Increased Risk of Cardiovascular Death in Breast Cancer Patients Without Chemotherapy or (and) Radiotherapy: A Large Population-Based Study

Tianwang Guan; Hanbin Zhang; Jinming Yang; Wenrui Lin; Kenie Wang; Miao Su; Weien Peng; Yemin Li; Yanxian Lai; Cheng Liu

doi:10.3389/fonc.2020.619622

Increased Risk of Cardiovascular Death in Breast Cancer Patients Without Chemotherapy or (and) Radiotherapy: A Large Population-Based Study

Front Oncol. 2021 Jan 28:10:619622. doi: 10.3389/fonc.2020.619622. eCollection 2020.

Authors

Tianwang Guan^{1

2

3}, Hanbin Zhang^{2

4}, Jinming Yang^{2

4}, Wenrui Lin^{2

4}, Kenie Wang⁵, Miao Su^{2

4}, Weien Peng⁴, Yemin Li⁴, Yanxian Lai^{1

2}, Cheng Liu^{1

2}

Affiliations

¹ Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.
² Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.
³ Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
⁴ Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou, China.
⁵ The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.

Abstract

Background: Cardiovascular death (CVD) in breast cancer patients without chemotherapy (CT) or (and) radiotherapy (RT) has not been studied yet. This study evaluates the correlation between breast cancer and CVD risk independent of chemotherapy or (and) radiotherapy.

Methods: Data of female breast cancer patients without receiving CT or RT were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database (2004-2015). Data were divided into two cohorts: tumor resection cohort and no resection cohort. The CVD risk in patients was expressed as standardized mortality ratios (SMRs). A 1:1 propensity score matching (PSM) was applied to balance inter-group bias, and competing risk regressions were utilized to evaluate the impact of tumor resection on CVD.

Results: The CVD risk was significantly higher (SMR = 2.196, 95% CI: 2.148-2.245, P<0.001) in breast cancer patients who did not receive CT or RT compared to the general population. Breast cancer patients without tumor resection showed higher CVD risk than patients who underwent tumour resection (tumor resection SMR = 2.031, 95% CI: 1.983-2.079, P<0.001; no resection SMR = 5.425, 95% CI: 5.087-5.781, P<0.001). After PSM, the CVD risk among patients without tumor resection indicated an increase of 1.165-fold compared to patients with tumor resection (HR=1.165, 95% CI: 1.039-1.306, P=0.009).

Conclusions: Female breast cancer patients are at higher risk of CVD despite unexposure to cardio-toxic CT or RT. However, female breast cancer patients subjected to tumor resection have decreased CVD risk. These results indicated that monitoring female breast cancer patients not receiving RT or CT might serve as a preventative measure against CVD.

Keywords: breast cancer; cardio-oncology; cardiovascular death; chemotherapy; radiotherapy.