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

Judith Anne W Chapman, Daniel Meng, Lois Shepherd, Wendy Parulekar, James N. Ingle, Hyman B. Muss, Michael Palmer, Changhong Yu, Paul E. Goss

Research output: Contribution to journalArticle

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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 (range0-7 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 ≥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.

Original languageEnglish (US)
Pages (from-to)252-260
Number of pages9
JournalJournal of the National Cancer Institute
Volume100
Issue number4
DOIs
StatePublished - Feb 2008

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Cause of Death
Breast Neoplasms
Therapeutics
Neoplasms
letrozole
National Cancer Institute (U.S.)
Tamoxifen
Osteoporosis
Canada
Survivors
Cardiovascular Diseases
Lymph Nodes
Placebos
Clinical Trials

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chapman, J. A. W., Meng, D., Shepherd, L., Parulekar, W., Ingle, J. N., Muss, H. B., ... Goss, P. E. (2008). Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. Journal of the National Cancer Institute, 100(4), 252-260. https://doi.org/10.1093/jnci/djn014

Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. / Chapman, Judith Anne W; Meng, Daniel; Shepherd, Lois; Parulekar, Wendy; Ingle, James N.; Muss, Hyman B.; Palmer, Michael; Yu, Changhong; Goss, Paul E.

In: Journal of the National Cancer Institute, Vol. 100, No. 4, 02.2008, p. 252-260.

Research output: Contribution to journalArticle

Chapman, JAW, Meng, D, Shepherd, L, Parulekar, W, Ingle, JN, Muss, HB, Palmer, M, Yu, C & Goss, PE 2008, 'Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer', Journal of the National Cancer Institute, vol. 100, no. 4, pp. 252-260. https://doi.org/10.1093/jnci/djn014
Chapman, Judith Anne W ; Meng, Daniel ; Shepherd, Lois ; Parulekar, Wendy ; Ingle, James N. ; Muss, Hyman B. ; Palmer, Michael ; Yu, Changhong ; Goss, Paul E. / Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. In: Journal of the National Cancer Institute. 2008 ; Vol. 100, No. 4. pp. 252-260.
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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 (range0-7 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 ≥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.",
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AU - Yu, Changhong

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