Paramita Dasgupta1, Joanne F Aitken2, Christopher Pyke3, Peter D Baade4. 1. Cancer Council Queensland, PO Box 201, Spring Hill QLD 4004, Australia. Electronic address: paramitadasgupta@cancerqld.org.au. 2. Cancer Council Queensland, PO Box 201, Spring Hill QLD 4004, Australia; School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove QLD 4059, Australia; School of Population Health, University of Queensland, Brisbane, Australia. Electronic address: joanneaitken@cancerqld.org.au. 3. Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia. Electronic address: c_pyke@mc.mater.org.au. 4. Cancer Council Queensland, PO Box 201, Spring Hill QLD 4004, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport QLD 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane QLD 4000, Australia. Electronic address: peterbaade@cancerqld.org.au.
Abstract
BACKGROUND: Understanding the burden of competing (non-breast cancer) mortality is important for the growing number of breast cancer survivors. We quantity these patterns, and the impact of two leading non-cancer causes of death, within ten years of breast cancer diagnosis. METHODS: Population based cancer registry study of 23,809 women aged 50-79 diagnosed with first primary breast cancer in Queensland, Australia, 1997 to 2012 with additional data linkage to identify individual non-cancer mortality causes. Flexible parametric competing-risks models were used to estimate the crude and adjusted probabilities of death. RESULTS: While overall mortality increased with age at diagnosis, this effect was strongest for non-cancer (such as cardiovascular and cerebrovascular disease) mortality. Women diagnosed with advanced breast cancer had a higher crude probability of breast cancer death (23.1% versus 4.5% for localised) but similar probability of competing mortality (11.6% versus 11.3%). Within each category of spread of disease, the probability of breast-cancer deaths remained relatively constant with age, while the probability of competing deaths increased. The 10-year probability of dying from breast cancer was 3.7%, 4.2% and 5.6% among women with localised disease aged 50 to 59, 60-69 and 70-79 respectively, but 3.1%, 7.8% and 22.9% for competing mortality. Increasing age, advanced disease and being unpartnered were independently associated with increased risk of breast cancer and competing deaths. CONCLUSIONS: Promotion of improved health behaviors after a cancer diagnosis and development of individualized strategies for clinical management should be prioritized as part of optimal care for breast cancer survivors.
BACKGROUND: Understanding the burden of competing (non-breast cancer) mortality is important for the growing number of breast cancer survivors. We quantity these patterns, and the impact of two leading non-cancer causes of death, within ten years of breast cancer diagnosis. METHODS: Population based cancer registry study of 23,809 women aged 50-79 diagnosed with first primary breast cancer in Queensland, Australia, 1997 to 2012 with additional data linkage to identify individual non-cancer mortality causes. Flexible parametric competing-risks models were used to estimate the crude and adjusted probabilities of death. RESULTS: While overall mortality increased with age at diagnosis, this effect was strongest for non-cancer (such as cardiovascular and cerebrovascular disease) mortality. Women diagnosed with advanced breast cancer had a higher crude probability of breast cancer death (23.1% versus 4.5% for localised) but similar probability of competing mortality (11.6% versus 11.3%). Within each category of spread of disease, the probability of breast-cancer deaths remained relatively constant with age, while the probability of competing deaths increased. The 10-year probability of dying from breast cancer was 3.7%, 4.2% and 5.6% among women with localised disease aged 50 to 59, 60-69 and 70-79 respectively, but 3.1%, 7.8% and 22.9% for competing mortality. Increasing age, advanced disease and being unpartnered were independently associated with increased risk of breast cancer and competing deaths. CONCLUSIONS: Promotion of improved health behaviors after a cancer diagnosis and development of individualized strategies for clinical management should be prioritized as part of optimal care for breast cancer survivors.
Authors: Mark J Rutherford; Therese M-L Andersson; Tor Åge Myklebust; Bjørn Møller; Paul C Lambert Journal: BMC Med Res Methodol Date: 2022-01-06 Impact factor: 4.615