Abstract
PurposeHeart disease is a significant concern among breast cancer survivors, in part due to cardiotoxic treatments including chemotherapy and radiotherapy. Long-term trends in heart disease mortality have not been well characterized. We examined heart disease mortality trends among US breast cancer survivors by treatment type.MethodsWe included first primary invasive breast cancer survivors diagnosed between 1975 and 2016 (aged 18–84; survived 12 + months; received initial chemotherapy, radiotherapy, or surgery) in the SEER-9 Database. Standardized mortality ratios (SMRs) and 10-year cumulative heart disease mortality estimates accounting for competing events were calculated by calendar year of diagnosis and initial treatment regimen. Ptrends were assessed using Poisson regression. All statistical tests were 2-sided.ResultsOf 516,916 breast cancer survivors, 40,812 died of heart disease through 2017. Heart disease SMRs declined overall from 1975–1979 to 2010–2016 (SMR 1.01 [95%CI: 0.98, 1.03] to 0.74 [0.69, 0.79], ptrend < 0.001). This decline was also observed for survivors treated with radiotherapy alone and chemotherapy plus radiotherapy. A sharper decline in heart disease SMRs was observed from 1975 to 1989 for left-sided radiotherapy, compared to right-sided. In contrast, there was a non-significant increasing trend in SMRs for chemotherapy alone, and significant by regional stage (ptrend = 0.036). Largest declines in 10-year cumulative mortality were observed from 1975–1984 to 2005–2016 among surgery only: 7.02% (95%CI: 6.80%, 7.23%) to 4.68% (95%CI: 4.39%, 4.99%) and radiotherapy alone: 6.35% (95%CI: 5.95%, 6.77%) to 2.94% (95%CI: 2.73%, 3.16%).ConclusionsWe observed declining heart disease mortality trends by most treatment types yet increasing for regional stage patients treated with chemotherapy alone, highlighting a need for additional studies with detailed treatment data and cardiovascular management throughout cancer survivorship.
Highlights
Advances in cancer treatment have contributed to the 5-year survival rates among breast cancer survivors approaching 90% [1]
We examined the long-term trends in heart disease mortality among women diagnosed with a first primary invasive breast cancer in the US using data from the Surveillance, Epidemiology, and End Results (SEER)-9 cancer registries according to initial treatment regimen and breast cancer characteristics from 1975 to 2017
We examined trends in heart disease Standardized mortality ratios (SMRs) by calendar year of breast cancer diagnosis and treatment type, latency defined as time since breast cancer diagnosis (1–9 years/10–19 years/20 + years), age of breast cancer diagnosis (18–49 years/50–59 years/60–69 years/70–84 ye ars), and breast cancer stage
Summary
Advances in cancer treatment have contributed to the 5-year survival rates among breast cancer survivors approaching 90% [1]. These advances have shifted attention to the late adverse effects of treatment. Cardiovascular disease is the leading cause of non-cancer deaths in women diagnosed with breast cancer in the US [2, 3]. Chemotherapy and radiotherapy both increase the risk of cardiovascular disease, and these adverse effects can occur acutely during treatment or decades after treatment has ended.
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