Abstract
Purpose
To study incidence of radiation-related heart disease in a large population of breast
cancer patients followed for up to 30 years.
Material and methods
72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976–2006 and
followed prospectively. Radiation-related risk was studied by comparing women with
left-sided and right-sided tumours.
Results
34,825 women (48%) received radiotherapy. Among unirradiated women tumour laterality
had little relevance to heart disease. Among irradiated women mean dose to the whole
heart was 6.3 Gy for left-sided tumours and 2.7 Gy for right-sided tumours. Mortality was similar in irradiated women with left-sided
and right-sided tumours, but incidence ratios, left-sided versus right-sided, were
raised: acute myocardial infarction 1.22 (95% CI 1.06–1.42), angina 1.25 (1.05–1.49),
pericarditis 1.61 (1.06–2.43), valvular heart disease 1.54 (1.11–2.13). Incidence
ratios for all heart disease were as high for women irradiated since 1990 (1.09 [1.00–1.19])
as for women irradiated during 1976–1989 (1.08 [0.99–1.17]), and were higher for women
diagnosed with ischaemic heart disease prior to breast cancer than for other women
(1.58 [1.19–2.10] versus 1.08 [1.01–1.15], p for difference = 0.01).
Conclusions
Breast cancer radiotherapy has, at least until recently, increased the risk of developing
ischaemic heart disease, pericarditis and valvular disease. Women with ischaemic heart
disease before breast cancer diagnosis may have incurred higher risks than others.
Keywords
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Article info
Publication history
Published online: July 13, 2011
Accepted:
June 8,
2011
Received in revised form:
June 8,
2011
Received:
October 1,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
