Originally published as JCO Early Release 10.1200/JCO.2005.05.1037 on August 14 2006
Journal of Clinical Oncology, Vol 24, No 25 (September 1), 2006: pp. 4100-4106
© 2006 American Society of Clinical Oncology.
Late Cardiac Mortality and Morbidity in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment
Eleanor E.R. Harris,
Candace Correa,
Wei-Ting Hwang,
Jessica Liao,
Harold I. Litt,
Victor A. Ferrari,
Lawrence J. Solin
From the Department of Radiation Oncology; Department of Biostatistics and Epidemiology; Cardiovascular Imaging Section, Department of Radiology; and Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
Address reprint requests to Eleanor E.R. Harris, MD, Moffitt Cancer Center and Research Institute, Division of Radiation Oncology, 12902 Magnolia Dr, Tampa, FL 33612; e-mail: HarrisE{at}moffitt.usf.edu
Purpose Several studies have reported increased cardiac mortality related to the use of left-sided breast or chest-wall irradiation. This study was undertaken as a comprehensive examination of the long-term cardiac mortality and morbidity after breast irradiation using contemporary irradiation techniques.
Methods The medical records of 961 consecutive patients presenting between 1977 and 1994 with stage I or II breast cancer treated with breast conservation treatment were reviewed. Data was recorded on baseline pretreatment patient, tumor and treatment characteristics and on subsequent cancer or cardiac related events. The median follow-up time was 12 years.
Results There was no difference in overall mortality from any cardiac cause (P = .25). Death from any cardiac cause occurred in 2% of right-sided patients and 3.5% of left-sided patients. However, in the second decade after treatment, there was a higher rate of cardiac deaths in left-sided patients, with a cumulative risk of 6.4% (95% CI, 3.5% to 11.5%) for left-sided compared with 3.6% (95% CI, 1.8% to 7.2%) for right-sided patients at 20 years. There were statistically higher rates of chest pain, coronary artery disease, and myocardial infarction diagnosed in left-sided patients (all P .002). The presence of hypertension was associated with a higher risk of coronary artery disease in left-sided patients.
Conclusion Irradiation to the left breast is not associated with a higher risk of cardiac death up to 20 years after treatment, but is associated with an increased rate of diagnoses of coronary artery disease and myocardial infarction compared with right breast treatment.
published online ahead of print at www.jco.org on August 14, 2006.
Supported in part by US Army Medical Research and Material Command under DAMD17-03-1-0309 (E.E.R.H., J.L.) and Breast Cancer Research Foundation (E.E.R.H., W.-T.H., L.J.S.). These funding sources had no role in the collection, analysis, interpretation or reporting of the data presented, or in the decision to submit the data for publication.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike Complore Connotea Del.icio.us Digg Facebook Reddit Technorati Twitter What's this?
Related Correspondence
- Coronary Artery Disease After Radiation Therapy for Early Breast Cancer
Ashok K. Verma and Pooja Ramakant
JCO 2008 26: 1390
[Full Text]
This article has been cited by other articles:

