Abstract P3-12-01: Risk of ischemic heart disease after adjuvant radiotherapy for breast cancer

Abstract Background Adjuvant radiotherapy (RT) for breast cancer (BC) has been associated with an increased risk of ischemic heart disease (IHD). We examined the incidence of IHD in a large population-based cohort of women with BC. Methods The Breast Cancer DataBase Sweden (BCBaSe) includes all women diagnosed with BC from 1992 to 2012 (n = 60,217) and age-matched women without a history of BC (n = 300,791) in three Swedish health care regions. Information on comorbidity, educational level, and incidence of IHD was obtained through linkage with population-based registries. The risk of IHD was estimated by Cox proportional hazard regression analyses and cumulative incidence by the Kaplan-Meier method. Results Women with BC had a lower risk of IHD compared to women without BC with a hazard ratio (HR) of 0.91 (95% CI 0.88–0.95). When women with left-sided BC were compared to right-sided BC, an increased HR for IHD of 1.09 (95% CI 1.01–1.17) was seen. In women receiving RT, a HR of 1.18 (95% CI 1.06–1.31) was seen in left-sided compared to right-sided BC, and the HRs increased with more extensive lymph node involvement and with the addition of systemic therapy. The cumulative IHD incidence was increased in women receiving left-sided RT compared to right-sided RT, starting from the first years after RT and sustained with longer follow-up. Conclusions Women given RT for left-sided BC during 1992 to 2012 had an increased risk of IHD compared to women treated for right-sided BC. These women were treated in the era of three-dimensional conformal RT (3DCRT), and the results emphasize the importance of further developing and implementing RT techniques that lower the cardiac doses, without compromising the beneficial effects of RT.

Download Full-text

Cardiac Morbidity of Adjuvant Radiotherapy for Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.13.755 ◽

2005 ◽

Vol 23 (30) ◽

pp. 7475-7482 ◽

Cited By ~ 165

Author(s):

Debra A. Patt ◽

James S. Goodwin ◽

Yong-Fang Kuo ◽

Jean L. Freeman ◽

Dong D. Zhang ◽

...

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Valvular Heart Disease ◽

Adjuvant Radiotherapy ◽

Ischemic Heart ◽

Cardiac Morbidity ◽

Conduction Abnormalities

Purpose Adjuvant breast irradiation has been associated with an increase in cardiac mortality, because left-sided breast radiation can produce cardiac damage. The purpose of this study was to determine whether modern adjuvant radiotherapy is associated with increased risk of cardiac morbidity. Patients and Methods Data from the Surveillance, Epidemiology, and End Results–Medicare database were used for women who were diagnosed with nonmetastatic breast cancer from 1986 to 1993, had known disease laterality, underwent breast surgery, and received adjuvant radiotherapy. The Cox proportional-hazards model was used to compare patients with left- versus right-sided breast cancer for the end points of hospitalization with the following discharge diagnoses (International Classification of Diseases, 9th Revision codes): ischemic heart disease (410-414, 36.0, and 36.1), valvular heart disease (394-397, 424, 35), congestive heart failure (428, 402.01, 402.11, 402.91, and 425), and conduction abnormalities (426, 427, 37.7-37.8, and 37.94-37.99). Results Eight thousand three hundred sixty-three patients had left-sided breast cancer, and 7,907 had right-sided breast cancer. Mean follow-up was 9.5 years (range, 0 to 15 years). There were no significant differences in patients with left- versus right-sided cancers for hospitalization for ischemic heart disease (9.9% v 9.7%), valvular heart disease (2.9% v 2.8%), conduction abnormalities (9.7% v 9.6%), or heart failure (9.7% v 9.7%). The adjusted hazard ratio for left- versus right-sided breast cancer was 1.05 (95% CI, 0.94 to 1.16) for ischemic heart disease, 1.07 (95% CI, 0.89 to 1.30) for valvular heart disease, 1.07 (95% CI, 0.96 to 1.19) for conduction abnormalities, and 1.05 (95% CI, 0.95 to 1.17) for heart failure. Conclusion With up to 15 years of follow-up there were no significant differences in cardiac morbidity after radiation for left- versus right-sided breast cancer.

