title: Incident comorbidities and all-cause mortality among 5-year survivors of Stage I and II breast cancer diagnosed at age 65 or older: a prospective-matched cohort study.
abstract: Five-year breast cancer survivors, diagnosed after 65 years of age, may develop more incident comorbidities than similar populations free of cancer. We investigated whether older breast cancer survivors have a similar comorbidity burden 6-15 years after cancer diagnosis to matched women free of breast cancer at start of follow-up and whether incident comorbidities are associated with all-cause mortality. In this prospective cohort study, 1,361 older 5-year early-stage breast cancer survivors diagnosed between 1990 and 1994 and 1,361 age- and health system-matched women were followed for 10 years. Adjudicated medical record review captured prevalent and incident comorbidities during follow-up or until death as collected from the National Death Index. Older 5-year breast cancer survivors did not acquire incident comorbidities more often than matched women free of breast cancer in the subsequent 10 years [hazard ratio (HR) 1.0, 95 % confidence interval (95 % CI) 0.93, 1.1]. Adjusted for cohort membership, women with incident comorbidities had a higher mortality rate than those without incident comorbidities (HR 4.8, 95 % CI 4.1, 5.6). A breast cancer history continued to be a hazard for mortality 6-15 years after diagnosis (HR 1.3, 95 % CI 1.1, 1.4). We found that older breast cancer survivors who developed comorbidities had an increased all-cause mortality rate even after adjusting for age and prevalent comorbidity burden. Additionally, survivors acquire comorbidities at a rate similar to older women free of breast cancer. These results highlight the association between comorbidity burden and long-term mortality risk among older breast cancer survivors and their need for appropriate oncology and primary care follow-up.
authors.affiliation: Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Jordan
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Thwin
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.forename: Pamala A
authors.initials: PA
authors.lastname: Pawloski
authors.forename: Hans V
authors.initials: HV
authors.lastname: Petersen
authors.forename: Marianne N
authors.initials: MN
authors.lastname: Prout
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009026:Mortality; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies; D017741:Survivors