Cardiovascular Disease Risk in a Large, Population-Based Cohort of Breast Cancer Survivors
- Epidemiology, Netherlands Cancer Institute, Amsterdam (Netherlands)
- Medical Oncology, University Medical Center Groningen, Groningen (Netherlands)
- Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands)
- Radiation Oncology, Institute Verbeeten, Tilburg (Netherlands)
- Radiotherapy, Catharina Hospital Eindhoven, Eindhoven (Netherlands)
- Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands)
- Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam (Netherlands)
- Steering Committee Cardiac Interventions Netherlands, Leiden University Medical Center, Leiden (Netherlands)
- Registration and Research, Comprehensive Cancer Center The Netherlands, Utrecht (Netherlands)
- Surgery, Netherlands Cancer Institute, Amsterdam (Netherlands)
Purpose: To conduct a large, population-based study on cardiovascular disease (CVD) in breast cancer (BC) survivors treated in 1989 or later. Methods and Materials: A large, population-based cohort comprising 70,230 surgically treated stage I to III BC patients diagnosed before age 75 years between 1989 and 2005 was linked with population-based registries for CVD. Cardiovascular disease risks were compared with the general population, and within the cohort using competing risk analyses. Results: Compared with the general Dutch population, BC patients had a slightly lower CVD mortality risk (standardized mortality ratio 0.92, 95% confidence interval [CI] 0.88-0.97). Only death due to valvular heart disease was more frequent (standardized mortality ratio 1.28, 95% CI 1.08-1.52). Left-sided radiation therapy after mastectomy increased the risk of any cardiovascular event compared with both surgery alone (subdistribution hazard ratio (sHR) 1.23, 95% CI 1.11-1.36) and right-sided radiation therapy (sHR 1.19, 95% CI 1.04-1.36). Radiation-associated risks were found for not only ischemic heart disease, but also for valvular heart disease and congestive heart failure (CHF). Risks were more pronounced in patients aged <50 years at BC diagnosis (sHR 1.48, 95% CI 1.07-2.04 for left- vs right-sided radiation therapy after mastectomy). Left- versus right-sided radiation therapy after wide local excision did not increase the risk of all CVD combined, yet an increased ischemic heart disease risk was found (sHR 1.14, 95% CI 1.01-1.28). Analyses including detailed radiation therapy information showed an increased CVD risk for left-sided chest wall irradiation alone, left-sided breast irradiation alone, and internal mammary chain field irradiation, all compared with right-sided breast irradiation alone. Compared with patients not treated with chemotherapy, chemotherapy used ≥1997 (ie, anthracyline-based chemotherapy) increased the risk of CHF (sHR 1.35, 95% CI 1.00-1.83). Conclusion: Radiation therapy regimens used in BC treatment between 1989 and 2005 increased the risk of CVD, and anthracycline-based chemotherapy regimens increased the risk of CHF.
- OSTI ID:
- 22645148
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 94, Issue 5; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
Similar Records
Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer
Long-Term Results of a Highly Performing Conformal Electron Therapy Technique for Chest Wall Irradiation After Mastectomy