64 Cardiovascular Disease Risk Among Rural and Urban Black Breast Cancer Survivors

Faculty Mentor: Mia Hashibe (Family & Preventative Medicine, University of Utah)

Cancer is the overgrowth of cells in the body and tumor suppressor genes such as BRCA1 and BRCA2 prevent the development and growth of cancerous cells in the body. There are more than 4 million breast cancer survivors in the US today. Comorbidities such as cardiovascular disease, diabetes, obesity, high blood pressure, and arthritis can negatively impact breast cancer survivorship. Women of color are 40% more likely to die from breast cancer than Non-Hispanic White women.

Having a comorbidity decreases 5-years relative survival rates and prevents the patient from receiving the full benefits of cancer therapy. The objective of our study is to investigate the risk of cardiovascular disease among rural Non-Hispanic Black (NHB), and Non-Hispanic Whites (NHW) breast cancer survivors compared to their counterparts in the SEER-Medicare data. This study was based on a retrospective population-based cohort of 1,108 rural NHB, 4,702 urban NHB, 23,280 rural NHW, and 75,987 urban NHW breast cancer survivors. Other eligibility criteria that were used to identify the cohort in this study were age at cancer diagnosis >65 years, and diagnosis years 2000- 2017. Rural NHW breast cancer survivors had a higher proportion without baseline comorbidities (56.7%) compared to rural NHB breast cancer survivors (35.5%). Rural NHB breast cancer patients were less likely to receive surgery and radiation therapy, but more likely to receive chemotherapy than rural NHW breast cancer patients. The risk of cardiovascular disease increased significantly among rural vs. urban patients among NHB breast cancer survivors (HR for heart failure NHW=1.20, 95%CI=1.16, 1.24). Cardiovascular disease prevention may thus be important for rural NHB breast cancer survivors. Living in certain populations can impact breast cancer survivorship.

People who live in rural areas lack many resources, are less likely to be married, education is not higher than high school diploma, and make less than 35,000 a year. While people who stay in urban areas are more likely to be married, have a high school diploma or higher, have access to more resources, and access great insurance. Non-Hispanic blacks are more likely to have baseline comorbidities than non-Hispanic whites because of their fear of going to the doctor, cost of treatments, and lack of transportation, and because of these non-Hispanic blacks are more likely to be diagnosed at later stages than non-Hispanic whites. Non-Hispanic blacks are also more likely to be obese, physically inactive, and have diabetes, and hypertension before being diagnosis with breast cancer.

There are several types of treatment for breast cancer such as chemotherapy, radiation, and surgery. Radiation is more likely to cause heart disease because it must be done directly to the breast, and this can affect the heart’s tissue. There are abnormalities found in BRCA1 and BRCA2 from anthracycline that can damage the heart over time. For early prevention, it is important women have their yearly mammograms. Mammograms use small doses of X-Rays to catch cancer early and normally mammograms will detect the breast cancer before a woman starts to notice symptoms such as a breast lump, tenderness, skin irritation, dimpling, nipple discharge, pain, and ulceration. With the assistance of mammograms, and undergoing a thorough physical and history examination, women can receive earlier detection if they are found with breast cancer, or cardiovascular disease. They have a higher chance of different treatment options which can save their lives.