Breast Cancer Stage May Influence Risk of Prevalent CVD

Patients exhibiting greater, advanced stages of breast cancer at the time of their diagnosis are 10% more vulnerable to developing a prevalent cardiovascular disease (CVD). These findings highlight the role of delayed diagnoses and, as such, could help guide updated screening recommendations, according to a recent study published in JAMA Network Open.¹

CVD risk increases with more advanced breast cancer stage. | Image credit: © soumen - stock.adobe.com

Cancer and CVD are among the top contributors to mortality throughout the US. A growing subset of literature has been suggesting a causal link between CVD and progressive cancer. Prior research has found that patients with heart failure experience higher rates of cancer,² and that heart failure and cardiac remodeling may play a role in tumor progression and metastasis.^3,4

“This effect is notable in breast cancer, where CVD induces an immunosuppressive state, fostering accelerated breast tumor cell growth and spread,” the authors write. As this evidence has surfaced, the researchers sought to further assess the risk of having prevalent CVD for patients with advanced breast cancers compared with those with earlier-stage disease.

Data were collected from the Surveillance, Epidemiology, and End Results-Medicare linked databases between 2009 and 2020. Female patients with invasive breast cancer were identified and were eligible for inclusion if they were 66 years or older and underwent a mammogram screening within 2 years of receiving their diagnosis.

A total of 19,292 patients with breast cancer were included in the analysis with a median age of 73 years. This population was 86.5% White (n = 16,681), 8.7% Black (n = 1676), and 5.5% Hispanic (n = 1058). Nearly half (49.1%) in the matched cohort had CVD; over 90% (n = 8675) had their CVD detected between 13 and 24 months before receiving their breast cancer diagnosis. Those included were divided into 2 groups, matched with one another depending on their diagnosis of early-stage breast cancer (n = 9646) or metastatic/locally advanced breast cancer (n = 9646).

The risk of prevalent CVD was significantly greater for those in the metastatic/locally advanced breast cancer group (OR, 1.10; 95% CI, 1.03-1.17; P = .007), particularly among those with hormone receptor-positive breast cancer (OR, 1.11; 95% CI, 1.03-1.19; P = .006); however, patients with hormone receptor-negative breast cancer did not exhibit a significant association (OR, 1.02; 95% CI, 0.86-1.21; P = .83). The researchers noted how their OR results were in line with separate observations conducted for metastatic breast cancer (OR, 1.20; 95% CI, 0.94-1.54; P = .15) and locally advanced disease (OR, 1.09; 95% CI, 1.02-1.17; P = .02) throughout each examined receptor subtype.

The observational and retrospective nature of the study was somewhat limiting, the authors add, citing its susceptibility to confounding, bias, and that it cannot truly indicate causality. For this reason, they advocate for future research in this area to incorporate prospective designs, taking extra caution that CVD has not been misclassified.

Overall, these results suggest that patients with more advanced breast cancer are more vulnerable to developing prevalent CVD. These associations were observed for those with later-stage disease at their diagnosis; however, the researchers concluded that these prognoses were not associated with diagnostic delays.

“Future studies are needed to determine whether individuals with CVD may benefit from personalized breast cancer screening approaches, which may be particularly relevant in the setting of current conflicting screening recommendations regarding age and frequency,” the authors write.

References

1. Angelov I, Haas AM, Brock E, et al. Cardiovascular disease and breast cancer stage at diagnosis. JAMA Netw Open. 2025;8(1):e2452890. doi:10.1001/jamanetworkopen.2024.52890

2. Roderburg C, Loosen SH, Jahn JK, et al. Heart failure is associated with an increased incidence of cancer diagnoses. ESC Heart Fail. 2021;8(5):3628-3633. doi:10.1002/ehf2.13421

3. Meijers WC, Maglione M, Bakker SJL, et al. Heart failure stimulates tumor growth by circulating factors.Circulation. 2018;138(7):678-691. doi:10.1161/CIRCULATIONAHA.117.030816

4. Avraham S, Abu-Sharki S, Shofti R, et al. Early cardiac remodeling promotes tumor growth and metastasis.Circulation. 2020;142(7):670-683. doi:10.1161/CIRCULATIONAHA.120.046471