Deprivation,stage at diagnosis and cancer survival

The association between an area-based measure of deprivation and survival from the 10 most common cancers was studied in 155,682 patients diagnosed between 1980 and 1989 in the area covered by the South Thames Regional Health Authority. Furthermore, the impact of stage of disease at diagnosis on this association was studied. The measure of deprivation was the Car-stairs Index of the census enumeration district of each patient's residence at diagnosis (5 categories) and the cancers studied were: lung, breast, colorectum, bladder, prostate, stomach, pancreas, ovary, uterus and cervix. In the univariate analyses the measure of outcome was the relative survival rate and in the multivariate analyses it was the hazard ratio. Both univariate and multivariate analyses showed that patients from affluent areas had better survival than patients from deprived areas for cancers of the lung, breast, colorectum, bladder, prostate, uterus and cervix. Stage of disease at diagnosis did not explain the survival differences by deprivation category. For cancers of the stomach, pancreas and ovary, no variation in survival by deprivation category was found. For most cancer sites, a clear gradient in survival by deprivation category was observed, which implies a large potential reduction of cancer mortality among the lower socioeconomic groups. Future studies need to incorporate other possible explanatory factors, besides stage, of the association between deprivation and survival.     

Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997–2006

Women diagnosed with breast cancer in the UK display marked differences in survival between categories defined by socio‐economic deprivation. Timeliness of diagnosis is one of the possible explanations for these patterns. Women whose cancer is screen‐detected are more likely to be diagnosed at an earlier stage. We examined deprivation and screening‐specific survival in order to evaluate the role of early diagnosis upon deprivation‐specific survival differences in the West Midlands (UK) and New South Wales (Australia). We estimated net survival for women aged 50–65 years at diagnosis and whom had been continuously eligible for screening from the age of 50. Records for 5,628 women in West Midlands (98.5% of those eligible, mean age at diagnosis 53.7 years) and 6,396 women in New South Wales (99.9% of those eligible, mean age at diagnosis 53.8 years). In New South Wales, survival was similar amongst affluent and deprived women, regardless of whether their cancer was screen‐detected or not. In the West Midlands, there were large and persistent differences in survival between affluent and deprived women. Deprivation differences were similar between the screen‐detected and non‐screen detected groups. These differences are unlikely to be solely explained by artefact, or by patient or tumour factors. Further investigations into the timeliness and appropriateness of the treatments received by women with breast cancer across the social spectrum in the UK are warranted.     

Socioeconomic effects on breast cancer survival: proportion attributable to stage and morphology

Breast cancer patients of lower socioeconomic status tend to have poorer survival. Among 10 865 cases of breast cancer from the East Anglian Cancer Registry diagnosed between 1982 and 1993, we estimated the extent to which the differences in survival by socioeconomic status, measured by both occupational and area-based methods, can be explained by differences between socioeconomic groups in stage and morphological type of tumour. In univariate survival analyses, lower social class (manual occupation) was associated with a relative hazard of 1.32 (95% CI 1.12-1.55) for death from breast cancer as underlying cause. Women resident in the most deprived area had a relative hazard of 1.21 (0.95-1.54) for death from breast cancer as underlying cause. Stage of disease accounted for 28% of the effect of social class on survival but for none of the effect of deprivation category. Morphological type accounted for 3% of the effect of social class and none of the effect of deprivation category. Thus, stage at presentation explains some but not all of the socioeconomic differences in breast cancer survival. Future research on histological grade and socioeconomic status is indicated.     

Trends and inequalities in laryngeal cancer survival in men and women: England and Wales 1991-2006

