Abstract
BackgroundBreast cancer patients are at an increased risk of venous thromboembolism (VTE). However, current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. We present data from a large cohort of patients from the UK and pool these with previous data from a systematic review.MethodsUsing the Clinical Practice Research Datalink (CPRD) dataset, we identified a cohort of 13,202 breast cancer patients, of whom 611 were diagnosed with VTE between 1997 and 2006 and 12,591 did not develop VTE. Hazard ratios (HR) were used to compare mortality between the two groups. These were then pooled with existing data on this topic identified via a search of the MEDLINE and EMBASE databases (until January 2015) using a random-effects meta-analysis.ResultsWithin the CPRD, VTE was associated with increased mortality when treated as a time-varying covariate (HR = 2.42; 95% CI, 2.13–2.75), however, when patients were permanently classed as having VTE based on presence of a VTE event within 6 months of cancer diagnosis, no increased risk was observed (HR = 1.22; 0.93–1.60). The pooled HR from seven studies using the second approach was 1.69 (1.12–2.55), with no effect seen when restricted to studies which adjusted for key covariates.ConclusionA large HR for VTE in the time-varying covariate analysis reflects the known short-term mortality following a VTE. When breast cancer patients are fortunate to survive the initial VTE, the influence on longer-term mortality is less certain.
Highlights
Breast cancer patients are at an increased risk of venous thromboembolism (VTE)
611 women developed VTE during the study period and these were compared with 12,591 women who remained free from VTE
The median age was 62 years (IQR 52–74) and 3.6% of women with VTE had distant metastases compared with 3.4% of those without VTE
Summary
Breast cancer patients are at an increased risk of venous thromboembolism (VTE). Current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. The association between cancer and venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) was first established more than 10 decades ago by Trousseau [2]. It is reported that breast cancer patients are 3–4 fold more likely to develop VTE compared with patients of equivalent age without cancer [4, 5]. The association between the development of VTE in patients with cancer and reduced overall survival was first evidenced in a seminal paper published in 2000 by Sorensen and colleagues which found that the 12-month survival rate was 3-times higher in cancer patients without a VTE [10].
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