title: Medical comorbidities predict mortality in women with a history of early stage breast cancer.
abstract: This analysis was conducted to determine whether comorbid medical conditions predict additional breast cancer events and all-cause mortality in women with a history of early stage breast cancer. Women (n = 2,542) participating in a randomized diet trial completed a self-administered questionnaire regarding whether they were currently being treated for a wide variety of diseases (cardiovascular, diabetes, gallbladder, gastrointestinal, arthritis, and osteoporosis) and conditions (high blood pressure, elevated cholesterol level). Height and weight were measured at baseline. Participants were followed for a median of 7.3 years (range 0.8-15.0). Cox regression analysis was performed to assess whether comorbidities predicted disease-free and overall survival; hazard ratio (HR) was the measure of association. Overall, there were 406 additional breast cancer events and 242 deaths. Participants with diabetes had over twofold the risk of additional breast cancer events (HR 2.1, 95% CI: 1.3, 3.4) and mortality (HR 2.5, 95% CI: 1.4, 4.4). The presence of multiple comorbidities did not statistically significantly predict additional breast cancer events. However, compared to no comorbidities, participants with 3 or more comorbidities had a HR of 2.1, 95% CI: 1.3, 3.3 for mortality. In conclusion, type 2 diabetes is associated with poor breast cancer prognosis. Given that 85% of deaths were caused by breast cancer, these findings suggest that multiple comorbidities may reduce the likelihood of surviving additional breast cancer events.
authors.affiliation: Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901, USA. repatterson@ucsd.edu
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Patterson
authors.forename: Shirley W
authors.initials: SW
authors.lastname: Flatt
authors.forename: Nazmus
authors.initials: N
authors.lastname: Saquib
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Rock
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.forename: Gail A
authors.initials: GA
authors.lastname: Laughlin
authors.forename: Kirsten
authors.initials: K
authors.lastname: Erickson
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Bardwell
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hajek
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D015897:Comorbidity / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult