Mapping the heterogeneity of mortality: age- and race-specific trajectories in 839 698 breast cancer survivors

BACKGROUND: With steadily rising survival rates, the cause-of-death landscape for breast cancer patients is evolving. This study. AIMS: to delineate mortality patterns and demographic disparities to inform long-term survivorship strategies. METHODS: We performed a retrospective analysis of 839,698 breast cancer patients from U.S. population-based registries (2000-2021). Standardized Mortality Ratios (SMRs) and Incidence Rate Ratios (IRRs) were calculated to assess the risk of non-cancer deaths across age and racial/ethnic groups. RESULTS: By 10 years of follow-up, 48.6% of all deaths were attributed to non-cancer causes. Significant disparities emerged: Black patients (aged 0-54) exhibited the highest all-cause mortality risk (IRR: 1.70; 95% CI: 1.66-1.74), whereas Asian/Pacific Islanders (aged 65-74) showed the lowest (IRR: 0.67; 95% CI: 0.65-0.69). Notably, patients faced drastically elevated risks for external causes, including suicide (SMR: 17.4; 95% CI: 16.1-18.8) and homicide (SMR: 10.1; 95% CI: 8.37-12.13), alongside cardiovascular/non-cancer diseases. CONCLUSION: Mortality in breast cancer survivors is progressively shifting from malignancy to non-cancer causes, with distinct racial and age-dependent patterns. These findings necessitate a paradigm shift toward personalized, risk-stratified survivorship care that integrates cardiovascular monitoring and psychosocial interventions.