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

Authors
  • 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)
Type
Published Article
Journal
Breast Cancer Research
Publisher
BioMed Central
Publication Date
Jan 22, 2020
Volume
22
Issue
1
Identifiers
DOI: 10.1186/s13058-020-1249-2
Source
Springer Nature
Keywords
License
Green

Abstract

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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