|
 |

|
 |
 
C. Bouchardy, E. Rapiti, M. Usel, S. B. Majno, G. Vlastos, S. Benhamou, R. Miralbell, I. Neyroud-Caspar, H. M. Verkooijen, and V. Vinh-Hung
Excess of cardiovascular mortality among node-negative breast cancer patients irradiated for inner-quadrant tumors
Ann. Onc.,
August 24, 2009;
(2009)
mdp341v1.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. S Gilchrist, M. L. Galantino, M. Wampler, V. G Marchese, G S. Morris, and K. K Ness
A Framework for Assessment in Oncology Rehabilitation
Physical Therapy,
March 1, 2009;
89(3):
286 - 306.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. A. Buchholz
Radiation Therapy for Early-Stage Breast Cancer after Breast-Conserving Surgery
N. Engl. J. Med.,
January 1, 2009;
360(1):
63 - 70.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. J. Lenihan and F. J. Esteva
Multidisciplinary Strategy for Managing Cardiovascular Risks When Treating Patients with Early Breast Cancer
Oncologist,
December 1, 2008;
13(12):
1224 - 1234.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Grossman, G. Deuring, S. N. Garland, T. S. Campbell, and L. E. Carlson
Patterns of Objective Physical Functioning and Perception of Mood and Fatigue in Posttreatment Breast Cancer Patients and Healthy Controls: An Ambulatory Psychophysiological Investigation
Psychosom Med,
September 1, 2008;
70(7):
819 - 828.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Coccaro and G. Gallucci
Late Cardiac Effects of Adjuvant Radiotherapy and Chemotherapy in Early Breast Cancer
J. Clin. Oncol.,
July 1, 2008;
26(19):
3288 - 3288.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Y. Belkacemi, J. Gligorov, M. Ozsahin, H. Marsiglia, B. De Lafontan, H. Laharie-Mineur, L. Aimard, E.-C. Antoine, B. Cutuli, M. Namer, et al.
Concurrent trastuzumab with adjuvant radiotherapy in HER2-positive breast cancer patients: acute toxicity analyses from the French multicentric study
Ann. Onc.,
June 1, 2008;
19(6):
1110 - 1116.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. K. Verma and P. Ramakant
Coronary Artery Disease After Radiation Therapy for Early Breast Cancer
J. Clin. Oncol.,
March 10, 2008;
26(8):
1390 - 1390.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. E. R. Harris, C. Correa, H. Litt, W.-T. Hwang, V. Ferrari, and L. Solin
In Reply:
J. Clin. Oncol.,
March 10, 2008;
26(8):
1390 - 1392.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. A. Ganz, M. A. Hussey, C. M. Moinpour, J. M. Unger, L. F. Hutchins, S. R. Dakhil, J. K. Giguere, J. W. Goodwin, S. Martino, and K. S. Albain
Late Cardiac Effects of Adjuvant Chemotherapy in Breast Cancer Survivors Treated on Southwest Oncology Group Protocol S8897
J. Clin. Oncol.,
March 10, 2008;
26(8):
1223 - 1230.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. W. Jones, M. J. Haykowsky, J. J. Swartz, P. S. Douglas, and J. R. Mackey
Early Breast Cancer Therapy and Cardiovascular Injury
J. Am. Coll. Cardiol.,
October 9, 2007;
50(15):
1435 - 1441.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. R. Correa, H. I. Litt, W.-T. Hwang, V. A. Ferrari, L. J. Solin, and E. E. Harris
Coronary Artery Findings After Left-Sided Compared With Right-Sided Radiation Treatment for Early-Stage Breast Cancer
J. Clin. Oncol.,
July 20, 2007;
25(21):
3031 - 3037.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. Gyenes
Late Cardiac Morbidity and Mortality in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment
J. Clin. Oncol.,
June 10, 2007;
25(17):
2489 - 2489.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. E.R. Harris
In Reply
J. Clin. Oncol.,
June 10, 2007;
25(17):
2489 - 2490.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W.H. W. Tang and G. S. Francis
The Year in Heart Failure
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2575 - 2583.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
What Does Left-Sided Breast Irradiation Leave Behind?
Journal Watch Women's Health,
October 26, 2006;
2006(1026):
4 - 4.
[Full Text]
|
 |
|

|
 |

|
 |
 
Cardiac Morbidity from Breast Cancer Treatments
Journal Watch (General),
October 12, 2006;
2006(1012):
2 - 2.
[Full Text]
|
 |
|

|
 |

|
 |
 
A. Recht
Which Breast Cancer Patients Should Really Worry About Radiation-Induced Heart Disease--And How Much?
J. Clin. Oncol.,
September 1, 2006;
24(25):
4059 - 4061.
[Full Text]
[PDF]
|
 |
|
|