Time to remove the subspecialty blinders: breast cancer does not exist in isolation.

摘要

As oncologists, we focus on treating cancer and preventing cancer-related deaths. However, how aggressively are our patients treated for non-cancer-related medical problems? This question should be of great importance to oncologists, particularly those who treat breast cancer patients. The survival rates for breast cancer have improved over the past several decades, likely because of an increase in screening and improvements in therapy (1,2). As deaths from breast cancer fall and the population ages, breast cancer patients are increasingly likely to die of other illnesses. Thus, appropriate treatment of medical conditions other than breast cancer is critical for our patients' overall health. Understanding the risk of death from . breast cancer in the context of the competing risk of death from other causes is also essential when estimating the risk and benefits of therapy for breast cancer patients. For instance, if a patient has a limited life expectancy because she has cardiovascular disease, systemic adjuvant therapies for breast cancer are unlikely to impact survival. In a patient who is 70 years old and has a 2-cm estrogen receptor-positive tumor and four positive lymph nodes, adjuvant hormonal therapy is associated with a 32% relative reduction in risk of death from breast cancer (3). If she is in perfect health, the relative risk reduction would translate to a 10% absolute survival benefit at 10 years. However, if she has a major comorbid illness, the absolute survival benefit would be reduced to less than 1%.