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J Natl Cancer Inst. 2008 Feb 20;100(4):252-60. doi: 10.1093/jnci/djn014. Epub 2008 Feb 12.

Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer.

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  • 1National Cancer Institute of Canada Clinical Trials Group, Queen's University, 10 Stuart St, Kingston, ON, Canada. jchapman@ctg.queensu.ca

Abstract

BACKGROUND:

Older women with early-stage breast cancer experience higher rates of non-breast cancer-related death. We examined factors associated with cause-specific death in a large cohort of breast cancer patients treated with extended adjuvant endocrine therapy.

METHODS:

In the MA.17 trial, conducted by the National Cancer Institute of Canada Clinical Trials Group, 5170 breast cancer patients (median age = 62 years; range = 32-94 years) who were disease free after approximately 5 years of adjuvant tamoxifen treatment were randomly assigned to treatment with letrozole (2583 women) or placebo (2587 women). The median follow-up was 3.9 years (range 0-7 years). We investigated the association of 11 baseline factors with the competing risks of death from breast cancer, other malignancies, and other causes. All statistical tests were two-sided likelihood ratio criterion tests.

RESULTS:

During follow-up, 256 deaths were reported (102 from breast cancer, 50 from other malignancies, 100 from other causes, and four from an unknown cause). Non-breast cancer deaths accounted for 60% of the 252 known deaths (72% for those > or = 70 years and 48% for those < 70 years). Two baseline factors were differentially associated with type of death: cardiovascular disease was associated with a statistically significant increased risk of death from other causes (P.002), and osteoporosis was associated with a statistically significant increased risk of death from other malignancies (P.05). An increased risk of breast cancer-specific death was associated with lymph node involvement (P < .001). Increased risk of death from all three causes was associated with older age (P < .001).

CONCLUSIONS:

Non-breast cancer-related deaths were more common than breast cancer-specific deaths in this cohort of 5-year breast cancer survivors, especially among older women.

Comment in

PMID:
18270335
[PubMed - indexed for MEDLINE]
PMCID:
PMC2745611
Free PMC Article
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