Originally published as JCO Early Release 10.1200/JCO.2006.06.5516 on November 6 2006

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Decreased Risk of Stroke Among 10-Year Survivors of Breast Cancer

Maartje J. Hooning, Lucille D.A. Dorresteijn, Berthe M.P. Aleman, Arnoud C. Kappelle, Jan G.M. Klijn, Willem Boogerd, Flora E. van Leeuwen

From the Departments of Epidemiology, Neuro-oncology, and Radiation Oncology, the Netherlands Cancer Institute, Amsterdam; Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen; Department of Medical Oncology, Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands

Address reprint requests to Flora E. van Leeuwen, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; e-mail: f.v.leeuwen{at}nki.nl

PURPOSE: To assess treatment-specific risk of cerebrovascular events in early breast cancer (BC) patients, accounting for cerebrovascular risk factors.

PATIENTS AND METHODS: We studied the incidence of cerebrovascular accidents (CVA; stroke and transient ischemic attack [TIA]) in 10-year survivors of early BC (n = 4,414) treated from 1970 to 1986. Follow-up was 96% complete until January 2000. Treatment-specific incidence of CVA was evaluated by standardized incidence ratios (SIRs) based on comparison with general population rates and by Cox proportional hazards regression.

RESULTS: After a median follow-up of 18 years, 164 strokes and 109 TIAs were observed, resulting in decreased SIRs of 0.8 (95% CI, 0.6 to 0.9) for stroke and 0.8 (95% CI, 0.7 to 1.0) for TIA. Significantly increased risk of stroke was found in women who had received hormonal treatment (HT; tamoxifen) and in women who had hypertension or hypercholesterolemia, with hazard ratios (HRs) of 1.9, 2.1, and 1.6, respectively. Patients irradiated on the supraclavicular area and/or internal mammary chain (IMC) did not experience a higher risk of stroke (HR = 1.0; 95% CI, 0.7 to 1.6) or TIA (HR = 1.4; 95% CI, 0.9 to 2.5) compared with patients who did not receive radiotherapy or who were irradiated on fields other than the supraclavicular area or IMC.

CONCLUSION: Long-term survivors of BC experience no increased risk of cerebrovascular events compared with the general population. HT is associated with an increased risk of stroke. Radiation fields including the carotid artery do not seem to increase the risk of stroke compared with other fields.

published online ahead of print at www.jco.org on November 6, 2006.

Supported by Dutch Cancer Society Grant No. NKI 98-1833.

Both M.J.H. and L.D.A.D. contributed equally to this work.

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

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