Naomi B Boekel1, Michael Schaapveld1, Jourik A Gietema2, Nicola S Russell3, Philip Poortmans4, Jacqueline C M Theuws5, Dominic A X Schinagl6, Derek H F Rietveld7, Michel I M Versteegh8, Otto Visser9, Emiel J T Rutgers10, Berthe M P Aleman3, Flora E van Leeuwen11. 1. Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 2. Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands. 3. Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands; Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 5. Radiotherapy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 6. Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 7. Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands. 8. Steering Committee Cardiac Interventions Netherlands, Leiden University Medical Center, Leiden, The Netherlands. 9. Registration and Research, Comprehensive Cancer Center The Netherlands, Utrecht, The Netherlands. 10. Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands. 11. Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: f.v.leeuwen@nki.nl.
Abstract
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.
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.
Authors: Brenna E Blackburn; Patricia A Ganz; Kerry Rowe; John Snyder; Yuan Wan; Vikrant Deshmukh; Michael Newman; Alison Fraser; Ken Smith; Kimberly Herget; Jaewhan Kim; Anne C Kirchhoff; Christina Porucznik; Heidi Hanson; Marcus Monroe; Mia Hashibe Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-11-22 Impact factor: 4.254
Authors: Kyae Hyung Kim; Seulggie Choi; Kyuwoong Kim; Jooyoung Chang; Sung Min Kim; Seong Rae Kim; Yoosun Cho; Yun Hwan Oh; Gyeongsil Lee; Joung Sik Son; Sang Min Park Journal: Breast Cancer Res Treat Date: 2021-02-18 Impact factor: 4.872
Authors: Frances K Duane; Naomi B Boekel; Judy N Jacobse; Zhe Wang; Berthe M P Aleman; Sarah C Darby; Michael Schaapveld; Flora E van Leeuwen; Margreet H A Baaijens; Samantha Warren; Carolyn W Taylor Journal: Clin Transl Radiat Oncol Date: 2022-07-16
Authors: Jason R Cuomo; Sean P Javaheri; Gyanendra K Sharma; Deepak Kapoor; Adam E Berman; Neal L Weintraub Journal: Heart Date: 2018-05-15 Impact factor: 5.994