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Cardiovascular mortality among cancer survivors who developed breast cancer as a second primary malignancy

British Journal of Cancer volume 125, pages 1450–1458 (2021)Cite this article

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Abstract

Background

To assess the risk of cardiovascular mortality among cancer survivors who developed breast cancer as a second malignancy (BCa-2) compared with patients with first primary breast cancer (BCa-1) and the general population.

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 1,024,047 BCa-1 and 41,744 BCa-2 patients diagnosed from the age 30 between 1975 and 2016, and the corresponding US female population (994,415,911 person-years; 5,403,551 cardiovascular deaths). Compared with the general population and BCa-1 patients, we calculated incidence rate ratios (IRRs) of cardiovascular deaths among BCa-2 patients using Poisson regression. To adjust for unmeasured confounders, we performed a nested, case-crossover analysis among BCa-2 patients who died from cardiovascular disease.

Results

Although BCa-2 patients had a mildly increased risk of cardiovascular mortality compared with the population (IRR 1.08) and BCa-1 patients (IRR 1.15), the association was pronounced among individuals aged 30–49 years (BCa-2 vs. population: IRR 6.61; BCa-2 vs. BCa-1: IRR 3.03). The risk elevation was greatest within the first month after diagnosis, compared with the population, but comparable with BCa-1 patients. The case-crossover analysis confirmed these results.

Conclusion

Our findings suggest that patients with BCa-2 are at increased risk of cardiovascular mortality.

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Fig. 1: Incidence rate ratios (IRRs) of cardiovascular deaths among patients with the primary breast cancer (BCa-2) developed from non-mammary malignancy by time since cancer diagnosis, compared with the female population and patients with primary breast cancer (BCa-1): a population-based study in the U.S., 1975–2016.
Fig. 2: Incidence rate ratios (IRRs) of cardiovascular deaths at attained age 30–79 years among patients with the primary breast cancer (BCa-2) developed from non-mammary malignancy by characteristics of the first malignancy, compared with the female population and patients with primary breast cancer (BCa-1): a population-based study in the U.S., 1975–2016.

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Funding

This study was supported by the National Natural Science Foundation of China (grant number: 81872307; to Dr. Lu) and Swedish Research Council (grant number: 2018-00648; to Dr. Lu) and Full-time Postdoc Research and Development Foundation of West China Hospital (grant number: 2019HXBH098; to Dr. Wang).

Author information

Authors and Affiliations

  1. Laboratory of Molecular Diagnosis of Cancer, and Department of Medical Oncology, Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China

    Chengshi Wang & Chuanxu Luo

  2. Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Chengshi Wang

  3. Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

    Kejia Hu, Fang Fang & Donghao Lu

  4. Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA

    Lei Deng

  5. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85, Örebro, Sweden

    Katja Fall

  6. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA

    Rulla M. Tamimi, Unnur A. Valdimarsdóttir & Donghao Lu

  7. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA

    Rulla M. Tamimi

  8. Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101, Reykjavik, Iceland

    Unnur A. Valdimarsdóttir

  9. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, 171 77, Solna, Sweden

    Unnur A. Valdimarsdóttir

  10. West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China

    Donghao Lu

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Contributions

CW and DL had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: CW and DL. Acquisition, analysis or interpretation of the data: CW, KH and DL. Drafting of the manuscript: CW, KH, CL and DL. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: CW. Obtained funding: CW and DL. Administrative, technical or material support: DL. Study supervision: DL.

Corresponding author

Correspondence to Donghao Lu.

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The authors declare no competing interests.

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This study was reviewed by the Biomedical Research Ethics Committee at West China Hospital, Sichuan University (reference number 2018-230).

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Wang, C., Hu, K., Luo, C. et al. Cardiovascular mortality among cancer survivors who developed breast cancer as a second primary malignancy. Br J Cancer 125, 1450–1458 (2021). https://doi.org/10.1038/s41416-021-01549-w

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  • DOI: https://doi.org/10.1038/s41416-021-01549-w

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