Breast Cancer Research and Treatment

, Volume 144, Issue 3, pp 643–663 | Cite as

Comprehensive evaluation of the incidence of late effects in 5-year survivors of breast cancer

  • Timothy L. LashEmail author
  • Soe Soe Thwin
  • Marianne Ulcickas Yood
  • Ann M. Geiger
  • Jaclyn Bosco
  • Virginia P. Quinn
  • Terry S. Field
  • Pamala A. Pawloski
  • Rebecca A. Silliman


Late effects of breast cancer affect the quality of survivorship. Using administrative data, we compared the occurrence of almost all ICD9 codes among older breast cancer survivors to that among a matched comparison cohort to generate new hypotheses. Breast cancer patients 65 years or older diagnosed 1990–1994 in 6 integrated care settings and who survived at least 5 years were matched with a cohort of women without a history of breast cancer on care setting, age, and calendar time. We collected data on the occurrence of incident ICD9 codes beginning 6 years after the breast cancer diagnosis date and continuing to year 15, and comparable data for the matched woman. We calculated hazard ratios (HRs) and 95 % confidence intervals associating breast cancer survivorship with incidence of each ICD9 code. We used semi-Bayes methods to address multiple comparisons. Older breast cancer survivors had about the same occurrence of diseases and conditions 6–15 years after breast cancer diagnosis as comparable women. The median of 564 adjusted HRs equaled 1.06, with interquartile range 0.92–1.3. The distribution of HRs pertaining to cancer-related ICD codes was shifted toward positive associations, and the distribution pertaining to cardiovascular-related ICD codes was shifted toward negative associations. In this hypothesis-scanning study, we observed little difference in the occurrence of non-breast cancer-related diseases and conditions among older, long-term breast cancer survivors, and comparable women without a history of breast cancer.


Breast neoplasms, complications Breast neoplasms, quality of life Breast neoplasms, late effects Breast neoplasms, survivorship 



Supported by Public Health Service grant R01CA093772-05A2 (Silliman, PI) from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services. The authors wish to thank Dr. Marianne Prout for her assistance with categorizing individual ICD9 codes into disease groups. This manuscript was prepared while Dr. Geiger was employed at Wake Forest School of Medicine. The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Timothy L. Lash
    • 1
    Email author
  • Soe Soe Thwin
    • 2
  • Marianne Ulcickas Yood
    • 3
  • Ann M. Geiger
    • 4
  • Jaclyn Bosco
    • 5
  • Virginia P. Quinn
    • 6
  • Terry S. Field
    • 7
  • Pamala A. Pawloski
    • 8
  • Rebecca A. Silliman
    • 9
  1. 1.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Healthcare SystemBostonUSA
  3. 3.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  4. 4.Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleUSA
  5. 5.Real-World & Late Phase Research Division of Quintiles, Inc.CambridgeUSA
  6. 6.Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  7. 7.Meyers Primary Care InstituteWorcesterUSA
  8. 8.HealthPartners Institute for Education and ResearchMinneapolisUSA
  9. 9.Section of Geriatrics, Boston University School of MedicineBoston Medical CenterBostonUSA

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