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Medical comorbidities predict mortality in women with a history of early stage breast cancer

  • Epidemiology
  • Published:
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Abstract

This analysis was conducted to determine whether comorbid medical conditions predict additional breast cancer events and all-cause mortality in women with a history of early stage breast cancer. Women (n = 2,542) participating in a randomized diet trial completed a self-administered questionnaire regarding whether they were currently being treated for a wide variety of diseases (cardiovascular, diabetes, gallbladder, gastrointestinal, arthritis, and osteoporosis) and conditions (high blood pressure, elevated cholesterol level). Height and weight were measured at baseline. Participants were followed for a median of 7.3 years (range 0.8–15.0). Cox regression analysis was performed to assess whether comorbidities predicted disease-free and overall survival; hazard ratio (HR) was the measure of association. Overall, there were 406 additional breast cancer events and 242 deaths. Participants with diabetes had over twofold the risk of additional breast cancer events (HR 2.1, 95% CI: 1.3, 3.4) and mortality (HR 2.5, 95% CI: 1.4, 4.4). The presence of multiple comorbidities did not statistically significantly predict additional breast cancer events. However, compared to no comorbidities, participants with 3 or more comorbidities had a HR of 2.1, 95% CI: 1.3, 3.3 for mortality. In conclusion, type 2 diabetes is associated with poor breast cancer prognosis. Given that 85% of deaths were caused by breast cancer, these findings suggest that multiple comorbidities may reduce the likelihood of surviving additional breast cancer events.

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Notes

  1. Note that 74 participants were excluded from this analysis because of missing physical health data.

  2. Surveillance, Epidemiology and End Results Program.

References

  1. Ries L, Eisner M (2007) SEER survival monograph: cancer survival among adults: U.S. SEER Program, 1988–2001. In: Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-Je. National Cancer Institute, SEER Program, Bethesda, MD. NIH Pub. No. 07-6215

  2. 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(5):1213–1219

    Article  CAS  PubMed  Google Scholar 

  3. Lipscombe LL, Goodwin PJ, Zinman B, McLaughlin JR, Hux JE (2006) Increased prevalence of prior breast cancer in women with newly diagnosed diabetes. Breast Cancer Res Treat 98(3):303–309

    Article  PubMed  Google Scholar 

  4. Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285(7):885–892

    Article  CAS  PubMed  Google Scholar 

  5. Jee SH, Kim HJ, Lee J (2005) Obesity, insulin resistance and cancer risk. Yonsei Med J 46(4):449–455

    Article  CAS  PubMed  Google Scholar 

  6. Bardwell WA, Major JM, Rock CL, Newman VA, Thomson CA, Chilton JA, Dimsdale JE, Pierce JP (2004) Health-related quality of life in women previously treated for early-stage breast cancer. Psychooncology 13(9):595–604

    Article  PubMed  Google Scholar 

  7. Chan MF, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Welch A, Khaw KT (2007) Usual physical activity and endogenous sex hormones in postmenopausal women: the European prospective investigation into cancer-norfolk population study. Cancer Epidemiol Biomarkers Prev 16(5):900–905

    Article  CAS  PubMed  Google Scholar 

  8. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, Perri MG, Stanczyk FZ, Van Horn L, Wang CY (2006) Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring) 14(9):1662–1677

    Article  CAS  Google Scholar 

  9. Verkasalo PK, Thomas HV, Appleby PN, Davey GK, Key TJ (2001) Circulating levels of sex hormones and their relation to risk factors for breast cancer: a cross-sectional study in 1092 pre- and postmenopausal women (United Kingdom). Cancer Causes Control 12(1):47–59

    Article  CAS  PubMed  Google Scholar 

  10. Rock CL, Flatt SW, Laughlin GA, Gold EB, Thomson CA, Natarajan L, Jones LA, Caan BJ, Stefanick ML, Hajek RA et al (2008) Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer. Cancer Epidemiol Biomarkers Prev 17(3):614–620

    Article  CAS  PubMed  Google Scholar 

  11. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365(9453):60–62

    Article  CAS  PubMed  Google Scholar 

  12. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity a critical review of available methods. J Clin Epidemiol 56(3):221–229

    Article  PubMed  Google Scholar 

  13. Extermann M (2000) Measuring comorbidity in older cancer patients. Eur J Cancer 36(4):453–471

    Article  CAS  PubMed  Google Scholar 

  14. Extermann M (2000) Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 35(3):181–200

    Article  CAS  PubMed  Google Scholar 

  15. Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW, Kealey S, Jones VE, Caan BJ, Gold EB et al (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23(6):728–756

    Article  PubMed  Google Scholar 

  16. Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW, Rock CL, Kealey S, Al-Delaimy WK, Bardwell WA et al (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298(3):289–298 PMCID: 2083253

    Article  CAS  PubMed  Google Scholar 

  17. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  18. Michels KB, Solomon CG, Hu FB, Rosner BA, Hankinson SE, Colditz GA, Manson JE (2003) Type 2 diabetes and subsequent incidence of breast cancer in the Nurses’ Health Study. Diabetes Care 26(6):1752–1758

