Key result
HF mortality in breast cancer patients declines ~1% annually despite persistent demographic and regional disparities.
Why the study?
Heart failure has emerged as a leading non-cancer cause of death among older breast cancer survivors, prompting an analysis of US mortality trends and disparities.
Heart failure-related mortality among US female breast cancer survivors declined from 1999 to 2020, though significant disparities persist among older adults, non-Hispanic Blacks, and those in the Midwest or non-metropolitan areas.
Persistent disparities despite overall decline warrant targeted monitoring in older, Black, and rural survivors; extends trends data but leaves open causal factors and interventions.
Background: Advances in breast cancer treatment have improved survival outcomes, with the 5-year survival rates approximately 99% for early-stage breast cancer patients. Despite these therapeutic achievements, cardiovascular complications, particularly heart failure (HF), have emerged as a leading cause of non-cancer mortality among breast cancer survivors aged 65+, thereby compromising long-term survival and posing a greater mortality risk than cancer itself. We aim to analyze trends in HF-related mortality among women with breast cancer in the U.S. over two decades (1999-2020) and highlight key demographic and regional disparities. Methods: We used the CDC WONDER (Wide-ranging ONline Data for Epidemiologic Research) mortality database to extract age-adjusted mortality rates (AAMRs) per 100,000 US women aged ≥25 years for breast cancer and HF mortality from 1999 to 2020. The Joinpoint Regression Program calculated the average annual percentage change (AAPC) in AAMRs. Results: From 1999 to 2020, HF caused 56,006 deaths among U.S. women with breast cancer, with a decline over time (AAPC: -1.16%; 95% CI: -1.50 to -0.86). The overall AAMR was 1.94 (1.93 - 1.96). Older adults (≥65 years) showed a significantly higher AAMR [8.88 (8.80 - 8.96)] with an AAPC of -1.17% (-1.45 to -0.93) than younger adults (25-64 years) [0.26 (0.25 - 0.27)] with an AAPC of -1.24% (-2.37 to -0.36). Among the racial and ethnic groups, the highest AAMR was observed in non-Hispanic (NH) Blacks [2.37 (2.31 - 2.43)], followed by NH Whites [2.03 (2.01 - 2.05)], Hispanics [0.98 (0.94 - 1.03)], and NH Asians or Pacific Islanders [0.66 (0.61 - 0.72)]. NH Blacks showed the highest mortality burden and a slight increase in AAMRs [AAPC: 0.15% (-0.48 to 0.66)]. NH Asians or Pacific Islanders showed the lowest mortality burden with the highest decline in AAMRs [AAPC: -1.47% (-2.71 to -0.28)], followed by Hispanics or Latinos (-1.27%) and NH Whites (-1.01%). Regionally, the Midwest showed the highest AAMR [2.25 (2.21 - 2.29)], followed by the West [1.95 (1.92 - 1.99)], the Northeast [1.85 (1.81 - 1.88)], and the South [1.81 (1.78 - 1.83)]. The Northeast showed the highest decline in AAMRs [AAPC: -1.48% (-2.06 to -0.98)], and the South showed the lowest [-0.59% (-0.99 to -0.20)]. Women in non-metropolitan areas had higher AAMRs [2.36 (2.32 - 2.41)] than those in metropolitan areas [1.87 (1.85 - 1.88)]. Metro and non-metropolitan regions showed a similar decline in AAMRs over the study period (-1.05% vs. -1.20%). Conclusion: HF-related mortality among U.S. female breast cancer survivors has declined over the past two decades; however, older adults, NH Blacks, patients residing in the Midwest, and non-metropolitan areas experienced higher mortality burdens, highlighting the need for targeted interventions that incorporate risk stratification, integrated cardiovascular surveillance and equity centered interventions into survivorship planning. Ultimately, addressing demographic and regional disparities is essential to improving long-term survival outcomes for breast cancer survivors. Citation Format: M. C. Anyanwu, A. Raza, A. Nawaz, U. Khan. Trends and Disparities in Heart Failure Mortality Among US Adult Females with Breast Cancer from 1999 to 2020: A 22-Year Retrospective Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-02-19.
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Anyanwu et al. (2026) studied this question. Heart failure mortality in US women with breast cancer declined by 1.16% annually (1999-2020), but remained highest in ≥65 years, NH Blacks, Midwest, and non-metro areas.
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