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Long-term risk of ischemic heart disease after adjuvant radiotherapy in breast cancer: results from a large population-based cohort

  • Wennstig, Anna-Karin1, 2
  • Wadsten, Charlotta1, 2
  • Garmo, Hans3, 4
  • Fredriksson, Irma5, 6
  • Blomqvist, Carl7
  • Holmberg, Lars4, 8
  • Nilsson, Greger9, 10, 11
  • Sund, Malin1
  • 1 Umeå University, Umeå, Sweden , Umeå (Sweden)
  • 2 Sundsvall Hospital, Sundsvall, Sweden , Sundsvall (Sweden)
  • 3 Uppsala University/Uppsala University Hospital, Uppsala, Sweden , Uppsala (Sweden)
  • 4 King’s College London, London, UK , London (United Kingdom)
  • 5 Karolinska University Hospital, Stockholm, Sweden , Stockholm (Sweden)
  • 6 Karolinska Institutet, Stockholm, Sweden , Stockholm (Sweden)
  • 7 Örebro University, University Hospital, Örebro, Sweden , Örebro (Sweden)
  • 8 Uppsala University, Uppsala, Sweden , Uppsala (Sweden)
  • 9 Uppsala University, University Hospital, Uppsala, Sweden , Uppsala (Sweden)
  • 10 Gävle Hospital, Gävle, Sweden , Gävle (Sweden)
  • 11 Visby Hospital, Visby, Sweden , Visby (Sweden)
Published Article
Breast Cancer Research
BioMed Central
Publication Date
Jan 22, 2020
DOI: 10.1186/s13058-020-1249-2
Springer Nature


BackgroundAdjuvant 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.MethodsThe 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.ResultsWomen 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.ConclusionsWomen 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.

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