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Long-term risk of ischemic heart disease after adjuvant radiotherapy in breast cancer: results from a large population-based cohort
Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden;Sundsvall Hosp, Dept Oncol, Sundsvall, Sweden.
Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden;Sundsvall Hosp, Dept Surg, Sundsvall, Sweden.
Uppsala Univ, Uppsala Univ Hosp, Reg Canc Ctr, Uppsala, Sweden;Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England.
Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
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2020 (English)In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 22, article id 10Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BMC , 2020. Vol. 22, article id 10
Keywords [en]
Breast cancer, Radiotherapy, Survivorship, Ischemic heart disease, Long-term side effects
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-407283DOI: 10.1186/s13058-020-1249-2ISI: 000513643300002PubMedID: 31969169OAI: oai:DiVA.org:uu-407283DiVA, id: diva2:1416739
Funder
The Breast Cancer Foundation, 750491Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2020-03-25Bibliographically approved

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