New Study Finds Co-Existing Conditions Increase Breast Cancer Mortality

KANSAS CITY – The Women’s Foundation today released a study showing that nearly half of Missouri women diagnosed with breast cancer from 2002 and 2012 also suffered from type 2 diabetes, essential hypertension, or cardiovascular disease – and that the presence of these diseases substantially increased their risk of dying from cancer.

The first-of-its-kind study – Understanding the Consequences of Co-Existing Medical Conditions Among Women Diagnosed with Breast Cancer in Missouri – was commissioned by the Women’s Foundation with funding support from Missouri Foundation for Health and conducted by a team of population-based scientists and clinicians from Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, and the University of Missouri, which is home to the Missouri Cancer Registry and Research Center.

“We’re committed to conducting high-impact research that helps address the pressing issues women face – and breast cancer is no exception,” said Wendy Doyle, Women’s Foundation President & CEO. “About 1 in 8 women in the U.S. will develop invasive breast cancer, a deadly disease that has far-reaching effects on the well-being of women and their families. By shedding light on the impact of co-existing conditions on breast cancer mortality, we hope this research helps patients, providers, and policymakers improve the overall health of women with breast cancer – and ultimately save lives.”

The study drew from a data set that included 36,581 Missouri women diagnosed with invasive breast cancer between 2002 and 2012. Benefiting from a large sample and high-quality data representing the entire state over many years, the results indicate that women can reduce their risk of dying from cancer by maintaining good overall health throughout their lives.

“What was really groundbreaking about this study is the size and quality of data we were able to compile from the Missouri Cancer Registry. By building a data set that includes tens of thousands of breast cancer cases over a ten-year period, this study lays the foundation for additional research into the causes and risk factors for this and other cancers,” said Professor Kala Visvanathan MD, MHS, a Medical Oncologist and Cancer Epidemiologist at the Johns Hopkins Bloomberg School of Public Health and Kimmel Cancer Center. “These results provide strong evidence that co-existing conditions such as CVD, diabetes and hypertension play a major role in the mortality of breast cancer patients in the state of Missouri.”

Key Findings:

  • The three most prevalent non-cancer conditions identified at the time of breast cancer diagnosis were type 2 diabetes, essential hypertension, and CVD. Notably, 46% of women with breast cancer had at least one of the three co-existing conditions. The prevalence of these conditions was higher among African American women with over half of them having at least one.

  • A higher percentage of women living in neighborhoods with >20% of the poverty level were burdened by 2 or more co-existing conditions (20.5%) compared to breast cancer patients living in neighborhoods with <5% of the national poverty level (11.1%).

  • There were differences in mortality based on the presence of co-existing conditions by age, race, and poverty. African American women with CVD had a two-fold risk of all-cause mortality.

  • Women living in large urban areas with all three co-existing conditions were more than three times more likely to die of any cause. Women with an increased poverty score also had higher mortality.

  • Researchers found an increase in breast cancer-specific mortality among women with co-existing conditions, supporting the hypothesis that these conditions may also contribute to disease progression of their cancer. Specifically, women with two co-existing conditions had a 30% increase in breast cancer mortality and those with three co-existing conditions had a 57% increase in breast cancer mortality.

  • Researchers found that the number of hospitalizations was a strong predictor of survival among breast cancer survivors with co-existing conditions. Women with all three co-existing conditions were more than three times more likely to ever be hospitalized compared to women without the conditions. Breast cancer patients with five or more hospitalizations had over a 300% increase in risk of death compared to those without hospitalizations.


Policy Implications

  • These results provide strong evidence that co-existing conditions such as CVD, diabetes and hypertension play a major role in the mortality of breast cancer patients in the state of Missouri.

  • Evaluation, treatment and monitoring of co-existing conditions at the time of breast cancer diagnosis has the potential to improve survival, particularly in vulnerable populations. This could have significant public health impact given the prevalence of breast cancer.

  • Frequency of hospitalizations may be a good indicator of the impact of co-existing conditions among breast cancer survivors.

  • The public health impact could be even greater through the implementation of approaches to reduce and control co-existing conditions in cancer-free women so if they are diagnosed with breast cancer they are more likely to survive.

An executive summary of the findings is online here.

The full report is available here.

Manuscript in progress.

The Women’s Foundation promotes equity and opportunity for women of all ages, using research, philanthropy and policy solutions to make meaningful change. More information about the organization can be found at www.Womens-Foundation.org.


Funding for this project was provided by Missouri Foundation for Health. The Foundation is a resource for the region, working with communities and nonprofits to generate and accelerate positive changes in health. As a catalyst for change, the Foundation improves the health of Missourians through a combination of partnership, experience, knowledge, and funding.


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