Laryngeal cancer in men is a relatively common malignancy, with a marked socioeconomic gradient in survival between affluent and deprived patients. Cancer of the larynx in women is rare. Survival tends to lower than for men, and little is known about the association between deprivation and survival in women with laryngeal cancer. This paper explores the trends and socio-economic inequalities in laryngeal cancer survival in women, with comparison to men. We examined relative survival among men and women diagnosed with laryngeal cancer in England and Wales during 1991-2006, followed up to 31 December 2007. We estimated the difference in survival between the most deprived and most affluent groups (the 'deprivation gap') at one and five years after diagnosis, for each sex, anatomical subsite and calendar period. Five year survival for all laryngeal cancers combined was up to 8% lower in women than in men. This difference is only partially explained by the differential distribution of anatomical subsites in men and women. Disparities in survival between men and women were also present within specific subsites. In contrast to men, there was little evidence of a consistent deprivation gap in survival for women at any of the anatomical subsites. The stark socioeconomic inequalities in laryngeal cancer survival in men do not appear to be replicated in women. The origins of the socio-economic inequalities in survival among men, and the disparities in survival between men and women at specific tumour subsites remains unclear.     

Socio-economic deprivation and stage of disease at presentation in women with breast cancer

Background:This study describes and compares the pathologicalprognostic factors and surgeon assessment of stage of breast cancer of womenliving in affluent and deprived areas to assess whether clinical stage atpresentation may explain the known poorer survival outcomes for deprivedwomen. Patients and methods:A population-based review of the caserecords of 417 women with breast cancer was carried out. Results:No difference in pathological criteria was found betweenthe 88% of women living in affluent and deprived areas for whom suchdata were available. Clinical assessment of the remaining 50 cases showed thatwomen living in deprived areas were more likely to present with locallyadvanced or metastatic disease. Conclusion:The poorer survival of women from deprived areas withbreast cancer may be explained by more deprived women presenting with advancedcancers.     

Survival from rectal and anal cancers in England and Wales, 1986-2001

The aim of this study was to investigate the effects of tumour and patient characteristics on trends in the survival of patients with cancer of the anus or rectum in England and Wales. A total of 132,542 adults (15-99 years) who were diagnosed during the 14 years 1986-1999 were followed up to 2001 through the National Health Service Central Register. Relative survival up to 5 years after diagnosis was estimated, using deprivation-specific life tables. Generalised linear models were used to estimate relative excess risks of death, adjusted for patient and tumour characteristics. The results showed that 5-year relative survival was higher in women, younger patients and more affluent patients, and higher for anal cancer than rectal cancer. Survival improved by more than 10% from the late 1980s (around 38%) to the late 1990s (49%). This trend was not explained by changes in the distribution of age, anatomical site, morphology or deprivation. The trend was more marked in younger and more affluent patients, and for adenocarcinoma and epidermoid carcinoma than for tumours with other morphology. The inequality in survival between affluent and deprived patients widened. It is concluded that improvements in survival may reflect improvements in disease stage, diagnostic technique or treatment. Which of these factors contribute to the widening socioeconomic inequalities in survival remains to be elucidated.     

Breast cancer incidence trends in deprived and affluent Scottish women

OBJECTIVE : Breast cancer is commoner in the affluent and breast cancer rates in many countries are rising; it remains unclear whether this incidence rise is consistent across the different socio-economic groups. The rising incidence of breast cancer may be related to changes in population risk factor profiles. This study aimed to determine breast cancer incidence trends in women of different socio-economic categories and whether these trends were related to breast cancer risk factor trends. DESIGN : Data on breast cancer incidence rates by deprivation quintile in Scotland 1991-2000 were analysed using linear regression. Data on first births at late maternal age, BMI trends (based on the Scottish Health Surveys) and breast screening uptake trends in the different categories were also analysed and their relation to breast cancer incidence trends explored. POPULATION AND SETTING : Breast cancer incidence data was based on all women in Scotland. BMI data was based on representative cross-sectional survey data from the Scottish Health Surveys-women in the 1995, 1998 and 2003 surveys were 16-64, 16-74 and aged 16 and over, respectively. First birth data was based on all women aged 35-39 in Scotland. Breast screening uptake data was studied in women of screening age, that is, aged 50-64. RESULTS : Breast cancer incidence rates in Scottish women are rising in parallel across all socio-economic categories and the incidence gap between deprived and affluent still remains. Since the late 1980s, numbers of first birth in Scottish women aged 35-39 have risen dramatically, especially in the affluent, but numbers were stable before this. The prevalence of obesity and mean BMI has increased over time in all socio-economic classes but BMI continues to be higher in the deprived. Uptake of screening invitations has increased in all socio-economic groups. CONCLUSIONS : Breast cancer is rising in women of all socio-economic status in Scotland and the deprived-affluent gap remains. Trends in late age at first pregnancy, prevalence of obesity and screening uptake do not fully explain the observed trends.     

