Cardiac Health Can Determine Breast Cancer Severity

TOPLINE:

Patients presenting with advanced breast cancer at diagnosis are more likely to have prevalent cardiovascular disease, and this association is more specific to hormone receptor–positive and ERBB2-negative disease.

METHODOLOGY:

• Researchers conducted a population-based case control study to evaluate if individuals presenting with advanced breast cancer have prevalent cardiovascular disease.
• They used the Surveillance, Epidemiology, and End Results–Medicare–linked databases to identify 19,292 female patients diagnosed with invasive breast cancer between 2010 and 2019 (median age, 73 years; 86.5% White individuals).
• Researchers used propensity score matching to compare early-stage breast cancer with locally advanced or metastatic disease and included 9646 participants in each group.
• The status of cardiovascular disease was assessed between 3 and 24 months before the diagnosis of breast cancer.
• The primary analysis compared the status of cardiovascular disease between individuals with early-stage breast cancer (T1-T2 and N0 and M0) and those with advanced disease (T3-T4 or N+ or M+).

TAKEAWAY:

• Cardiovascular disease was prevalent in 49.1% of the individuals with breast cancer, and 91.5% of the cases were detected 13-24 months before the diagnosis of breast cancer.
• Individuals with locally advanced or metastatic breast cancer had increased odds of prevalent cardiovascular disease (odds ratio [OR], 1.10; P = .007).
• A similar pattern was found when separately examining locally advanced disease (OR, 1.09; P = .02).
• Increased odds of prevalent cardiovascular disease were found in hormone receptor–positive (OR, 1.11; P = .006) and hormone receptor–positive/ERBB2-negative (OR, 1.12; P = .02) breast cancer, but not in hormone receptor–negative or ERBB2-positive cases.

IN PRACTICE:

“A direct impact of cardiovascular disease on a more aggressive underlying breast cancer biology may at least partially explain the increased breast cancer–specific mortality observed among patients with cardiovascular disease,” the authors wrote. “If acute events drive the biological link between cardiovascular disease and cancer, then more indolent cancer types, such as hormone receptor-positive and ERBB2-negative breast cancer, may have a larger time window to be effected prior to initial diagnosis,” they added.

SOURCE:

The study was led by Ivan Angelov, Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston. It was published online on January 2, 2025, in JAMA Network Open.

LIMITATIONS:

The observational nature of this study prevented establishing causality and left scope for residual bias and confounding. Cardiovascular disease might have been misclassified due to the use of diagnostic and procedure codes. Moreover, the predominance of White participants in the cohort could affect the generalizability of the findings.

DISCLOSURES:

The research was supported, in part, by a grant from the National Institutes of Health. Some authors reported receiving grants from the Cancer Prevention and Research Institute of Texas or the National Cancer Institute. One author reported receiving grants, salary support, personal fees, and equity from companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.