THE RELATIVE BURDEN OF COMORBIDITIES IN BREAST CANCER SURVIVORS: RESULTS FROM THE CLUE II AND BOSS COHORTS

Breast cancer survivors;mortality;cardiovascular disease;cardiovascular disease risk factors;bone health;osteopenia;osteoporosis;not listed

Ramin, CodyVisvanathan, Kala ;

Johns Hopkins University

关键词: Breast cancer survivors;    mortality;    cardiovascular disease;    cardiovascular disease risk factors;    bone health;    osteopenia;    osteoporosis;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/61056/RAMIN-DISSERTATION-2018.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Advances in screening and treatment strategies have led to a growing population of long-term breast cancer survivors in the United States. Although studies in breast cancer survivors have reported bone loss, cardiovascular disease (CVD), and trends in mortality, the additional effect of cancer and its treatment on these outcomes is unclear due to limited comparisons with cancer-free women. The aim of this dissertation was to evaluate the risk of bone loss, CVD, and mortality in breast cancer survivors relative to a cancer-free comparison within the same cohort.First, we prospectively examined all-cause and CVD-related mortality in breast cancer survivors relative to cancer-free women in a community-based cohort. We found that survivors, irrespective of stage, estrogen-receptor (ER)-status, and time since diagnosis, had a higher risk of all-cause mortality compared to cancer-free women. We further observed an increase in all-cause mortality over time among survivors diagnosed at age ≥70. Survivors had higher CVD-related mortality after 8 years, particularly among those diagnosed at age ≥70 and those with ER-positive tumors, compared to cancer-free women.Second, we examined incident CVD risk factors shortly after diagnosis in breast cancer survivors compared to cancer-free women within a familial risk cohort. Overall, survivors did not have a higher risk of hypertension, high cholesterol, or diabetes compared to cancer-free women. However, compared to cancer-free women, survivors had an increased risk of high triglycerides and survivors diagnosed at age ≤50 years had an increased risk of hypertension. Third, we prospectively evaluated bone loss in breast cancer survivors compared to cancer-free women within a familial risk cohort. We found an overall increased risk of bone loss in survivors compared to cancer-free women. Risk of bone loss was higher among women diagnosed at age ≤50 years, women with ER-positive tumors, and women treated with aromatase inhibitors alone or chemotherapy plus any hormonal therapy.Overall, this dissertation informs and improves our understanding of breast cancer and its related treatment on bone loss, CVD, and mortality. Results support a more tailored approach to treatment and prevention strategies, and further evaluation of these interventions to improve the long-term survival in breast cancer survivors.