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. 2013 Oct 9;8(10):e76013.
doi: 10.1371/journal.pone.0076013. eCollection 2013.

Comorbid diseases interact with breast cancer to affect mortality in the first year after diagnosis--a Danish nationwide matched cohort study

Anne Gulbech Ording  1 , Jens Peter Garne, Petra Mariann Witt Nyström, Trine Frøslev, Henrik Toft Sørensen, Timothy L Lash
Affiliations

Comorbid diseases interact with breast cancer to affect mortality in the first year after diagnosis--a Danish nationwide matched cohort study

Anne Gulbech Ording et al. PLoS One. .

Abstract

Background: Survival of breast cancer patients with comorbidity, compared to those without comorbidity, has been well characterized. The interaction between comorbid diseases and breast cancer, however, has not been well-studied.

Methods: From Danish nationwide medical registries, we identified all breast cancer patients between 45 and 85 years of age diagnosed from 1994 to 2008. Women without breast cancer were matched to the breast cancer patients on specific comorbid diseases included in the Charlson comorbidity Index (CCI). Interaction contrasts were calculated as a measure of synergistic effect on mortality between comorbidity and breast cancer.

Results: The study included 47,904 breast cancer patients and 237,938 matched comparison women. In the first year, the strongest interaction between comorbidity and breast cancer was observed in breast cancer patients with a CCI score of ≥4, which accounted for 29 deaths per 1000 person-years. Among individual comorbidities, dementia interacted strongly with breast cancer and accounted for 148 deaths per 1000 person-years within one year of follow-up. There was little interaction between comorbidity and breast cancer during one to five years of follow-up.

Conclusions: There was substantial interaction between comorbid diseases and breast cancer, affecting mortality. Successful treatment of the comorbid diseases or the breast cancer can delay mortality caused by this interaction in breast cancer patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Mortality rates per 1,000 person-years for 0–1 year of follow-up by Charlson Comorbidity Index (CCI) scores and individual diseases in this comorbidity index.
The total mortality rate contribution is represented by the baseline rate, comorbidity, breast cancer, and interaction.
Figure 2
Figure 2. Standardized mortality rates per 1,000 person-years for >1–5 years of follow-up by Charlson Comorbidity Index (CCI) scores and individual diseases in the CCI.
The total mortality rate contribution is represented by the baseline rate, comorbidity, breast cancer, and interaction.
See this image and copyright information in PMC

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