Abstract

Simple SummaryDespite the known multiple correlations between venous thromboembolism (VTE) and breast cancer, only a limited number of studies have investigated the association between breast cancer and VTE during the long-term follow-up. Given the constantly increasing number of newly diagnosed breast cancers, the significance of focusing research on the correlation between breast cancer and VTE is becoming increasingly relevant. Furthermore, VTE has a high impact on a patient’s quality of life, with permanent consequences or mortality in the most severe cases. Thus, this study aims to assess the occurrence and timing of VTE during a long period of follow-up to analyze possible correlated factors and the overall survival. These results could impact the health care community, adding knowledge about VTE risk factors. These factors can be helpful as prognostic information and eventually target preventive treatment for VTE because the co-existence of invasive breast cancer VTE has a substantial impact on survival.Albeit it does not have the highest venous thromboembolism (VTE) incidence compared to other neoplasms, breast cancer contributes to many VTE events because it is the most diagnosed tumor in women. We aim to analyze the occurrence and timing of VTE during the follow-up of patients who underwent breast surgery, the possible correlated factors, and the overall survival. This retrospective study included all female patients diagnosed with mammary pathology and surgically treated in our clinic between January 2002 and January 2012. Of 5039 women who underwent breast surgery, 1056 were found to have no evidence of malignancy, whereas 3983 were diagnosed with breast cancer. VTE rate resulted significantly higher in patients with invasive breast cancer than in women with benign breast disease or carcinoma in situ. Invasive cancers other than lobular or ductal were associated with a higher VTE rate. In addition, chronic hypertension, high BMI, cancer type, and evidence of metastasis turned out to be the most significant risk factors for VTE in women who underwent breast surgery. Moreover, VTE occurrence significantly impacted survival in invasive breast cancer patients. Compared to women with benign mammary pathology, VTE prevalence in women with breast cancer is significantly higher. The knowledge about the risk factors of VTE could be helpful as prognostic information, but also to eventually target preventive treatment strategies for VTE, as far as the co-existence of invasive breast cancer and VTE has a significantly negative impact on survival.

Highlights

  • Breast cancer is the most common female cancer worldwide, being 25% of new female cancer cases and the first cancer-related mortality cause (16% of all deaths) [1]

  • Information was gathered from the clinical files of our center by medical doctor experts in breast surgery supervised by a specialist in thrombosis and hemostasis

  • Adjuvant chemotherapy was administered to 39.76% of women (1401/3524), while hormonal therapy was given to 74.32% (2619/3524) of them

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Summary

Introduction

Breast cancer is the most common female cancer worldwide, being 25% of new female cancer cases and the first cancer-related mortality cause (16% of all deaths) [1]. Cancer among women is associated with a significant burden of venous thromboembolism (VTE). Despite the low incidence of VTE in localized breast cancer (5 per 1000 person years), the great number of early breast cancers worldwide justifies the numerous VTE cases associated with breast cancer (about 14% of all cancer-associated VTE) [2,3]. The introduction of systematic mammographic screening programs all over the world increased the number of early breast cancer diagnoses, as well as the number of women susceptible to surgical treatment, and significantly improved the survival after surgery or after the exposure to adjuvant treatments [4,5]. There is a recognized VTE risk linked to the surgical treatment of the neoplasm [11], a hazard related to adjuvant therapies [5,12,13], and an intrinsic VTE risk linked to the possible association between blood hypercoagulability and tumor aggressiveness [7,14]

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