Originally published as JCO Early Release 10.1200/JCO.2005.05.1037 on August 14 2006

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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.

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