Originally published as JCO Early Release 10.1200/JCO.2005.13.755 on September 12 2005

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Cardiac Morbidity of Adjuvant Radiotherapy for Breast Cancer

From the Departments of Medical Oncology, Radiation Oncology, and Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston; and Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch at Galveston, Galveston, TX

Address reprint requests to Sharon H. Giordano, MD, MPH, 1515 Holcombe Blvd, Box 424, Houston, TX 77030; e-mail: sgiordan{at}mdanderson.org

PURPOSE: Adjuvant breast irradiation has been associated with an increase in cardiac mortality, because left-sided breast radiation can produce cardiac damage. The purpose of this study was to determine whether modern adjuvant radiotherapy is associated with increased risk of cardiac morbidity.

PATIENTS AND METHODS: Data from the Surveillance, Epidemiology, and End Results–Medicare database were used for women who were diagnosed with nonmetastatic breast cancer from 1986 to 1993, had known disease laterality, underwent breast surgery, and received adjuvant radiotherapy. The Cox proportional-hazards model was used to compare patients with left- versus right-sided breast cancer for the end points of hospitalization with the following discharge diagnoses (International Classification of Diseases, 9th Revision codes): ischemic heart disease (410-414, 36.0, and 36.1), valvular heart disease (394-397, 424, 35), congestive heart failure (428, 402.01, 402.11, 402.91, and 425), and conduction abnormalities (426, 427, 37.7-37.8, and 37.94-37.99).

RESULTS: Eight thousand three hundred sixty-three patients had left-sided breast cancer, and 7,907 had right-sided breast cancer. Mean follow-up was 9.5 years (range, 0 to 15 years). There were no significant differences in patients with left- versus right-sided cancers for hospitalization for ischemic heart disease (9.9% v 9.7%), valvular heart disease (2.9% v 2.8%), conduction abnormalities (9.7% v 9.6%), or heart failure (9.7% v 9.7%). The adjusted hazard ratio for left- versus right-sided breast cancer was 1.05 (95% CI, 0.94 to 1.16) for ischemic heart disease, 1.07 (95% CI, 0.89 to 1.30) for valvular heart disease, 1.07 (95% CI, 0.96 to 1.19) for conduction abnormalities, and 1.05 (95% CI, 0.95 to 1.17) for heart failure.

CONCLUSION: With up to 15 years of follow-up there were no significant differences in cardiac morbidity after radiation for left- versus right-sided breast cancer.

Supported by National Institutes of Health Grant No. 1K07 CA 109064-01 (S.H.G.).

Presented at the 2004 San Antonio Breast Cancer Symposium, San Antonio, TX, December 8-11, 2004 (abstr 4063).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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