Cardiovascular Mortality Trends and Disparities in U.S. Breast Cancer Patients, 1999-2020: a Population-based Retrospective Study

Overview

Journal Cardiooncology

Publisher Biomed Central

Specialty Oncology

Date 2024 Dec 19

PMID 39696722

Authors

Yong-Hao Yeo

Boon-Jian San

Jia-Yi Tan

Min-Choon Tan

Teodora Donisan

Justin Z Lee

Laura M Franey

Salim S Hayek

Affiliations

Soon will be listed here.

Abstract

Background: Breast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.

Objective: To investigate trends and disparities in CVD mortality among breast cancer patients.

Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.

Results: A total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50-2.65]) in 1999 to 1.20 (95% CI [1.15-1.24]) in 2020, with an average annual percent change (AAPC) of - 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90-1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72-0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62-1.67] vs. 1.55, 95%CI [1.53-1.56]).

Conclusion: The study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.

References

Obeng-Gyasi S, Obeng-Gyasi B, Tarver W . Breast Cancer Disparities and the Impact of Geography. Surg Oncol Clin N Am. 2021; 31(1):81-90. PMC: 8594754. DOI: 10.1016/j.soc.2021.08.002. View

Kyalwazi A, Loccoh E, Brewer L, Ofili E, Xu J, Song Y . Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019. Circulation. 2022; 146(3):211-228. PMC: 9310198. DOI: 10.1161/CIRCULATIONAHA.122.060199. View

Kostakou P, Kouris N, Kostopoulos V, Damaskos D, Olympios C . Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology. Heart Fail Rev. 2018; 24(1):91-100. DOI: 10.1007/s10741-018-9731-y. View

Buddeke J, Gernaat S, Bots M, van den Bongard D, Grobbee D, Vaartjes I . Trends in the risk of cardiovascular disease in women with breast cancer in a Dutch nationwide cohort study. BMJ Open. 2019; 9(5):e022664. PMC: 6549609. DOI: 10.1136/bmjopen-2018-022664. View

Vo J, Ramin C, Barac A, Berrington de Gonzalez A, Veiga L . Trends in heart disease mortality among breast cancer survivors in the US, 1975-2017. Breast Cancer Res Treat. 2022; 192(3):611-622. PMC: 8960573. DOI: 10.1007/s10549-022-06515-5. View

Alexander K, Orav J, Singh A, Jacob S, Menon A, Padera R . Geographic Disparities in Reported US Amyloidosis Mortality From 1979 to 2015: Potential Underdetection of Cardiac Amyloidosis. JAMA Cardiol. 2018; 3(9):865-870. PMC: 6233639. DOI: 10.1001/jamacardio.2018.2093. View

Kaur M, Joshu C, Visvanathan K, Connor A . Trends in breast cancer incidence rates by race/ethnicity: Patterns by stage, socioeconomic position, and geography in the United States, 1999-2017. Cancer. 2021; 128(5):1015-1023. PMC: 9533488. DOI: 10.1002/cncr.34008. View

Bikiewicz A, Banach M, von Haehling S, Maciejewski M, Bielecka-Dabrowa A . Adjuvant breast cancer treatments cardiotoxicity and modern methods of detection and prevention of cardiac complications. ESC Heart Fail. 2021; 8(4):2397-2418. PMC: 8318493. DOI: 10.1002/ehf2.13365. View

Hamirani Y, Fanous I, Kramer C, Wong A, Salerno M, Dillon P . Anthracycline- and trastuzumab-induced cardiotoxicity: a retrospective study. Med Oncol. 2016; 33(7):82. PMC: 5253226. DOI: 10.1007/s12032-016-0797-x. View

10.

Orji C, Kanu C, Adelodun A, Brown C . Factors that Influence Mammography Use for Breast Cancer Screening among African American Women. J Natl Med Assoc. 2020; 112(6):578-592. DOI: 10.1016/j.jnma.2020.05.004. View

11.

Berry D, Cronin K, Plevritis S, Fryback D, Clarke L, Zelen M . Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005; 353(17):1784-92. DOI: 10.1056/NEJMoa050518. View

12.

Amin M, Siddiqui S, Ibrahim M, Hakim M, Ahammed M, Kabir A . Inflammatory cytokines in the pathogenesis of cardiovascular disease and cancer. SAGE Open Med. 2020; 8:2050312120965752. PMC: 7594225. DOI: 10.1177/2050312120965752. View

13.

Sturgeon K, Deng L, Bluethmann S, Zhou S, Trifiletti D, Jiang C . A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J. 2019; 40(48):3889-3897. PMC: 6925383. DOI: 10.1093/eurheartj/ehz766. View

14.

Ruddy K, Sangaralingham L, Van Houten H, Nowsheen S, Sandhu N, Moslehi J . Utilization of Cardiac Surveillance Tests in Survivors of Breast Cancer and Lymphoma After Anthracycline-Based Chemotherapy. Circ Cardiovasc Qual Outcomes. 2020; 13(3):e005984. PMC: 7101030. DOI: 10.1161/CIRCOUTCOMES.119.005984. View

15.

Bartlett F, Colgan R, Donovan E, McNair H, Carr K, Evans P . The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiother Oncol. 2015; 114(1):66-72. DOI: 10.1016/j.radonc.2014.11.018. View

16.

Giordano S, Lin Y, Kuo Y, Hortobagyi G, Goodwin J . Decline in the use of anthracyclines for breast cancer. J Clin Oncol. 2012; 30(18):2232-9. PMC: 3397719. DOI: 10.1200/JCO.2011.40.1273. View

17.

Kobo O, Van Spall H, Mamas M . Urban-rural disparities in diabetes-related mortality in the USA 1999-2019. Diabetologia. 2022; 65(12):2078-2083. PMC: 9630196. DOI: 10.1007/s00125-022-05785-4. View

18.

Barish R, Lynce F, Unger K, Barac A . Management of Cardiovascular Disease in Women With Breast Cancer. Circulation. 2019; 139(8):1110-1120. DOI: 10.1161/CIRCULATIONAHA.118.039371. View

19.

Contiero P, Boffi R, Borgini A, Fabiano S, Tittarelli A, Mian M . Causes of death in women with breast cancer: a risks and rates study on a population-based cohort. Front Oncol. 2023; 13:1270877. PMC: 10646497. DOI: 10.3389/fonc.2023.1270877. View

20.

Denlinger C, Sanft T, Baker K, Broderick G, Demark-Wahnefried W, Friedman D . Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018; 16(10):1216-1247. PMC: 6438378. DOI: 10.6004/jnccn.2018.0078. View