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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

  • Epidemiology
  • Published:
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Abstract

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.

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Abbreviations

AJCC:

American Joint Committee on Cancer

BOW:

Breast Cancer Treatment Effectiveness in Older Women cohort study

CCI:

Charlson Comorbidity Index

CI:

Confidence interval

HR:

Hazard ratio

mCCI:

Modified Charlson Comorbidity Index

SEER:

Surveillance, epidemiology, and end results

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jennifer H. Jordan

  2. Section of Geriatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Soe Soe Thwin & Rebecca A. Silliman

  3. Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Healthcare System, Jamaica Plain, MA, USA

    Soe Soe Thwin

  4. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Timothy L. Lash

  5. Group Health Research Institute, Seattle, WA, USA

    Diana S. M. Buist

  6. Meyers Primary Care Institute, Worcester, MA, USA

    Terry S. Field

  7. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Reina Haque & Virginia P. Quinn

  8. HealthPartners Institute for Education and Research, Minneapolis, MN, USA

    Pamala A. Pawloski

  9. Lovelace Respiratory Research Institute, Albuquerque, NM, USA

    Hans V. Petersen

  10. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Marianne N. Prout & Marianne Ulcickas Yood

  11. Health Services and Economics Branch (HSEB), Applied Research Program (ARP), Division of Cancer Control and Prevention (DCCPS), National Cancer Institute (NCI), 9609 Medical Center Dr., MSC 9762, Rockville, MD, 20892, USA

    Ann M. Geiger

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  1. Jennifer H. Jordan
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  2. Soe Soe Thwin
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  5. Terry S. Field
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  7. Pamala A. Pawloski
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  8. Hans V. Petersen
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  9. Marianne N. Prout
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  10. Virginia P. Quinn
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  11. Marianne Ulcickas Yood
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  12. Rebecca A. Silliman
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  13. Ann M. Geiger
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Corresponding author

Correspondence to Ann M. Geiger.

Additional information

This article was prepared while Dr. Geiger was employed at Wake Forest School of Medicine. The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

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Jordan, J.H., Thwin, S.S., Lash, T.L. et al. 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. Breast Cancer Res Treat 146, 401–409 (2014). https://doi.org/10.1007/s10549-014-3021-8

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  • DOI: https://doi.org/10.1007/s10549-014-3021-8

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