Association of Breast Cancer Treatment Type and Death due to Cardiovascular Disease Comparing Black Women to White Women Open Access
Borger, Kylee Madison (Spring 2019)
Abstract
In 2017, an estimated 316,120 women were newly diagnosed with breast cancer (1) . Over the past decades, improvements in treatment and earlier detection of breast cancer have greatly improved survival rates of women (2) corresponding to relative 5‐, 10-, and 15-year survival rates of 89%, 83%, and 78%, respectively in 2016 (1) . Increased survival rate has led to new concerns about the long-term effects of breast cancer treatment, particularly cardiometabolic disease— which is the number one cause of mortality among U.S. women (3) . However, overall- and breast cancer-specific mortality rates are more pronounced among black women compared to white women, the former having a 40% increased risk of death. We utilized population-based registry data from the Georgia Comprehensive Cancer Registry (GCR) on newly diagnosed breast cancer cases from the greater Atlanta region within the state of Georgia for non-Hispanic white (NHW) and non-Hispanic black (NHB) women who had breast cancer diagnoses between from January 1, 2010 and December 31, 2014 (n=8,523). Women were followed until December 31, 2016 to investigate racial disparities in death due to cardiovascular disease (CVD) and modified by breast cancer treatment using Cox Proportional Hazard Models. Endocrine therapy was associated with a higher hazard of death by CVD for NHB women compared to NHW women with a hazard ratio (HR) of 2.1 (95% confidence interval (CI): 1.3, 3.5) for those who received the therapy compared to a null hazard ratio (95% CI of 0.5, 1.9) for NHB who did not receive the therapy. NHB women who received radiation and chemotherapy had HRs of 1.4 (CI: 0.7, 2.8) and 0.7 (CI: 0.3, 2.0), respectively compared to NHW women. We observed no difference in CVD-related outcomes by race. Further research with larger samples and longer follow-up are necessary to investigate potential CVD mortality disparities among NHW and NHB women.
Table of Contents
1. Background (pp. 1-3)
2. Methods (pp. 4-7)
3. Results (pp. 8-10)
4. Discussion (pp. 10-12)
5. Tables (pp. 13-16)
5a. Table 1: Demographic characteristics of study population by race, according to selected characteristics*.
5b. Table 2: Multivariable Cox Proportional Hazard Model of the association between breast cancer treatment and cardiovascular mortality.
5c. Table 3: Multivariable Cox Proportional Hazard Model of the association between race and cardiovascular mortality.
6. Figures and Figure Legends (pp. 17-21)
6a. Figure 1: Directed Acyclic Graph Demonstrating the Effect of Race on Death by Cardiovascular Disease.
6b. Figure 2: Directed Acyclic Graph Demonstrating the Effect of Chemotherapy on Death by Cardiovascular Disease.
6c. Figure 3: Directed Acyclic Graph Demonstrating the Effect of Radiation on Death by Cardiovascular Disease.
6d. Figure 4: Directed Acyclic Graph Demonstrating the Effect of Endocrine Therapy on Death by Cardiovascular Disease.
6e. Figure 5: Directed Acyclic Graph Demonstrating the Effect of Receipt of Herceptin on Death by Cardiovascular Disease.
7. Appendices (pp. 22-30)
7a. Appendix A: Institutional Review Board Exemption
7b. Appendix B: Results From Evaluating the Proportional Hazards Assumptions for Predictors
8. References (pp. 31-34)
About this Master's Thesis
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