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Health

Additional Illnesses Hurt Survival Chances For Missouri Breast Cancer Patients, Study Finds

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Women in Missouri with two co-existing conditions had a 30 percent increase in breast cancer mortality, and those with three had a 57 percent increase.

Nearly 5,000 women in Missouri were diagnosed with breast cancer in 2015, the last year for which figures are available from the Centers for Disease Control and Prevention. That’s about 130 cases per 100,000 women, making breast cancer the leading type of cancer for Missouri women by far – nearly two-and-a-half times the diagnosis rate for lung cancer.

The incidence of breast cancer in Kansas isn’t much lower – about 124 cases per 100,000 women.

And now there’s growing evidence that women diagnosed with breast cancer who have co-existing conditions like type 2 diabetes, hypertension and cardiovascular disease have a considerably worse prognosis.

That may sound obvious, but providers and policymakers don’t always take those other conditions into account when devising strategies to counter breast cancer, according to a study commissioned by the Women’s Foundation in Kansas City.

“Understanding how these conditions can really impact mortality rate can provide patients, providers and policymakers with valuable insight on how to improve the overall health of women with breast cancer in Missouri and ultimately… improve their quality of life and increase their longevity,” said Kala Visvanathan, one of the authors of the study.

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One key finding of the study: women with two co-existing conditions had a 30 percent increase in breast cancer mortality and those with three had a 57 increase.

“Collectively, these results provide strong evidence that coexisting conditions such as cardiovascular disease, diabetes, and hypertension play a major role in the mortality of breast cancer patients in the state of Missouri,” Visvanathan said during a presentation of the study’s findings Wednesday.

Washington University researchers have identified 80 counties in the United States with the highest breast cancer mortality rates – and nine of them are in Missouri.

Visvanathan and Avonne Connor, cancer epidemiologists at the Johns Hopkins Bloomberg School of Public Health, along with researchers at the University of Missouri, examined how commonly diagnosed co-existing medical conditions affect breast cancer mortality rates among Missouri women.

And what they found, after drawing on a dataset of more than 36,000 women diagnosed with invasive breast cancer in Missouri between 2002 and 2012, is that those conditions play a significant role.

“Importantly, in terms of policy implications, it’s clear that evaluation, treatment and monitoring of coexisting conditions at the time of breast cancer diagnosis is important and then, throughout their follow-up, it has the potential to improve survival, particularly in vulnerable populations,” Visvanathan said.

The study’s authors say their findings have important policy implications. Among them:

  • Evaluating and treating co-existing conditions when a woman is diagnosed with breast cancer may improve survival rates, particularly for vulnerable populations.
  • Reducing and controlling pre-existing conditions in women who don’t have cancer could improve survival rates if they're later diagnosed with breast cancer.

Not surprisingly, the Hopkins researchers found that mortality rates also differed based on race and poverty. For example, African-American women with breast cancer who also had cardiovascular disease had a two-fold risk of dying from any cause. And African American women were more likely to have a co-existing condition in the first place, with half having at least one such condition.
“We also saw differences in mortality among women living in urban areas and in high poverty areas – two areas that would really be important from a policy perspective,” Visvanathan said. “Women living in large urban areas with all three coexisting conditions were more than three times more likely to die of any cause and women with an increased poverty score also had high mortality.”

Wendy Doyle, president and CEO of the Women’s Foundation, said the foundation was looking to commission “a unique and impactful study that Missouri hadn’t done, looking at health.”

“It’s some pretty basic information,” Doyle said, “but until you see it on paper, it's kind of an ‘aha.’ It hadn't been done before, so we're hoping this will lead to what could be some easy lifts be within the health care system that could address this.”

Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.

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