2 research outputs found
Radiation Dose-Response for Risk of Myocardial Infarction in Breast Cancer Survivors
Previous reports suggest that
radiation therapy for breast
cancer can cause ischemic
heart disease, with radiationrelated risk increasing linearly with mean whole heart
dose. This study aimed to
validate these findings and
assesses additional risk factors for radiation-related
myocardial infarction in a
case-control study nested
within a cohort of BC survivors treated 70 years of age
during 1970-2009. The study
confirms a linear relationship
between mean whole heart
dose and myocardial infarction risk after radiation for
breast cancer
Cardiovascular disease incidence after internal mammary chain irradiation and anthracycline-based chemotherapy for breast cancer
Background: Improved breast cancer (BC) survival and evidence showing beneficial effects of internal mammary chain (IMC) irradiation underscore the importance of studying late cardiovascular effects of BC treatment. Methods: We assessed cardiovascular disease (CVD) incidence in 14,645 Dutch BC patients aged <62 years, treated during 1970β2009. Analyses included proportional hazards models and general population comparisons. Results: CVD rate-ratio for left-versus-right breast irradiation without IMC was 1.11 (95% CI 0.93β1.32). Compared to right-sided breast irradiation only, IMC irradiation (interquartile range mean heart doses 9β17 Gy) was associated with increases in CVD rate overall, ischaemic heart disease (IHD), heart failure (HF) and valvular heart disease (hazard ratios (HRs): 1.6β2.4). IHD risk remained increased until at least 20 years after treatment. Anthracycline-based chemotherapy was associated with an increased HF rate (HR = 4.18, 95% CI 3.07β5.69), emerging <5 years and remaining increased at least 10β15 years after treatment. IMC irradiation combined with anthracycline-based chemotherapy was associated with substantially increased HF rate (HR = 9.23 95% CI 6.01β14.18), compared to neither IMC irradiation nor anthracycline-based chemotherapy. Conclusions: Women treated with anthracycline-based chemotherapy and IMC irradiation (in an older era) with considerable mean heart dose exposure have substantially increased incidence of several CVDs. Screening may be appropriate for some BC patient groups