Diabetes and other comorbidities in breast cancer survival by race/ethnicity: The California breast cancer survivorship consortium (CBCSC)

Anna H. Wu, Allison W. Kurian, Marilyn L. Kwan, Esther M. John, Yani Lu, Theresa H Keegan, Scarlett Lin Gomez, Iona Cheng, Salma Shariff-Marco, Bette J. Caan, Valerie S. Lee, Jane Sullivan-Halley, Chiu Chen Tseng, Leslie Bernstein, Richard Sposto, Cheryl Vigen

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Methods: We investigated the association of specific comorbidities with mortality in a multiethnic cohort of 8,952 breast cancer cases within the California Breast Cancer Survivorship Consortium (CBCSC), which pooled questionnaire and cancer registry data from five California-based studies. In total, 2,187 deaths (1,122 from breast cancer) were observed through December 31, 2010. Using multivariable Cox proportional hazards regression, we estimated HRs and 95% confidence intervals (CI) for overall and breast cancer-specific mortality associated with previous cancer, diabetes, high blood pressure (HBP), and myocardial infarction. Results: Risk of breast cancer-specific mortality increased among breast cancer cases with a history of diabetes (HR, 1.48; 95% CI, 1.18-1.87) or myocardial infarction (HR, 1.94; 95% CI, 1.27-2.97). Risk patterns were similar across race/ethnicity (non-Latina white, Latina, African American, and Asian American), body size, menopausal status, and stage at diagnosis. In subgroup analyses, risk of breast cancer-specific mortality was significantly elevated among cases with diabetes who received neither radiotherapy nor chemotherapy (HR, 2.11; 95% CI, 1.32-3.36); no increased risk was observed among those who received both treatments (HR, 1.13; 95% CI, 0.70-1.84; Pinteraction = 0.03). A similar pattern was found for myocardial infarction by radiotherapy and chemotherapy (Pinteraction = 0.09). Conclusion: These results may inform future treatment guidelines for patients with breast cancer with a history of diabetes or myocardial infarction. Impact: Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome.

Background: The role of comorbidities in survival of patients with breast cancer has not been well studied, particularly in nonwhite populations.

Original languageEnglish (US)
Pages (from-to)361-368
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Issue number2
StatePublished - Feb 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Oncology


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