This abstract was withdrawn by the authors. Citation Format: Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami H-O, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault M-C, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh W-P, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Van Gils CH, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan J-M, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-01.
Background: Evidence suggests that the presence of Type-2 diabetes at the time of breast cancer diagnosis adversely affects survival independent of breast cancer stage, grade, and tumor phenotype. Few of these epidemiological studies have included Hispanic breast cancer survivors in whom diabetes and obesity are prevalent. Objective: We examined the association between self-reported diabetes history, breast cancer-specific and all-cause mortality among Hispanic and non-Hispanic white (NHW) women diagnosed with breast cancer (stages I-IIIa) from the New Mexico Health, Eating, Activity, and Lifestyle cohort. Methods: A total of 399 breast cancer survivors (96 Hispanic, 303 NHW) contributed data for the present study. Women with breast cancer diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) registry in New Mexico. Baseline demographic characteristics and breast cancer risk factors were collected approximately 5 months post diagnosis by trained interviewers. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazards regression models. Models were further stratified by ethnicity. Results: After a median follow-up time of 13.5 years from baseline interview to death, a total of 134 deaths occurred. The prevalence of diabetes did not significantly differ by ethnicity in our study; 11.5% of Hispanics reported having diabetes compared to 7.5% of NHW women. While a history of diabetes was associated with older age at breast cancer diagnosis (p=0.001), higher percent body fat (p=0.01), higher body mass index (p< 0.001), and increased waist-hip ratio (p< 0.001) compared to non-diabetics, no significant differences were observed between diabetics and non-diabetics for breast cancer stage, grade, tumor phenotype, or receipt of breast cancer treatment. In multivariable models, diabetes was associated with increased risk of all-cause mortality overall (HR, 2.10; 95% CI 1.24-3.55), with a significant association only observed among Hispanic women (HR, 3.07; 95% CI 1.05-8.94) when compared to NHW women (HR, 1.66; 95% CI 0.86-3.24). The interaction between ethnicity and diabetes was not statistically significant for all-cause mortality. Diabetes also was significantly associated with increased risk of breast cancer-specific mortality (HR, 2.89; 95% CI 1.27-6.60); however results were not statistically significant by ethnicity. Conclusions: Overall, diabetes significantly increased risk of all-cause mortality among women diagnosed with invasive BC from our study, particularly among Hispanic women. Diabetes was also found to be a significant prognostic factor for breast-cancer specific mortality. Future studies utilizing this data will be conducted to further evaluate the association between diabetes, glycemic control and breast cancer-specific mortality in Hispanic and NHW women. Citation Format: Connor AE, Visvanathan K, Boone SD, Baumgartner KB, Baumgartner RN. The association between type-2 diabetes and risk of mortality after invasive breast cancer among Hispanic and non-Hispanic white women from New Mexico [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-03.
Missouri is one of many states in the US burdened by high rates of mortality from female breast cancer (BC) as well as comorbidities such as Type-2 diabetes, cardiovascular disease (CVD), and hypertension. These comorbidity rates are higher among vulnerable populations including individuals in poverty and/or living in rural areas, African Americans, and the elderly. There is evidence that women with comorbidities at the time of BC diagnosis have a worse prognosis. We hypothesize that the co-existence of comorbidities is likely to impact survival and may contribute to survival disparities observed among women diagnosed with BC from these vulnerable populations. Objective: To examine whether the number and/or type of comorbidity at BC diagnosis is associated with higher BC and all-cause mortality among women diagnosed with invasive BC in Missouri between 2004 and 2012. Methods: Women age 18+ diagnosed with BC in Missouri during 2004–2012 were identified from the Missouri Cancer Registry. These data were then merged with hospital discharge data from the Missouri Patient Abstract System. Associations were evaluated in all women and by race, neighborhood poverty level, rural/urban residence, and age at diagnosis. A comorbidity score was constructed to account for the number of comorbidities (Type-2 diabetes, hypertension, and CVD) identified for each individual. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression models, adjusting for age at diagnosis, race, tumor hormone receptor status, stage, BC treatment, and rural/urban residence. Models were further stratified by race, poverty level, rural/urban residence, and age group. Results: A total of 31,133 women with incident invasive BC and with comorbidity data at the time of BC diagnosis were included in the analysis. After a median follow-up time of 79 months, 9,912 deaths occurred, of which 4,900 deaths were due to BC. Increasing number of comorbidities was significantly associated with BC mortality (ptrend < 0.001). BC mortality (HR, 1.33; 95% CI 1.19-1.49) and all-cause mortality (HR, 1.51; 90% CI 1.32-1.61) were significantly higher in women with ≥2 comorbidities. CVD accounted for the largest increase in BC mortality (HR, 1.36; 95% CI 1.19-1.55). In stratified analyses, we did not observe significant differences in associations by race, poverty, rural/urban residence, or age; however, there was a statistically significant interaction with age when modeled as a continuous measure, comorbidity score, and risk of mortality outcomes (p< 0.001). White women with all 3 comorbidities had the highest risk of death (BC-specific: HR, 1.95; all-cause: HR, 2.28). Women in rural areas with ≥2 comorbidities were 1.78 times more likely to die of BC while women living in the metro with all 3 comorbidities were almost 2 times more likely to die of any cause. Conclusion: Our results demonstrate the negative impact that comorbidities such as diabetes, CVD, and hypertension can have on BC and overall mortality in a diverse group of BC patients diagnosed and treated in Missouri. The data produced from this study can be utilized to identify and implement targeted preventive strategies to improve the quality of life and survival of BC patients. Citation Format: Connor AE, May B, Schmaltz CL, Jackson-Thompson J, Visvanathan K. The impact of existing comorbidities on survival disparities among women diagnosed with invasive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-11.
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