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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2014

01-04-2014 | Epidemiology

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

Authors: Denise M. Boudreau, Onchee Yu, Jessica Chubak, Heidi S. Wirtz, Erin J. Aiello Bowles, Monica Fujii, Diana S. M. Buist

Published in: Breast Cancer Research and Treatment | Issue 2/2014

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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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Metadata
Title
Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer
Authors
Denise M. Boudreau
Onchee Yu
Jessica Chubak
Heidi S. Wirtz
Erin J. Aiello Bowles
Monica Fujii
Diana S. M. Buist
Publication date
01-04-2014
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2014
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-014-2870-5

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