Advertisement

Breast Cancer Research and Treatment

, Volume 131, Issue 3, pp 907–914 | Cite as

Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer

  • Aditya Bardia
  • Erin T. Arieas
  • Zhe Zhang
  • Andrew DeFilippis
  • Karineh Tarpinian
  • Stacie Jeter
  • Anne Nguyen
  • N. Lynn Henry
  • David A. Flockhart
  • Daniel F. Hayes
  • Jill Hayden
  • Anna Maria Storniolo
  • Deborah K. Armstrong
  • Nancy E. Davidson
  • John Fetting
  • Pamela Ouyang
  • Antonio C. Wolff
  • Roger S. Blumenthal
  • M. Dominique Ashen
  • Vered StearnsEmail author
Clinical trial

Abstract

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.

Keywords

Breast cancer risk Cardiovascular disease risk Adjuvant! Online Modified Framingham risk score Cancer survivorship 

Notes

Acknowledgments

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.

References

  1. 1.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300PubMedCrossRefGoogle Scholar
  2. 2.
    American cancer society: breast cancer overview (2011) http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-key-statistics. Accessed July 25, 2011
  3. 3.
    Esserman L, Shieh Y, Thompson I (2009) Rethinking screening for breast cancer and prostate cancer. JAMA 302(15):1685–1692PubMedCrossRefGoogle Scholar
  4. 4.
    Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G (2007) Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 25(14):1858–1869PubMedCrossRefGoogle Scholar
  5. 5.
    Muss HB, Biganzoli L, Sargent DJ, Aapro M (2007) Adjuvant therapy in the elderly: making the right decision. J Clin Oncol 25(14):1870–1875PubMedCrossRefGoogle Scholar
  6. 6.
    Ahern TP, Lash TL, Thwin SS, Silliman RA (2009) Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors. Med Care 47(1):73–79PubMedCrossRefGoogle Scholar
  7. 7.
    Clough-Gorr KM, Stuck AE, Thwin SS, Silliman RA (2010) Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol 28(3):380–386PubMedCrossRefGoogle Scholar
  8. 8.
    Goodwin JS, Hunt WC, Same JM (1993) Determinants of cancer therapy in elderly patients. Cancer 72(2):594–601PubMedCrossRefGoogle Scholar
  9. 9.
    CDC (2011) Heart disease and stroke prevention. www.cdc.gov/nccdphp/publications/AAG/pdf/dhdsp.pdf. Accessed July 25, 2011
  10. 10.
    Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA, Debus J, Bischof M (2010) Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer 10:105PubMedCrossRefGoogle Scholar
  11. 11.
    Stewart S, MacIntyre K, Hole DJ, Capewell S, McMurray JJ (2001) More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 3(3):315–322PubMedCrossRefGoogle Scholar
  12. 12.
    Collins TC, Petersen NJ, Menke TJ, Souchek J, Foster W, Ashton CM (2003) Short-term, intermediate-term, and long-term mortality in patients hospitalized for stroke. J Clin Epidemiol 56(1):81–87PubMedCrossRefGoogle Scholar
  13. 13.
    Third report of the national cholesterol education program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report (2002) Circulation 106(25): 3143–3421Google Scholar
  14. 14.
    Mosca L, Mochari H, Christian A, Berra K, Taubert K, Mills T, Burdick KA, Simpson SL (2006) National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation 113(4):525–534PubMedCrossRefGoogle Scholar
  15. 15.
    Henry NL, Giles JT, Ang D, Mohan M, Dadabhoy D, Robarge J, Hayden J, Lemler S, Shahverdi K, Powers P et al (2008) Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. Breast Cancer Res Treat 111(2):365–372PubMedCrossRefGoogle Scholar
  16. 16.
    D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham heart study. Circulation 117(6):743–753PubMedCrossRefGoogle Scholar
  17. 17.
    Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97(18):1837–1847PubMedGoogle Scholar
  18. 18.
    Ravdin PM, Siminoff LA, Davis GJ, Mercer MB, Hewlett J, Gerson N, Parker HL (2001) Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol 19(4):980–991PubMedGoogle Scholar
  19. 19.
    Wickramasinghe SR, DeFilippis AP, Lloyd-Jones DM, Blumenthal RS (2009) A convenient tool to profile patients for generalized cardiovascular disease risk in primary care. Am J Cardiol 103(8):1174–1177PubMedCrossRefGoogle Scholar
  20. 20.
    Eagle KA, Ginsburg GS, Musunuru K, Aird WC, Balaban RS, Bennett SK, Blumenthal RS, Coughlin SR, Davidson KW, Frohlich ED et al (2010) Identifying patients at high risk of a cardiovascular event in the near future: current status and future directions: report of a national heart, lung, and blood institute working group. Circulation 121(12): 1447–1454Google Scholar
  21. 21.
    Berger JS, Jordan CO, Lloyd-Jones D, Blumenthal RS (2010) Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol 55(12):1169–1177PubMedCrossRefGoogle Scholar
  22. 22.
    Tan-Chiu E, Yothers G, Romond E, Geyer CE Jr, Ewer M, Keefe D, Shannon RP, Swain SM, Brown A, Fehrenbacher L et al (2005) Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor receptor 2-overexpressing breast cancer: NSABP B-31. J Clin Oncol 23(31):7811–7819PubMedCrossRefGoogle Scholar
  23. 23.
    Perez EA, Suman VJ, Davidson NE, Sledge GW, Kaufman PA, Hudis CA, Martino S, Gralow JR, Dakhil SR, Ingle JN et al (2008) Cardiac safety analysis of doxorubicin and cyclophosphamide followed by paclitaxel with or without trastuzumab in the North Central Cancer Treatment Group N9831 adjuvant breast cancer trial. J Clin Oncol 26(8):1231–1238PubMedCrossRefGoogle Scholar
