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 journalArticle

29 Citations (Scopus)

Abstract

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
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Comorbidity
Survival Rate
Breast Neoplasms
Confidence Intervals
Myocardial Infarction
Mortality
Radiotherapy
Drug Therapy
Asian Americans
Body Size
Hispanic Americans
African Americans
Survivors
Registries
Neoplasms
Therapeutics
Guidelines
Hypertension
Survival
Population

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Diabetes and other comorbidities in breast cancer survival by race/ethnicity : The California breast cancer survivorship consortium (CBCSC). / Wu, Anna H.; Kurian, Allison W.; Kwan, Marilyn L.; John, Esther M.; Lu, Yani; Keegan, Theresa H; Gomez, Scarlett Lin; Cheng, Iona; Shariff-Marco, Salma; Caan, Bette J.; Lee, Valerie S.; Sullivan-Halley, Jane; Tseng, Chiu Chen; Bernstein, Leslie; Sposto, Richard; Vigen, Cheryl.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 24, No. 2, 01.02.2015, p. 361-368.

Research output: Contribution to journalArticle

Wu, AH, Kurian, AW, Kwan, ML, John, EM, Lu, Y, Keegan, TH, Gomez, SL, Cheng, I, Shariff-Marco, S, Caan, BJ, Lee, VS, Sullivan-Halley, J, Tseng, CC, Bernstein, L, Sposto, R & Vigen, C 2015, 'Diabetes and other comorbidities in breast cancer survival by race/ethnicity: The California breast cancer survivorship consortium (CBCSC)', Cancer Epidemiology Biomarkers and Prevention, vol. 24, no. 2, pp. 361-368. https://doi.org/10.1158/1055-9965.EPI-14-1140
Wu, Anna H. ; Kurian, Allison W. ; Kwan, Marilyn L. ; John, Esther M. ; Lu, Yani ; Keegan, Theresa H ; Gomez, Scarlett Lin ; Cheng, Iona ; Shariff-Marco, Salma ; Caan, Bette J. ; Lee, Valerie S. ; Sullivan-Halley, Jane ; Tseng, Chiu Chen ; Bernstein, Leslie ; Sposto, Richard ; Vigen, Cheryl. / Diabetes and other comorbidities in breast cancer survival by race/ethnicity : The California breast cancer survivorship consortium (CBCSC). In: Cancer Epidemiology Biomarkers and Prevention. 2015 ; Vol. 24, No. 2. pp. 361-368.
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abstract = "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.",
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T1 - Diabetes and other comorbidities in breast cancer survival by race/ethnicity

T2 - The California breast cancer survivorship consortium (CBCSC)

AU - Wu, Anna H.

AU - Kurian, Allison W.

AU - Kwan, Marilyn L.

AU - John, Esther M.

AU - Lu, Yani

AU - Keegan, Theresa H

AU - Gomez, Scarlett Lin

AU - Cheng, Iona

AU - Shariff-Marco, Salma

AU - Caan, Bette J.

AU - Lee, Valerie S.

AU - Sullivan-Halley, Jane

AU - Tseng, Chiu Chen

AU - Bernstein, Leslie

AU - Sposto, Richard

AU - Vigen, Cheryl

PY - 2015/2/1

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N2 - 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.

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