Anxiety and support in breast cancer: is this different for affluent and deprived women? A questionnaire study

A postal questionnaire was sent to affluent and deprived women with breast cancer in order to compare psychosocial aspects of care with the purpose of understanding the balance of care and explaining why deprived women have poorer outcomes. Data were collected regarding reported sources of information, SF-36 scores and ongoing causes of anxiety. The results demonstrate that affluent women were more likely to have received information from their hospital specialist (94.8 vs 76.0%) and from a breast care nurse (70.1 vs 40.0%) than deprived women. They were also more likely to have received information from magazines (50.6 vs 33.0%), newspapers (45.5 vs 22.0%) and television news (45.5 vs 26.0%). Deprived women had poorer SF-36 scores than affluent women, and reported greater anxiety about money (12.2 vs 2.8%), other health problems (22.1 vs 8.2%) and family problems (17.5 vs 6.9%). Personal and professional support is clearly important for patients with breast cancer. Health professionals need to be aware of the greater psychological distress demonstrated by deprived women, even some years after diagnosis with breast cancer, and seek to address it.     

Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden)

Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours 相似文献   

Incidence of and survival from upper aerodigestive tract cancers in the U.K.: the influence of deprivation

The aim of the study was to investigate the effect of social deprivation on the incidence of and survival from upper aerodigestive tract (UAT) cancers in the U.K. Incidence was calculated on 25 903 cases of malignant upper aerodigestive tract cancers collected from four cancer registries in the U.K. for the period 1984–1993. A Cox proportional hazard model was used to determine the influence of deprivation, measured in Carstairs quintiles for crude and cause-specific survival on 17 393 of these cases. Patients with UAT cancers who were younger, males or of South Asian origin were more likely to live in a deprived area than in an affluent area. The incidence of UAT cancers in a district was correlated with deprivation score for the district for both men (r=0.78) and for women (r=0.60). People who lived in deprived areas had a relative risk of 1.25 (95% confidence interval (CI):1.15–1.35) of dying from their cancer and of 1.24 (95% CI: 1.13–1.35) of dying from all causes compared with people who lived in affluent areas. People living in deprived areas were more likely to get UAT cancer and were more likely to die from their cancer than people living in affluent areas.     

Impact of breast cancer subtypes on 3-year survival among adolescent and young adult women

Introduction

Young women have poorer survival after breast cancer than do older women. It is unclear whether this survival difference relates to the unique distribution of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)-defined molecular breast cancer subtypes among adolescent and young adult (AYA) women aged 15 to 39 years. The purpose of our study was to examine associations between breast cancer subtypes and short-term survival in AYA women, as well as to determine whether the distinct molecular subtype distribution among AYA women explains the unfavorable overall breast cancer survival statistics reported for AYA women compared with older women.

Methods

Data for 5,331 AYA breast cancers diagnosed between 2005 and 2009 were obtained from the California Cancer Registry. Survival by subtype (triple-negative; HR+/HER2-; HR+/HER2+; HR-/HER2+) and age-group (AYA versus 40- to 64-year-olds) was analyzed with Cox proportional hazards regression with follow-up through 2010.

Results

With up to 6 years of follow-up and a mean survival time of 3.1 years (SD = 1.5 years), AYA women diagnosed with HR-/HER + and triple-negative breast cancer experienced a 1.6-fold and 2.7-fold increased risk of death, respectively, from all causes (HR-/HER + hazard ratio: 1.55; 95% confidence interval (CI): 1.10 to 2.18; triple-negative HR: 2.75; 95% CI, 2.06 to 3.66) and breast cancer (HR-/HER + hazard ratio: 1.63; 95% CI, 1.12 to 2.36; triple-negative hazard ratio: 2.71; 95% CI, 1.98 to 3.71) than AYA women with HR+/HER2- breast cancer. AYA women who resided in lower socioeconomic status neighborhoods, had public health insurance, and were of Black, compared with White, race/ethnicity experienced worse survival. This race/ethnicity association was attenuated somewhat after adjusting for breast cancer subtypes (hazard ratio, 1.33; 95% CI, 0.98 to 1.82). AYA women had similar all-cause and breast cancer-specific short-term survival as older women for all breast cancer subtypes and across all stages of disease.

