Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer - PubMed (original) (raw)

Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer

Denise M Boudreau et al. Breast Cancer Res Treat. 2014 Apr.

Abstract

Breast cancer tends to occur in an older age group of women also burdened with comorbidities such as cardiovascular disease (CVD). Numerous medications used to manage CVD (e.g., statins and antihypertensives) are hypothesized to alter breast cancer risk, but there are few studies on breast cancer outcomes. The COmmonly used Medications and Breast Cancer Outcomes (COMBO) cohort was developed to study how medications and co-morbidities influence breast cancer prognosis. Cohort study among adult women, diagnosed with incident early stage breast cancer, and enrolled in an integrated health plan. Data sources included health plan administrative databases, Surveillance, Epidemiology, and End Results tumor registry, and medical records. Statins, angiotensin-converting enzyme inhibitors (ACEI), beta blockers (BB), calcium blockers, and diuretics were the exposures of interest. The outcome was second breast cancer events (SBCE) defined as recurrence or second primary breast cancer. We used multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for SBCE, and components of SBCE. 4,216 women were followed for a median of 6.3 years, and 13.2 % experienced a SBCE (first of: n = 415 recurrences and n = 143 s primary breast cancers). Compared to non-users, we observed an increased risk of second primary breast cancer with ACEI use (HR = 1.66; 95 % CI, 1.06-2.58) and an increased risk of recurrence with BB use (HR = 1.29; 95 % CI, 1.01-1.64). There was suggestion of a reduced risk of SBCE with statin use (HR = 0.82; 95 % CI, 0.62-1.08) and second primary breast cancer with BB use (HR = 0.77; 95 % CI, 0.50-1.19). No differences in outcomes were observed by duration of medication use. A majority of CVD medications evaluated in this study appear safe with respect to SBCE, but ACEI and BB use warrant further evaluation. The study presented is one example of the questions that can be addressed using the COMBO cohort.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1

Schematic of data collection and exposure and outcome assessment in

mmonly Used

edications and

reast Cancer

utcomes (COMBO) Study

Figure 2

Cumulative hazard of second breast cancer events including recurrence and second primary breast cancer

Figure 3

Risk of second breast cancer events (SBCE) by ever/never medication use Abbreviations: HR – hazard ratio; CI – confidence interval; ACEI- angiotensin converting enzyme inhibitor; BB – beta blocker; CCB – calcium channel blocker. HR adjusted for all other medication classes of interest (ever/never use, time-varying), age at diagnosis (18–49, 50–59, 60–69, 70–79, 80+ years); diagnosis year (1990–1994, 1995–1999, 2000–2004, 2005–2008); AJCC stage (I, IIA, IIB); hormone receptor status (estrogen receptor [ER] −/progesterone receptor [PR] −, ER +/PR −, ER −/PR +, ER +/PR +, and ER and/or PR unknown); primary treatment for initial breast cancer (mastectomy, breast conserving surgery with radiation, breast conserving surgery without radiation); endocrine therapy for the incident breast cancer (yes/no, time-varying); body mass index (BMI) at diagnosis (<18.5, 18.5–24.9, 25.0–29.9, 30.0–34.9, 35+ kg/m2); smoking status at diagnosis (current, past, never/unknown); menopausal status at diagnosis (peri- or pre-menopausal, post-menopausal); Charlson co-morbidity score (0, 1, 2+, time-varying each year); diabetes (yes/no, time-varying); prescription non-steroidal anti-inflammatory medication use, Cox-2 inhibitors, and aspirin (yes/no, time-varying); and receipt of screening mammogram in the 12 months prior to events (yes/no, time-varying).

References

1. SEER Cancer Statistics Review. 1975–2009 http://seer.cancer.gov/csr/1975_2009_pops09/
1. Newman L. IOM Report sets policy priorities for improving breast cancer screening. J Natl Cancer Inst. 2001;93(8):574–575. - PubMed
1. Ritchie CS, Kvale E, Fisch MJ. Multimorbidity: an issue of growing importance for oncologists. J Oncol Pract. 2011;7(6):371–374. - PMC - PubMed
1. Boudreau DM, Yu O, Johnson J. Statin use and cancer risk: a comprehensive review. Expert Opin Drug Saf. 2010;9(4):603–621. - PMC - PubMed
1. Bonovas S, Filioussi K, Tsavaris N, Sitaras NM. Use of statins and breast cancer: a meta-analysis of seven randomized clinical trials and nine observational studies. J Clin Oncol. 2005;23(34):8606–8612. - PubMed

Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer - PubMed (original) (raw)