  24. 24.
    Ganz PA, Hussey MA, Moinpour CM, Unger JM, Hutchins LF, Dakhil SR, Giguere JK, Goodwin JW, Martino S, Albain KS (2008) Late cardiac effects of adjuvant chemotherapy in breast cancer survivors treated on southwest oncology group protocol s8897. J Clin Oncol 26(8):1223–1230PubMedCrossRefGoogle Scholar
  25. 25.
    Choueiri TK, Mayer EL, Je Y, Rosenberg JE, Nguyen PL, Azzi GR, Bellmunt J, Burstein HJ, Schutz FA (2011) Congestive heart failure risk in patients with breast cancer treated with bevacizumab. J Clin Oncol 29(6):632–638PubMedCrossRefGoogle Scholar
  26. 26.
    Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, Tan-Chiu E, Martino S, Paik S, Kaufman PA et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353(16):1673–1684PubMedCrossRefGoogle Scholar
  27. 27.
    Russell SD, Blackwell KL, Lawrence J, Pippen JE Jr, Roe MT, Wood F, Paton V, Holmgren E, Mahaffey KW (2010) Independent adjudication of symptomatic heart failure with the use of doxorubicin and cyclophosphamide followed by trastuzumab adjuvant therapy: a combined review of cardiac data from the national surgical adjuvant breast and bowel project B-31 and the north central cancer treatment group N9831 clinical trials. J Clin Oncol 28(21):3416–3421PubMedCrossRefGoogle Scholar
  28. 28.
    Procter M, Suter TM, de Azambuja E, Dafni U, van Dooren V, Muehlbauer S, Climent MA, Rechberger E, Liu WT, Toi M et al (2010) Longer-term assessment of trastuzumab-related cardiac adverse events in the Herceptin adjuvant (HERA) trial. J Clin Oncol 28(21):3422–3428PubMedCrossRefGoogle Scholar
  29. 29.
    Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Malin J et al (2010) American society of clinical oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28(23):3784–3796PubMedCrossRefGoogle Scholar
  30. 30.
    Amir E, Seruga B, Niraula S, Carlsson L, Ocana A (2011) Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst 103(17):1299–1309PubMedCrossRefGoogle Scholar
  31. 31.
    Schonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP (2011) Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol 29(12):1570–1577PubMedCrossRefGoogle Scholar
  32. 32.
    Patnaik JL, Byers T, Diguiseppi C, Dabelea D, Denberg TD (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13(3):R64PubMedCrossRefGoogle Scholar
  33. 33.
    Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103(14):1101–1111PubMedCrossRefGoogle Scholar
  34. 34.
    Christian AH, Rosamond W, White AR, Mosca L (2007) Nine-year trends and racial and ethnic disparities in women’s awareness of heart disease and stroke: an American heart association national study. J Womens Health (Larchmt) 16(1):68–81CrossRefGoogle Scholar
  35. 35.
    McTiernan A, Irwin M, Vongruenigen V (2010) Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 28(26):4074–4080PubMedCrossRefGoogle Scholar
  36. 36.
    Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy WK, Thomson CA, Kealey S, Hajek R et al (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25(17):2345–2351PubMedCrossRefGoogle Scholar
  37. 37.
    Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowske K, Moore DH, Slattery ML, Tammemagi M, Castillo A et al (2010) Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst 102(19):1468–1477PubMedCrossRefGoogle Scholar
  38. 38.
    Bardia A, Ebbert JO, Vierkant RA, Limburg PJ, Anderson K, Wang AH, Olson JE, Vachon CM, Cerhan JR (2007) Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality. J Natl Cancer Inst 99(11):881–889PubMedCrossRefGoogle Scholar
  39. 39.
    Cuzick J, Otto F, Baron JA, Brown PH, Burn J, Greenwald P, Jankowski J, La Vecchia C, Meyskens F, Senn HJ et al (2009) Aspirin and non-steroidal anti-inflammatory drugs for cancer prevention: an international consensus statement. Lancet Oncol 10(5):501–507PubMedCrossRefGoogle Scholar
  40. 40.
    Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW (2011) Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 377(9759):31–41PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Aditya Bardia
    • 1
    • 6
  • Erin T. Arieas
    • 2
    • 7
  • Zhe Zhang
    • 3
  • Andrew DeFilippis
    • 2
  • Karineh Tarpinian
    • 1
  • Stacie Jeter
    • 1
  • Anne Nguyen
    • 4
  • N. Lynn Henry
    • 5
  • David A. Flockhart
    • 4
  • Daniel F. Hayes
    • 5
  • Jill Hayden
    • 5
  • Anna Maria Storniolo
    • 4
  • Deborah K. Armstrong
    • 1
  • Nancy E. Davidson
    • 1
    • 8
  • John Fetting
    • 1
  • Pamela Ouyang
    • 2
  • Antonio C. Wolff
    • 1
  • Roger S. Blumenthal
    • 2
  • M. Dominique Ashen
    • 2
  • Vered Stearns
    • 1
    Email author
  1. 1.Breast Cancer Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Division of Cardiology, Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Division of Biostatistics and Bioinformatics, Department of OncologyJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.Department of Medicine, Melvin and Bren Simon Cancer CenterIndiana UniversityIndianapolisUSA
  5. 5.Breast Oncology Program, University of Michigan Comprehensive Cancer CenterAnn ArborUSA
  6. 6.Massachusetts General Hospital Cancer CenterBostonUSA
  7. 7.Mercy Medical Group, A Service of Catholic Healthcare West (CHW)Medical Foundation Internal MedicineSacramentoUSA
  8. 8.University of Pittsburgh Cancer Institute and UPMC Cancer CenterPittsburghUSA

Personalised recommendations