Conclusions

Among AYA women with breast cancer, short-term survival varied by breast cancer subtypes, with the distribution of breast cancer subtypes explaining some of the poorer survival observed among Black, compared with White, AYA women. Future studies should consider whether distribution of breast cancer subtypes and other factors, including differential receipt of treatment regimens, influences long-term survival in young compared with older women.     

Influence of age on cervical cancer survival in Japan

BACKGROUND: Relative 5-year survival for cervical cancer has been reported to be lower in older women in Japan. A population-based study was carried out to clarify why increased age is associated with decreased survival in spite of a nationwide cervical cancer screening program having been carried out since 1982 in Japan. METHODS: The Osaka Cancer Registry's data were used to investigate associations between age groups and survival for cervical cancer patients. Survival analysis was restricted to the reported 8966 cases diagnosed in 1975-1996 who lived in Osaka Prefecture (except for Osaka City), or resided in Osaka City in 1993-1996, since active follow-up data on vital status 5 years after the diagnosis were available. RESULTS: Relative 5-year survival for cervical cancer cases was lower in older age groups (88.6% in <30 years, 78.1% in 30-54 years, 67.7% in 55-64 years and 54.4% in 65+ years), as was the proportion of the detection by screening (6.3, 9.8, 9.2 and 6.0%), the proportion of the localized stage (83.0, 67.3, 51.0 and 42.7%) and the proportion of women who underwent surgery (79.2, 83.2, 65.6 and 35.2%). Among localized cases detected with screening, the survival in those > or =55 years old was >92% and almost comparable with that in 30 to 54 year olds, but significantly lower among those detected without screening. CONCLUSION: Lower survival among older women was caused mainly by the presence of more advanced disease at diagnosis. Further extension of the nationwide cervical cancer screening program should result in improved diagnosis of earlier stage disease, which might improve differences of cervical cancer survival among these age groups.     

Association of time since last birth,age at first birth and parity with breast cancer survival among parous women: A register‐based study from Norway

Reproductive factors that have a well‐documented effect on breast cancer risk may also influence the prognosis of the disease, but previous studies on breast cancer survival have yielded conflicting results. We combined information from two population‐based registries and obtained information on 16,970 parous women with invasive breast cancer. Cox regression analysis was used to assess breast cancer survival in relation to age at diagnosis, age at first birth, time since last birth and parity. We stratified the analyses by age at diagnosis (<50 and ≥50 years) as an approximation for menopausal age. In women diagnosed before 50 years of age, breast cancer survival was reduced with younger age at diagnosis (p for trend <0.001), whereas in women diagnosed at 50 years or later, survival was reduced with older age at diagnosis (p for trend 0.011). For breast cancer diagnosed before 50 years, survival was poorer in women with four or more births compared to women with one or two births (hazard ratio 1.3, 95% confidence interval 1.1–1.6). A short time since last birth was associated with reduced survival (p for trend 0.05), but adjustment for stage and grade attenuated the association. Among women diagnosed at 50 years or later, we found no association with survival for any of the reproductive factors. In summary, reproductive factors were associated with survival from breast cancer diagnosed before but not after age 50 years. Young women had a particularly poor prognosis throughout the study period.     

