Racial differences in breast cancer-specific mortality and CVD-specific mortality after breast cancer in post-menopausal women

Kerryn W. Reding, School of Nursing, University of Washington, Box 357266, 1959 NE Pacific Street, WA, 98195, Seattle, USA. kreding@uw.edu.
Alexi L Vasbinder, School of Nursing, University of Washington, Box 357266, 1959 NE Pacific Street, WA, 98195, Seattle, USA.
Richard K. Cheng, Division of Cardiology, School of Medicine, University of Washington, Seattle, WA, USA.
Ana Barac, Inova Schar Cancer and Inova Schar Heart and Vascular Institute, Falls Church, VA, USA.
Yongzhe Wang, Breast Oncology Division, City of Hope, Duarte, CA, USA.
Warren J. Szewczyk, School of Nursing, University of Washington, Box 357266, 1959 NE Pacific Street, WA, 98195, Seattle, USA.
Reina Haque, Department of Research & Evaluation, Kaiser Permanente, Pasadena, CA, USA.
Tarah J. Ballinger, School of Medicine, Indiana University, Bloomington, IN, USA.
Khadijah Breathett, Division of Cardiovascular Medicine, Indiana University Indianapolis, Indianapolis, IN, USA.
Aladdin H. Shadyab, Herbert Wertheim School of Public Health and Human Longevity Science, Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego La Jolla, San Diego, CA, USA.
Regina Shih, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Tomas Nuno, Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Robert A. Wild, School of Medicine, University of Oklahoma, Norman, OK, USA.
Xiaochen Zhang, College of Medicine, The Ohio State University, Columbus, OH, USA.
Rami Nassir, School of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia.
Charles Mouton, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Dorothy S. Lane, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Lisa Warsinger Martin, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
JoAnn E. Manson, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Marcia L. Stefanick, School of Medicine, Stanford University, Stanford, CA, USA.
Michael S. Simon, Karmanos Cancer Institute, Detroit, MI, USA.
Veronica Jones, Breast Oncology Division, City of Hope, Duarte, CA, USA.

Document Type

Letter to the Editor

Publication Date

12-17-2025

Journal

Cardio-oncology (London, England)

Volume

11

Issue

1

DOI

10.1186/s40959-025-00403-9

Keywords

Cardiovascular disease; Mortality; Neoplasm - breast; Post-menopausal; Race

Abstract

BACKGROUND: Racial disparities in all-cause mortality after breast cancer (BC) have been documented. While elevated risk of BC mortality experienced by Black women is clear, it is unclear the relative contribution of cardiovascular disease (CVD) mortality to the survival disparity in Black women. METHODS: This analysis from the Women's Health Initiative (WHI) included 8,410 women diagnosed with invasive BC during follow-up. Cardiovascular (CV) events were defined as adjudicated myocardial infarction, heart failure, or stroke. Cause of death was determined through adjudication by medical chart review, ICD codes, death certificate, and/or autopsy report. 10-year cumulative incidence rates were calculated for CV events, CVD mortality, and BC mortality, stratified by race. Sub-distribution hazards ratios (sHR) were calculated using Fine and Gray models to account for competing risks. RESULTS: In BC survivors (mean age = 70.9 years, median follow-up = 15.1 years), 8.5% self-reported as Black. Compared to White women, Black women had higher 10-year cumulative incidence of non-fatal CV events (10.9% vs. 8.2%, P = 0.001) and BC mortality (15.3% vs. 11.5%, P = 0.039). In contrast, White women had higher 10-year incidence of CVD mortality (7.2% vs. 10.1%, P = 0.001). BC mortality in Black women represented a higher proportion of death (35% vs. 20%), which was not true for White women. CONCLUSION: Our study reinforces prior findings that racial disparities are experienced by Black women with BC. This may be in large part driven by BC mortality. However, if improvements in BC mortality are made to reduce this gap, disparities in CVD mortality may become more prominent due to racial disparities in CV events.

Department

Medicine

Link to Full Text

Share

COinS