Long-term risk of medical conditions associated with breast cancer treatment.
Early and late effects of cancer treatment are of increasing concern with growing survivor populations, but relevant data are sparse. We sought to determine the prevalence and hazard ratio of such effects in breast cancer cases. Women with invasive breast cancer and women with no cancer history recruited for a cancer research cohort completed a mailed questionnaire at a median of 10 years post-diagnosis or matched reference year (for the women without cancer). Reported medical conditions including lymphedema, osteopenia, osteoporosis, and heart disease (congestive heart failure, myocardial infarction, coronary heart disease) were assessed in relation to breast cancer therapy and time since diagnosis using Cox regression. The proportion of women currently receiving treatment for these conditions was calculated. Study participants included 2,535 women with breast cancer and 2,428 women without cancer (response rates 66.0 % and 50.4 %, respectively) Women with breast cancer had an increased risk of lymphedema (Hazard ratio (HR) 8.6; 95 % confidence interval (CI) 6.3-11.6), osteopenia (HR 2.1; 95 % CI 1.8-2.4), and osteoporosis (HR 1.5; 95 % CI 1.2-1.9) but not heart disease, compared to women without cancer Hazard ratios varied by treatment and time since diagnosis. Overall, 49.3 % of breast cancer cases reported at least one medical condition, and at 10 or more years post-diagnosis, 37.7 % were currently receiving condition-related treatment. Responses from survivors a decade following cancer diagnosis demonstrate substantial treatment-related morbidity, and emphasize the need for continued medical surveillance and follow-up care into the second decade post-diagnosis.
Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131-0001, USA, dahill@salud.unm.edu.
Deirdre A
DA
Hill
Nora K
NK
Horick
Claudine
C
Isaacs
Susan M
SM
Domchek
Gail E
GE
Tomlinson
Jan T
JT
Lowery
Anita Y
AY
Kinney
Jonathan S
JS
Berg
Karen L
KL
Edwards
Patricia G
PG
Moorman
Sharon E
SE
Plon
Louise C
LC
Strong
Argyrois
A
Ziogas
Constance A
CA
Griffin
Carol H
CH
Kasten
Dianne M
DM
Finkelstein
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D001851:Bone Diseases, Metabolic / Q000453:epidemiology* / Q000209:etiology; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data
D000970:Antineoplastic Agents