Competing risk analysis of cardiovascular death in Breast Cancer: Evidence from SEER-Medicaid

Purpose: The aim of this study was to investigate the risk of cardiovascular mortality (CVM) in patients with breast cancer (BC). Methods: Patients diagnosed with primary BC between 2010 and 2018 were identified through the Surveillance, Epidemiology and End Results (SEER) database. Standardized mortality rate (SMRs) for cardiovascular disease (CVD) were calculated to compare the CVM of BC patients with that of the general population. Multivariate competing risk models were performed to identify predictors of CVM in BC patients. Results: Overall, 399,014 BC patients were included from the SEER database, of whom 7023 (1.8%) suffered death from CVD. The significantly higher overall SMR of CVM was observed in BC patients (SMR = 4.84, 95% CI: 4.72–4.95). Multivariate competing risk regression analysis revealed age, sex, race, American Joint Committee on Cancer stage, year of diagnosis, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, BC subtype, surgery, and median household income as independent predictors of CVM in BC patients. Conclusions: Compared to the general population, BC patients have a higher risk of experiencing CVM during the follow-up period after diagnosis. Early detection and intervention of cardiovascular risk factors will improve overall survival of BC patients.