What women with breast cancer die from? - A multiple cause-of-death analysis based on French death certificates

Résumé 0

In France like in most western countries, breast cancer is the most frequent cancer among women. Despite improved survival, breast cancer still ranks first among females’ death due to cancer. In France, average age at diagnosis is 63 years but death often occurs many years after diagnosis. Considering this, a relevant question is: what women with breast cancer die from? We investigate this point examining the death certificates mentioning a breast cancer in France at two points in time. The decline in mortality involving breast cancer – either as underlying or contributing cause – between 2000 and 2014, and the increase in the average age at death is not associated with major changes in the content of the death certificates. Deaths with breast cancer as a contributing cause occur at older ages (82.5 years) than deaths with breast cancer as underlying cause (72.4 years). In 2014, the standardized ratio of multiple to underlying mortality rate (SRMU) was 1.19 – as compared to 1.08 for all cancers – reaching 1.40 for deaths over the age of 80. At older ages, breast cancer is thus frequently not selected as the underlying cause, which often is a disease of the circulatory system, another cancer (mainly: cancer of the respiratory and digestive organs as well as cancer of lymphoid or hematopoietic tissue) or dementia (Alzheimer’s disease and other dementias). In the majority of the cases, breast cancer is the underlying cause. Four in five of these death certificates mention secondary malignant neoplasms (mainly: secondary malignant neoplasm of respiratory and digestive organs and of the lymph nodes). Other frequently mentioned complications of the breast cancer or its treatment are hepatic failure, sepsis, pulmonary embolism, pneumonia and pleural effusion.