Download Full-text

Radiation-Induced Ischemic Heart Disease in Breast Cancer: A Review

Acta Oncologica ◽

10.1080/028418698429522 ◽

1998 ◽

Vol 37 (3) ◽

pp. 241-246 ◽

Cited By ~ 40

Author(s):

Gábor Gyenes

Keyword(s):

Breast Cancer ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Radiation Induced

Download Full-text

Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in Denmark, 1977–2005

Radiotherapy and Oncology ◽

10.1016/j.radonc.2020.08.007 ◽

2020 ◽

Vol 152 ◽

pp. 103-110 ◽

Cited By ~ 1

Author(s):

Ebbe Laugaard Lorenzen ◽

Jens Christian Rehammar ◽

Maj-Britt Jensen ◽

Marianne Ewertz ◽

Carsten Brink

Keyword(s):

Breast Cancer ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Cancer Radiotherapy ◽

Breast Cancer Radiotherapy ◽

Radiation Induced

Download Full-text

Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer

New England Journal of Medicine ◽

10.1056/nejmoa1209825 ◽

2013 ◽

Vol 368 (11) ◽

pp. 987-998 ◽

Cited By ~ 1704

Author(s):

Sarah C. Darby ◽

Marianne Ewertz ◽

Paul McGale ◽

Anna M. Bennet ◽

Ulla Blom-Goldman ◽

...

Keyword(s):

Breast Cancer ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Ischemic Heart

Download Full-text

Aromatase inhibitors and cardiac outcomes in women undergoing cardiac angiography after early breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.558 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 558-558 ◽

Cited By ~ 1

Author(s):

Bostjan Seruga ◽

Vesna Zadnik ◽

Cvetka Grasic Kuhar ◽

Tanja Marinko ◽

Darko Zorman ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Early Breast Cancer ◽

Conditional Logistic Regression ◽

Left Breast ◽

Left Ventricular ◽

Ischemic Heart ◽

Cardiac Angiography

558 Background: Data show that in post-menopausal women with early breast cancer, longer use of aromatase inhibitor (AI) is associated with increased odds of ischemic heart disease. Here we explore the association between adjuvant AI use and cardiac disease in women undergoing cardiac angiography after a diagnosis of early breast cancer. Methods: We linked a database of 7,681 women who underwent cardiac angiography at the University Clinical Center of Ljubljana between December 2004 and November 2010 with the Cancer Registry for Slovenia. Women with early breast cancer that subsequently underwent cardiac angiography were identified. Information on cardiovascular risk factors was retrieved from the patients’ charts and from discharge letters after cardiac angiography. The endpoint of interest was a diagnosis of ischemic heart disease or left ventricular dysfunction (IHD-LVD) without evidence of valvular heart disease at the time of angiography. Conditional, logistic regression was used to test for associations between variables. Results: Among 117 eligible women 75% (n=88) were postmenopausal and 62% (n=73) had hormonal receptor positive (HR+) disease. Of these 42% (n=31) were treated with AI. Overall, 48% (n=56) of women were found to have IHD-LVD. In patients with HR+ breast cancer, use of AIs was significantly associated with IHD-LVD as compared to tamoxifen alone (HR 2.50, 95% CI 1.01-6.29, p=0.046). For each year of AI therapy, there was a trend for higher odds of IHD-LVD (OR: 1.25, 95% CI 0.95-1.67, p=0.116). This effect appeared independent of age, body mass index, baseline hypertension, hypercholesterolemia, diabetes and heart disease or prior anthracyclines exposure. Among all patients, use of anthracyclines and left-sided irradiation was associated with non-significant increases in IHD-LVD (HR 2.37, 95% CI 0.89-6.09, p=0.45 and HR 1.28, 95% CI 0.69-2.40, p=0.44 respectively). Conclusions: Compared to tamoxifen, AIs are associated with a time dependent increase in IHD-LVD. This risk appears independent of other risk factors for heart disease. Anthracycline exposure and left breast or chest wall radiation showed non-significant associations with IHD-LVD in this small cohort.

Download Full-text