Year: 2008
Type: dissertation
Study design: Observational Study
Abstract: Purpose To assess long-term cause-specific mortality in breast cancer patients. Patients and Methods We studied mortality in 7425 patients treated for early breast cancer between 1970 and 1986. Follow-up was 94% complete until January 2000. Treatment-specific mortality was evaluated by calculating standardized mortality ratios (SMRs) based on comparison with general population rates and by using Cox proportional hazards regression. Results After a median follow-up of 13.8 years, 4160 deaths were observed, of which 76% were due to breast cancer. Second malignancies showed a slightly increased SMR of 1.2 (95% confidence interval [CI]: 1.0 1.3). Radiotherapy (RT) as compared with surgery was associated with a 1.7-fold (95% CI: 1.2 2.5) increased mortality from cardiovascular disease (CVD). After postlumpectomy RT, no increased mortality from CVD was observed (hazard ratio = 1.0; 95% CI: 0.5 1.9). Postmastectomy RT administered before 1979 and between 1979 and 1986 was associated with a 2-fold (95% CI: 1.2 3.4) and 1.5-fold (95% CI: 0.9 2.7) increase, respectively. Patients treated before age 45 experienced a higher SMR (2.0) for both solid tumors (95% CI: 1.6 2.7) and CVD (95% CI: 1.3 3.1). Conclusion Currently, a large population of breast cancer survivors is at increased risk of death from CVDs and second cancers, especially when treated with RT at a young age. Patients irradiated after 1979 experience low (postmastectomy RT) or no (postlumpectomy RT) excess mortality from CVD. Cause-specific mortality in long-term survivors of breast cancer: a 25-year follow-up study 21
Author: Hooning, M.J.
Institution: Vrije Universiteit Amsterdam
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1597140278