Key result
Early-stage breast cancer survivorship is linked to ~16% higher cardiovascular mortality vs. general population.
Why the study?
Cardiovascular disease is the most common non-cancer cause of death in breast cancer survivors, but the age-specific timing when CVD deaths surpass breast cancer deaths and early indicators remain unknown.
Do women with early-stage breast cancer have a higher risk of cardiovascular-specific mortality compared to the general population, and at what time point does cardiovascular mortality exceed breast cancer-specific mortality?
Cohort (n=255,731)
Yes
Do women with early-stage breast cancer have a higher risk of cardiovascular-specific mortality compared to the general population, and at what time point does cardiovascular mortality exceed breast cancer-specific mortality?
Early-stage breast cancer survivors face a modestly elevated risk of cardiovascular death compared to the general population, with cardiovascular mortality surpassing cancer mortality at around 8 years post-diagnosis in women aged 70–85, highlighting the need for long-term cardiovascular monitoring.
Aim: Cardiovascular disease (CVD) is the most common non-cancer cause of death in breast cancer (BC) survivors, yet the age-specific point at which CVD deaths overtake BC deaths, and its early indicators, remain unknown. This study aimed to establish this time point and identify factors associated with cardiovascular-specific mortality (CSM) in early-stage BC. Methods: We analyzed 255,731 women diagnosed with stage I–III BC (2010–2020) from the Surveillance, Epidemiology, and End Results (SEER) 17 registries. CSM was compared with the general United States (US) female population using standardized mortality ratio (SMR) via Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Competing-risk methods estimated cumulative incidence, and Fine-Gray regression identified factors associated with CSM after adjustment for measured covariates. Results: Upon age standardization, the overall risk of CSM was modestly higher among BC patients than in the general female population [SMR = 1.16, 95% confidence intervals (CI): 1.13–1.19, P < 0.001], with marked heterogeneity by age; the relative excess was greatest in women aged < 50 (SMR = 2.894) and attenuated in older strata (50–59, SMR = 1.138; 60–69, SMR = 1.208; 70–85, SMR = 1.128). Cumulative CSM reached 2.53% at 84 months (7 years). Within the oldest cohort (70–85 years), cumulative CSM crossed above BC-specific mortality later, at approximately 8 years (97 months; 95% CI 91–101) [sub-distribution hazard ratio (SHR) = 19.37; 70–85 vs. 18–49], followed by unmarried status (1.59), Black race (1.37), advanced tumor (T4, 1.60) and nodal stage (N3, 1.34). Chemotherapy and radiotherapy were associated with lower CSM (SHR = 0.59 and 0.64); given SEER’s lack of treatment data, these likely reflect selection bias and residual confounding rather than protection. Conclusions: This is one of the first studies to identify an approximate mortality crossover point between CSM and BC-specific mortality at about 8 years (97 months) in women aged 70–85, providing a clinically relevant, exploratory time point for increased cardiovascular monitoring in this high-risk population.
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Djuma et al. (2026) conducted a cohort in Stage I-III breast cancer (n=255,731). Early-stage breast cancer survivorship vs. General US female population was evaluated on Cardiovascular-specific mortality compared to the general female population (SMR 1.16, 95% CI 1.13-1.19, p=<0.001). Early-stage breast cancer survivors had higher cardiovascular mortality risk than the general population (SMR 1.16); this overtook cancer-specific mortality at 8 years in women aged 70-85.
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