Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer
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The majority of breast cancers are diagnosed in postmenopausal women. Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for these women. We compared the 10-year predicted breast cancer recurrence risk with CVD risk among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer. CVD risk factor data were prospectively collected from postmenopausal women with stage I-III, HR+ breast cancer initiating adjuvant aromatase inhibitor therapy. We compared predicted 10-year CVD risk, including the composite index heart age, computed from modified Framingham risk score, with predicted 10-year risk of breast cancer recurrence using Adjuvant! Online. We created multivariable logistic regression models to estimate the odds ratios (OR) and 95% confidence intervals (CI) for greater CVD risk than breast cancer recurrence risk. Among 415 women, mean age and heart age were 60 and 67 years, respectively. Overall, 43% of women had a predicted 10-year CVD risk equivalent to breast cancer recurrence risk and 37% had CVD risk higher than breast cancer recurrence risk. Predicted CVD risk was higher than breast cancer recurrence risk for stage I disease (OR: 6.1, 95% CI: 3.4–11.2) or heart age >65 (OR: 12.4, 95% CI: 7.0–22.6). The majority of postmenopausal women with HR+ early breast cancer had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.
KeywordsBreast cancer risk Cardiovascular disease risk Adjuvant! Online Modified Framingham risk score Cancer survivorship
Supported in part by pharmacogenetics research network Grant U-01 GM61373, which supports the consortium on breast cancer pharmacogenomics, and by investigator-initiated grants from Novartis and Pfizer. Dr. DeFilippis is supported by a national research service award (NRSA) training Grant (T32-HL-07227). Drs. Flockhart and Stearns received research Grants from Novartis and Pfizer. Dr. Stearns received honoraria from AstraZeneca. Dr. Henry receiver research funding from AstraZeneca. Dr. Hayes has been a consultant to Oncimmune, Chugai, and biomarker strategies, owns stocks in Oncimmune, and received research funding from Novartis and Pfizer, GlaxoSmithKline and Veridex. Dr. Storniolo received honoraria from Pfizer.
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