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

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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.

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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.

Author information

Author notes

  1. Aditya Bardia

    Present address: Massachusetts General Hospital Cancer Center, 10 North Grove Street, Boston, MA, 02114, USA

  2. Erin T. Arieas

    Present address: Mercy Medical Group, A Service of Catholic Healthcare West (CHW), Medical Foundation Internal Medicine, 8120 Timberlake Way, #107, Sacramento, CA, 95823, USA

  3. Nancy E. Davidson

    Present address: University of Pittsburgh Cancer Institute and UPMC Cancer Center, 5150 Centre Ave, Suite 500, Pittsburgh, PA, 15232, USA

Authors and Affiliations

  1. Breast Cancer Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Bunting-Blaustein Cancer Research Building 1, Room 144, 1650 Orleans Street, Baltimore, MD, 21231, USA

    Aditya Bardia, Karineh Tarpinian, Stacie Jeter, Deborah K. Armstrong, Nancy E. Davidson, John Fetting, Antonio C. Wolff & Vered Stearns

  2. Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Erin T. Arieas, Andrew DeFilippis, Pamela Ouyang, Roger S. Blumenthal & M. Dominique Ashen

  3. Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Zhe Zhang

  4. Department of Medicine, Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA

    Anne Nguyen, David A. Flockhart & Anna Maria Storniolo

  5. Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    N. Lynn Henry, Daniel F. Hayes & Jill Hayden

Authors
  1. Aditya Bardia
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  2. Erin T. Arieas
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Corresponding author

Correspondence to Vered Stearns.

Additional information

Aditya Bardia and Erin T. Arieas contributed equally to this study.

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Bardia, A., Arieas, E.T., Zhang, Z. et al. Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer. Breast Cancer Res Treat 131, 907–914 (2012). https://doi.org/10.1007/s10549-011-1843-1

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  • DOI: https://doi.org/10.1007/s10549-011-1843-1

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