PURPOSE Breast cancer is a common disease with a relatively good prognosis. Therefore, understanding the spectrum of diseases and mortality among breast cancer patients is important, though currently incomplete. We systematically examined the incidence and mortality of all diseases following a breast cancer diagnosis, as well as the sequential association of disease occurrences (trajectories). METHODS In this national cohort study, 57,501 breast cancer patients (2001-2011) were compared to 564,703 matched women from the general Swedish population and followed until 2012. The matching criteria included year of birth, county of residence, and socioeconomic status. Based on information from the Swedish Patient and Cause of Death Registries, hazard ratios (HR) were estimated for disease incidence and mortality. Conditional logistic regression models were used to identify disease trajectories among breast cancer patients. RESULTS Among 225 diseases, 45 had HRs > 1.5 and p < 0.0002 when comparing breast cancer patients with the general population. Diseases with highest HRs included lymphedema, radiodermatitis, and neutropenia, which are side effects of surgery, radiotherapy, and chemotherapy. Other than breast cancer, the only significantly increased cause of death was other solid cancers (HR = 1.16, 95% CI = 1.08-1.24). Two main groups of disease trajectories were identified, which suggest menopausal disorders as indicators for other solid cancers, and both neutropenia and dorsalgia as diseases and symptoms preceding death due to breast cancer. CONCLUSIONS While an increased incidence of other diseases was found among breast cancer patients, increased mortality was only due to other solid cancers. Preventing death due to breast cancer should be a priority to prolong life in breast cancer patients, but closer surveillance of other solid cancers is also needed.

中文翻译：

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被诊断患有乳腺癌的妇女的疾病轨迹和死亡率。

目的乳腺癌是一种预后相对较好的常见疾病。因此，了解乳腺癌患者的疾病谱和死亡率很重要，尽管目前尚不完善。我们系统地检查了乳腺癌诊断后所有疾病的发生率和死亡率，以及疾病发生的顺序关联（轨迹）。方法在这项全国性队列研究中，比较了57,501例乳腺癌患者（2001年至2011年）与瑞典一般人群中564,703名匹配女性的情况，并随访至2012年。匹配标准包括出生年份，居住县和社会经济地位。根据瑞典患者和死亡原因登记处的信息，估算出疾病的发病率和死亡率的危险比（HR）。条件对数回归模型用于确定乳腺癌患者的疾病轨迹。结果在将225例疾病中，与普通人群比较的乳腺癌患者中，有45例HRs> 1.5和p <0.0002。HR最高的疾病包括淋巴水肿，放射性皮肤炎和中性粒细胞减少，这是手术，放射疗法和化学疗法的副作用。除乳腺癌外，唯一显着增加的死亡原因是其他实体癌（HR = 1.16，95％CI = 1.08-1.24）。确定了两个主要的疾病轨迹组，这表明更年期疾病可以作为其他实体癌的指标，中性粒细胞减少症和背痛可以作为乳腺癌死亡前的疾病和症状。结论虽然在乳腺癌患者中发现其他疾病的发生率有所增加，死亡率增加仅归因于其他实体癌。预防乳腺癌导致的死亡应该是延长乳腺癌患者寿命的优先事项，但是还需要对其他实体癌进行更严格的监视。