Factors Relating to Poor Survival Rates of Aged Cervical Cancer Patients: a Population-based Study with the Relative Survival Model in Osaka,Japan

Poor survival of older cervical cancer patients has been reported; however, related factors , such as theextent of disease and the competitive risk by aging have not been well evaluated. We applied the relative survivalmodel developed by Dickman et al to resolve this issue. Study subjects were cervical cancer patients retrievedfrom the Osaka Cancer Registry. They were limited to the 10,048 reported cases diagnosed from 1975 to 1999,based on the quality of data collection on vital status. Age at diagnosis was categorized into <30, 30-54, 55-64,and 65+ years. The impact of prognostic factors on 5-year survival was evaluated with the relative survivalmodel, incorporating patients’ expected survival in multivariate analysis. The age-specific relative excess risk(RER) of death was significantly higher for older groups as compared with women aged 30-54 years (RER, 1.58at 55-64 and 2.51 at 65+ years). The RER was decreased by 64.8% among the 55-64 year olds as an effect ofcancer stage at diagnosis, and by 43.4% among those 65 years old and over. After adding adjustment fortreatment modalities, the RER was no longer significantly higher among 55-64 year olds; however, it was stillhigher among 65 year olds and over. Advanced stage at diagnosis was the main determinant of poor survivalamong the aged cervical cancer patients, although other factors such as limitations on the combination of treatmentwere also suggested to have an influence in those aged 65 years and over.     

Radiation therapy and patient age in the survival from early-stage breast cancer.

PURPOSE: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. METHODS: Data for 27, 399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. RESULTS: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). CONCLUSION: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer.     

Survival of young and older breast cancer patients in Geneva from 1990 to 2001

The effect of age on breast cancer survival is still a matter of controversy. Breast cancer in young women is thought to be more aggressive and to have worse prognosis but results from clinical research have been neither consistent nor definitive. In this study, we have assessed the impact of young age at diagnosis on tumor characteristics, treatment and survival of breast cancer. The study included 82 very young (< or = 35 years), 790 young (36-49), and 2125 older (50-69) women recorded between 1990 and 2001 at the Geneva Cancer Registry. Very young and young patients had more often stage II cancers (P = 0.009), poorly differentiated (P < 0.001) and estrogen receptor negative (P < 0.001) tumors. They were also more likely to receive chemotherapy (P < 0.001) and less likely to receive hormonal therapy (P < 0.001). Specific five-year survival was not different in the three groups (91%, 90%, and 89% for very young, young and older, respectively). When adjusting for all prognostic variables, age was not significantly related to mortality from breast cancer with a hazard ratio of 0.8 (95% CI: 0.3-2.0) for very young and 1.1 (95% CI: 0.8-1.4) for young patients compared to older women. Tumor stage, differentiation, estrogen receptor status, surgery, and radiotherapy were all independent determinants of breast cancer prognosis. We conclude that age is not an independent prognostic factor when accounting for breast tumor characteristics and treatment.     

Race and differences in breast cancer survival in a managed care population.

BACKGROUND: African-American women with breast cancer have poorer survival than European-American women. After adjustment for socioeconomic variables, survival differences diminish but do not disappear, possibly because of residual differences in health care access, biology, or behavior. This study compared breast cancer survival in African-American and European-American women with similar health care access. METHODS: We measured survival in women with breast cancer who are served by a large medical group and a metropolitan Detroit health maintenance organization where screening, diagnosis, treatment, and follow-up are based on standard practices and mammography is a covered benefit. We abstracted data on African-American and European-American women who had been diagnosed with breast cancer from January 1986 through April 1996 (n = 886) and followed these women for survival through April 1997 (137 deaths). RESULTS: African-American women were diagnosed at a later stage than were European-American women. Median follow-up was 50 months. Five-year survival was 77% for African-American and 84% for European-American women. The crude hazard ratio for African-American women relative to European-American women was 1.6 (95% confidence interval [CI] = 1.1-2.2). Adjusting only for stage, the hazard ratio was 1.3 (95% CI = 0.9-1.9). Adjusting only for sociodemographic factors (age, marital status, and income), the hazard ratio was 1.2 (95% CI = 0.8-1.9). After adjusting for age, marital status, income, and stage, the hazard ratio was 1.0 (95% CI = 0.7-1.5). CONCLUSION: Among women with similar medical care access since before their diagnoses, we found ethnic differences in stage of breast cancer at diagnosis. Adjustment for this difference and for income, age, and marital status resulted in a negligible effect of race on survival.     

