Racial and ethnic disparities in treatment-related heart disease mortality among U.S. breast cancer survivors.
Racial and ethnic disparities in treatment-related heart disease mortality among U.S. breast cancer survivors.
- 2023
BACKGROUND: Racial/ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described. CONCLUSIONS: Our findings illuminated striking racial/ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt. Copyright Published by Oxford University Press 2023. METHODS: We included 739,557 women diagnosed with first primary invasive breast cancer between 2000-2017 (aged 18-84 years, received surgery, survived >=one year, followed through 2018) in the SEER-18 database. Standardized mortality ratios (SMRs; observed/expected) were calculated by race/ethnicity (Non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHP]); Non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and Non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy+surgery; chemotherapy, radiotherapy, +surgery; and radiotherapy+surgery) compared to the racial/ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks. RESULTS: SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy+surgery (range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, +surgery (1.29; 95%CI = 1.11,1.48), whereas SMRs were <1 for White women (range = 0.70-0.96). SMRs were especially high for women with advanced (regional/distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy+surgery (range = 1.28-3.61). Non-white women diagnosed at age < 60 had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor positive breast cancers. Black women had the highest ten-year cumulative risk of heart disease mortality: age < 60 (Black : 1.78%; 95%CI = 1.63%,1.94%) compared to White, AANHPI, and Latina women (<1%), and age >= 60 (Black : 7.92%; 95%CI = 7.53%,8.33%) compared to White, AANHPI, and Latina women (range = 3.90%-6.48%).
English
2515-5091
10.1093/jncics/pkad024 [doi] 7082546 [pii]
IN PROCESS -- NOT YET INDEXED
MedStar Heart & Vascular Institute
Journal Article
BACKGROUND: Racial/ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described. CONCLUSIONS: Our findings illuminated striking racial/ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt. Copyright Published by Oxford University Press 2023. METHODS: We included 739,557 women diagnosed with first primary invasive breast cancer between 2000-2017 (aged 18-84 years, received surgery, survived >=one year, followed through 2018) in the SEER-18 database. Standardized mortality ratios (SMRs; observed/expected) were calculated by race/ethnicity (Non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHP]); Non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and Non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy+surgery; chemotherapy, radiotherapy, +surgery; and radiotherapy+surgery) compared to the racial/ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks. RESULTS: SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy+surgery (range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, +surgery (1.29; 95%CI = 1.11,1.48), whereas SMRs were <1 for White women (range = 0.70-0.96). SMRs were especially high for women with advanced (regional/distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy+surgery (range = 1.28-3.61). Non-white women diagnosed at age < 60 had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor positive breast cancers. Black women had the highest ten-year cumulative risk of heart disease mortality: age < 60 (Black : 1.78%; 95%CI = 1.63%,1.94%) compared to White, AANHPI, and Latina women (<1%), and age >= 60 (Black : 7.92%; 95%CI = 7.53%,8.33%) compared to White, AANHPI, and Latina women (range = 3.90%-6.48%).
English
2515-5091
10.1093/jncics/pkad024 [doi] 7082546 [pii]
IN PROCESS -- NOT YET INDEXED
MedStar Heart & Vascular Institute
Journal Article