Abstract
BackgroundBreast cancer survivors are at high risk for fracture due to cancer treatment-induced bone loss, however, data is scarce regarding the scope of this problem from an epidemiologic and health services perspective among Chinese women with breast cancer.MethodsWe designed a cross-sectional study comparing prevalence of vertebral fractures among age- and BMI-matched women from two cohorts. Women in the Breast Cancer Survivors cohort were enrolled from a large cancer hospital in Beijing. Eligibility criteria included age 50–70 years, initiation of treatment for breast cancer at least 5 years prior to enrollment, and no history of metabolic bone disease or bone metastases. Data collected included sociodemographic characteristics; fracture-related risk factors, screening and preventive measures; breast cancer history; and thoracolumbar x-ray. The matched comparator group was selected from participants enrolled in the Peking Vertebral Fracture Study, an independent cohort of healthy community-dwelling postmenopausal women from Beijing.ResultsTwo hundred breast cancer survivors were enrolled (mean age 57.5 ± 4.9 years), and compared with 200 matched healthy women. Twenty-two (11%) vertebral fractures were identified among breast cancer survivors compared with 7 (3.5%) vertebral fractures in the comparison group, yielding an adjusted odds ratio for vertebral fracture of 4.16 (95%CI 1.69–10.21, p < 0.01). The majority had early stage (85.3%) and estrogen and/or progesterone receptor positive (84.6%) breast cancer. Approximately half of breast cancer survivors reported taking calcium supplements, 6.1% reported taking vitamin D supplements, and only 27% reported having a bone density scan since being diagnosed with breast cancer.ConclusionsDespite a four-fold increased odds of prevalent vertebral fracture among Chinese breast cancer survivors in our study, rates of screening for osteoporosis and fracture risk were low reflecting a lack of standardization of care regarding cancer-treatment induced bone loss.
Highlights
Breast cancer survivors are at high risk for fracture due to cancer treatment-induced bone loss, data is scarce regarding the scope of this problem from an epidemiologic and health services perspective among Chinese women with breast cancer
Breast cancer incidence worldwide has risen by 20% and mortality rates by 14% since 2008, with the bulk of this increase sustained by women in low- and middleincome countries (LMICs) due to increasing life expectancy, urbanization, and adoption of Western lifestyles [1]
Sociodemographic, reproductive and fracture-associated characteristics In total, 200 survivors of breast cancer were enrolled and 200 matched healthy women were selected from the Peking Vertebral Fracture (PK-VF) cohort
Summary
Breast cancer survivors are at high risk for fracture due to cancer treatment-induced bone loss, data is scarce regarding the scope of this problem from an epidemiologic and health services perspective among Chinese women with breast cancer. Several studies have shown that women with breast cancer are at increased risk for osteoporosis and fracture [3,4,5] This is largely attributable to the negative impact of breast cancer treatments on skeletal health, which occurs through decreased estrogen exposure [6, 7]. The majority of such studies have been carried out in the U.S and Europe, where most women are postmenopausal at the time of diagnosis and approximately 75% of patients have hormone-receptor positive disease [8]. A nation-wide epidemiologic study found that the average age at breast cancer diagnosis in China is approximately 10 years earlier than in the West, and only 57.4% of women with breast cancer had hormonereceptor positive disease [9]
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