Abstract P4-06-29: the Impact of Cardiovascular Disease on Breast Cancer Stage at Diagnosis

Background: Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the United States. Large-scale population-based and mechanistic studies support a direct effect of CVD on accelerated tumor growth and spread, including in breast cancer. Our objective was to test the hypothesis that individuals with prevalent CVD will present with more advanced breast cancers at the time of diagnosis compared to those without CVD. Methods: We conducted a retrospective cohort study in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases from 2009-2020. Participants were female patients aged 66 years or older at diagnosis of invasive breast cancer. We utilized a case-control design, based on breast cancer stage at diagnosis, propensity score matched on factors know to be related to delayed cancer diagnosis. Our full analytic cohort included 19,292 matched individuals, with median age 73 years (interquartile range 70-79), of which 86% were white and 49% had prevalent CVD. The exposure was prevalent CVD prior to breast cancer diagnosis. Our a priori hypothesis tested the odds of locally advanced (T3-4 or N+) or metastatic (M+) breast cancer at diagnosis based on prevalent CVD status. Results: In propensity score matched, multivariable adjusted models we found that individuals with prevalent CVD had a statistically significantly increased odds of locally advanced or metastatic breast cancer at diagnosis (OR, 1.10; 95% CI, 1.03-1.17; p=0.007). This association was observed among hormone receptor positive (OR, 1.11; 95% CI, 1.03-1.19; p=0.006), but not hormone receptor negative (OR, 1.02; 95% CI, 0.86-1.21; p=0.834) breast cancer. Our results were directionally consistent when separately examining locally advanced (OR, 1.09; 95% CI, 1.02-1.17; p=0.017) and metastatic (OR, 1.20; 95% CI, 0.94-1.54; p=0.152) disease, among all receptor subtypes. Conclusions: Our study provides evidence that prevalent cardiovascular disease is associated with more advanced breast cancer at diagnosis. This finding may be specific to hormone receptor positive disease. Future studies are needed to confirm our findings and investigate interventions to improve patient outcomes, including personalized screening. Citation Format: Kevin Nead, Ivan Angelov, Allen M. Haas, Elizabeth Brock, Lingfeng Luo, Jing Zhao, Benjamin D. Smith, Sharon H. Giordano, Nicholas J. Leeper. The impact of cardiovascular disease on breast cancer stage at diagnosis [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-06-29.