    Article  PubMed  Google Scholar 

  19. Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, Wolff AC, Brancati FL (2008) Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 300(23):2754–2764

    Article  CAS  PubMed  Google Scholar 

  20. WCRF (2007) Food, nutrition and the prevention of cancer: a global perspective, 2nd edn. World Cancer Research Fund, American Institute for Cancer Research, Washington, DC

  21. Heikkila K, Harris R, Lowe G, Rumley A, Yarnell J, Gallacher J, Ben-Shlomo Y, Ebrahim S, Lawlor DA (2009) Associations of circulating C-reactive protein and interleukin-6 with cancer risk: findings from two prospective cohorts and a meta-analysis. Cancer Causes Control 20(1):15–26

    Article  PubMed  Google Scholar 

  22. Barb D, Williams CJ, Neuwirth AK, Mantzoros CS (2007) Adiponectin in relation to malignancies: a review of existing basic research and clinical evidence. Am J Clin Nutr 86(3):s858–s866

    PubMed  Google Scholar 

  23. Kaaks R, Lukanova A (2001) Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proc Nutr Soc 60(1):91–106

    Article  CAS  PubMed  Google Scholar 

  24. Rosfjord EC, Dickson RB (1999) Growth factors, apoptosis, and survival of mammary epithelial cells. J Mammary Gland Biol Neoplasia 4(2):229–237

    Article  CAS  PubMed  Google Scholar 

  25. Lann D, LeRoith D (2008) The role of endocrine insulin-like growth factor-I and insulin in breast cancer. J Mammary Gland Biol Neoplasia 13(4):371–379

    Article  PubMed  Google Scholar 

  26. Hussain SP, Harris CC (2007) Inflammation and cancer: an ancient link with novel potentials. Int J Cancer 121(11):2373–2380

    Article  CAS  PubMed  Google Scholar 

  27. Baillargeon J, Rose DP (2006) Obesity, adipokines, and prostate cancer (review). Int J Oncol 28(3):737–745

    CAS  PubMed  Google Scholar 

  28. Pierce BL, Ballard-Barbash R, Bernstein L, Baumgartner RN, Neuhouser ML, Wener MH, Baumgartner KB, Gilliland FD, Sorensen BE, McTiernan A et al (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27(21):3437–3444

    Article  CAS  PubMed  Google Scholar 

  29. Srokowski TP, Fang S, Hortobagyi GN, Giordano SH (2009) Impact of diabetes mellitus on complications and outcomes of adjuvant chemotherapy in older patients with breast cancer. J Clin Oncol 27(13):2170–2176

    Article  PubMed  Google Scholar 

  30. Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120(2):104–110

    CAS  PubMed  Google Scholar 

  31. 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(11):664–670

    Article  CAS  PubMed  Google Scholar 

  32. Klein BE, Klein R, Knudtson MD, Lee KE (2005) Frailty, morbidity and survival. Arch Gerontol Geriatr 41(2):141–149

    Article  PubMed  Google Scholar 

  33. Urban RJ (1992) Neuroendocrinology of aging in the male and female. Endocrinol Metab Clin North Am 21(4):921–931

    CAS  PubMed  Google Scholar 

  34. Cummings SR, Tice JA, Bauer S, Browner WS, Cuzick J, Ziv E, Vogel V, Shepherd J, Vachon C, Smith-Bindman R et al (2009) Prevention of breast cancer in postmenopausal women: approaches to estimating and reducing risk. J Natl Cancer Inst 101(6):384–398

    Article  PubMed  Google Scholar 

  35. LaFleur J, McAdam-Marx C, Kirkness C, Brixner DI (2008) Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature. Ann Pharmacother 42(3):375–386

    Article  PubMed  Google Scholar 

  36. Chaudhry S, Jin L, Meltzer D (2005) Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care 43(6):607–615

    Article  PubMed  Google Scholar 

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Acknowledgments

The Women’s Healthy Eating and Living (WHEL) Study was initiated with the support of the Walton Family Foundation and continued with funding from National Cancer Institute Grant CA 69375. Some of the data were collected from General Clinical Research Centers, National Institute of Health grants M01-RR00070, M01-RR00079, and M01-RR00827.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, 92093-0901, USA

    Ruth E. Patterson, Shirley W. Flatt, Nazmus Saquib, Cheryl L. Rock, Barbara A. Parker, Kirsten Erickson, Wayne A. Bardwell & John P. Pierce

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Bette J. Caan

  3. Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA

    Gail A. Laughlin

  4. Arizona Cancer Center, University of Arizona, Tucson, AZ, USA

    Cynthia A. Thomson

  5. Department of Health Disparities Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Richard A. Hajek

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  1. Ruth E. Patterson
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  2. Shirley W. Flatt
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  3. Nazmus Saquib
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  4. Cheryl L. Rock
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  5. Bette J. Caan
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Correspondence to Ruth E. Patterson.

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Patterson, R.E., Flatt, S.W., Saquib, N. et al. Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122, 859–865 (2010). https://doi.org/10.1007/s10549-010-0732-3

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  • DOI: https://doi.org/10.1007/s10549-010-0732-3

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