancer. These results highlight the association between comorbidity burden and long-term mortality risk among older breast cancer survivors and their need for appropriate oncology and primary care follow-up.


Breast cancer Survivorship Comorbidity Geriatrics Managed care Mortality 



American Joint Committee on Cancer


Breast Cancer Treatment Effectiveness in Older Women cohort study


Charlson Comorbidity Index


Confidence interval


Hazard ratio


Modified Charlson Comorbidity Index


Surveillance, epidemiology, and end results



This study was funded by Public Health Service Grant R01CA093772 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services (PI: RA Silliman). The funding sponsors played no part in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Sponsors had no access to the data and did not perform any of the study analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws of the United States of America. This study was reviewed and approved by the Institutional Review Boards of each participating institution and at the Boston University Medical Center.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jennifer H. Jordan
    • 1
  • Soe Soe Thwin
    • 2
    • 3
  • Timothy L. Lash
    • 4
  • Diana S. M. Buist
    • 5
  • Terry S. Field
    • 6
  • Reina Haque
    • 7
  • Pamala A. Pawloski
    • 8
  • Hans V. Petersen
    • 9
  • Marianne N. Prout
    • 10
  • Virginia P. Quinn
    • 7
  • Marianne Ulcickas Yood
    • 10
  • Rebecca A. Silliman
    • 2
  • Ann M. Geiger
    • 11
  1. 1.Section on Cardiovascular Medicine, Department of Internal MedicineWake Forest School of MedicineWinston-SalemUSA
  2. 2.Section of Geriatrics, Boston Medical CenterBoston University School of MedicineBostonUSA
  3. 3.Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC)VA Healthcare SystemJamaica PlainUSA
  4. 4.Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaUSA
  5. 5.Group Health Research InstituteSeattleUSA
  6. 6.Meyers Primary Care InstituteWorcesterUSA
  7. 7.Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  8. 8.HealthPartners Institute for Education and ResearchMinneapolisUSA
  9. 9.Lovelace Respiratory Research InstituteAlbuquerqueUSA
  10. 10.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  11. 11.Health Services and Economics Branch (HSEB), Applied Research Program (ARP), Division of Cancer Control and Prevention (DCCPS)National Cancer Institute (NCI)RockvilleUSA

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