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The Effect of Comorbidity on 3-Year Survival of Women with Primary Breast Cancer

William A. Satariano, PhD, MPH; and David R. Ragland, PhD, MPH
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From the University of California at Berkeley, Berkeley, California. Requests for Reprints: William A. Satariano, PhD, MPH, Epidemiology Program, School of Public Health, University of California at Berkeley, Berkeley, CA 94720. Grant Support: By a grant from the National Institute on Aging (R01-AG04969), a contract from the National Cancer Institute (N01 CN-55423), and a grant from the American Cancer Society (PBR-67).

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(2):104-110. doi:10.7326/0003-4819-120-2-199401150-00002
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Objective: To determine the effect of comorbidity and stage of disease on 3-year survival in women with primary breast cancer.

Design: Longitudinal, observational study.

Setting: Metropolitan Detroit.

Patients: 936 women ages 40 to 84 years.

Measurements: Data on stage of breast cancer, treatment type, and comorbidity were obtained from Metropolitan Detroit Cancer Surveillance System (MDCSS) files and medical records. Personal interviews were the source of information on social and behavioral factors. Vital status and cause of death were obtained from MDCSS files.

Results: Patients who had 3 or more of 7 selected comorbid conditions had a 20-fold higher rate of mortality from causes other than breast cancer and a 4-fold higher rate of all-cause mortality when compared with patients who had no comorbid conditions. The effects of comorbidity were independent of age, disease stage, tumor size, histologic type, type of treatment, race, and social and behavioral factors. Moreover, women with severe comorbid conditions had uniformly higher mortality rates, and early diagnosis in these women conferred no survival advantage.

Conclusion: Comorbidity in patients with breast cancer appears to be a strong predictor of 3-year survival, independent of the effects of breast cancer stage. This finding suggests that trials assessing the efficacy of screening should routinely include measures of comorbidity.


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Figure 1.
Adjusted relative risks and 3-year mortality rates among 936 patients with breast cancer by number of comorbid conditions (0, 1, 2, 3+) and disease stage (local, regional, remote).

Each block represents the adjusted mortality rate per 1000 person-years of follow-up with the relative risk of the highest rate set at 1.0. Numbers on the tops of the blocks are the adjusted mortality rates, and the number of breast cancer cases is shown in the corresponding diamond grids. RR = relative risk.

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