Microvessel density and p53 overexpression in young women with breast cancer: a case-control study

Several reports have indicated that young women (less than 40 years of age) with breast cancer have a worse prognosis than older women. We performed a case-control study in order to confirm this observation and to determine whether this was attributable to increased microvessel density (MVD) or p53 expression. Twenty-six young women (cases) with stage I-III breast cancer that had adequate paraffin-embedded archival tissue were identified by the Montefiore Medical Center Tumor Registry over a 24-year period. For each case, two or three control subjects at least 40 years of age or older were selected from the registry and matched for nodal status and tumor size. Immunohistochemistry was performed for MVD and p53 overexpression. A Cox proportional hazard model was performed to examine the influence of age, MVD, p53 overexpression, and recognized prognostic factors on disease-free and overall survival. There were 26 cases (median age, 36 years) and 72 controls (median age, 64 years). The groups were well matched for known prognostic variables. There was no significant difference in p53 overexpression or MVD in the cases and controls. In multivariate analysis, the only features associated with an increased risk of recurrence included young age (hazard ratio [HR] = 2.49; 95% confidence interval [CI]: 1.18-5.25; P = 0.02) and positive lymph nodes (HR = 2.44; 95% CI: 1.12-5.30; P = 0.02). We have confirmed previous reports demonstrating a worse prognosis for women younger than 40 years with invasive breast cancer but found no correlation between young age and MVD or p53 overexpression when adjusted for other variables.     

新疆维吾尔族女性乳腺癌临床病理特点与预后分析

 目的 探讨新疆地区维吾尔族女性乳腺癌的发病特点、临床与病理特征及其与预后的关系。方法 对74例有完整病例资料及随访的维吾尔族女性乳腺癌患者的临床病理资料进行多因素COX回归分析。结果 74例女性维吾尔族乳腺癌3年生存率和5年生存率分别为 75.00 %（48／64）和43.50 %（20／46），经多因素COX回归分析显示，年龄、月经状况、淋巴结转移、TNM分期及PR表达5项指标反应维吾尔族女性乳腺癌的预后情况，危险度分别为0.037，0.103，13.851，18.877和0.046。结论 新疆维吾尔族女性乳腺癌患病的比重小，但发病年龄较早，以36～50岁多见，且以Ⅱ，Ⅲ期居多，预后较差。年龄、月经状况、淋巴结转移、TNM分期、PR表达是影响维吾尔族女性乳腺癌预后的独立指标。早诊断、早治疗是提高其生存率的关键。     

Body mass index and mortality among older breast cancer survivors in the Study of Osteoporotic Fractures.

BACKGROUND: Breast cancer survival is inversely related to body mass index (BMI), but previous studies have not included large numbers of older women. This study investigated the association between BMI and mortality after breast cancer diagnosis in a cohort of older Caucasian women enrolled in the Study of Osteoporotic Fractures. METHODS: All women were age >or=65 at study entry (N = 533). Cox proportional hazards regression analysis was used to determine the effect of BMI as a continuous variable on risk of all-cause, cardiovascular, any cancer, and breast cancer mortality. Interaction terms were included to evaluate effect modification by age at diagnosis. RESULTS: Mean age at diagnosis was 78.0 years (SD 5.7) with an average of 8.1 years (SD 4.4) of follow-up after diagnosis. There were 206 deaths during follow-up. The effect of BMI on mortality depended on age (P(interaction) = 0.02). At age 65, the risk of mortality was 1.4 times higher for a BMI of 27.3 kg/m(2) [95% confidence interval (95% CI), 1.03-2.01] and 2.4 times higher for a BMI of 34.0 kg/m2 (95% CI, 1.07-5.45) compared with women with a BMI of 22.6 kg/m2. At age 85, risk of death was lower for a BMI of 27.3 kg/m2 (hazard ratio, 0.81; 95% CI, 0.65-1.01) or a BMI of 34.0 kg/m2 (hazard ratio, 0.61; 95% CI, 0.36-1.02) compared with a BMI of 22.6 kg/m2. Similar results were observed for any cancer and breast cancer mortality. BMI was not associated with cardiovascular mortality. CONCLUSIONS: In this population of older women, the effect of increased BMI on risk of mortality after breast cancer varied by age. These results differ from those observed among populations of younger postmenopausal breast cancer survivors.