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Late Cardiac Morbidity and Mortality in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment

University of Alberta, Edmonton, Alberta, Canada

To the Editor:

Harris et al¹ have to be commended for their efforts in analyzing the medical records of 961 patients who received radiation therapy (RT) for early breast cancer. They found an increased risk of morbidity for ischemic heart disease after RT for left-sided cancer compared with right-sided RT, especially after more than 10 years post-treatment. There was a trend for increased mortality but their study must have been underpowered to detect a significant mortality difference. Their findings are consistent with some,^2-5 although, not all previous trials, and I agree with Recht who points out in his editorial⁶ that it is difficult to know which patients should really worry about this problem.⁷

Can anything be done about this potentially life-threatening complication other than optimizing RT techniques and waiting for 10 years to find out whether or not we were right? Advising patients to quit smoking and to have their blood pressure and lipids treated makes perfect sense, but I would recommend a more structured approach. Framingham risk score (FRS) calculations can give a reliable assessment of the patients' 10-year cardiovascular risks and it defines their lipid targets.⁸ Based on the aforementioned studies and on the study by Harris et al, it would be reasonable to assume that left-sided chest wall RT is a nonmodifiable risk factor that increases the risk by a factor of 1.5 to 2. Thus, the FRS could be multiplied by this factor and the patients' modifiable cardiac risk factors could be treated accordingly.

Alternatively, this may be the right time to initiate a multicenter open-label trial for such patients who could be randomly assigned for an FRS-based approach, including aggressive statin therapy versus usual care.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Harris EER, Correa C, Hwang WT, et al: Late cardiac mortality and morbidity in early-stage breast cancer after breast-conservation treatment. J Clin Oncol 24:4100-4106, 2006[Abstract/Free Full Text]

2. Paszat LF, Mackillop WJ, Groome PA, et al: Mortality from myocardial infarction following postlumpectomy radiotherapy for breast cancer: A population-based study in Ontario, Canada. Int J Radiat Oncol Biol Phys 43:755-762, 1999[CrossRef][Medline]

3. Gagliardi G, Lax I, Söderström S, et al: Prediction of long-term cardiac mortality after radiotherapy in stage I breast cancer patients. Radiother Oncol 46:63-71, 1998[CrossRef][Medline]

4. Gyenes G, Gagliardi G, Lax I, et al: Evaluation of irradiated heart volumes in stage I breast cancer patients treated with postoperative adjuvant radiotherapy. J Clin Oncol 15:1348-1353, 1997[Abstract/Free Full Text]

5. Gyenes G, Rutqvist LE, Liedberg A, et al: Long-term cardiac morbidity and mortality in a randomized trial of pre- and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiother Oncol 48:185-190, 1998[CrossRef][Medline]

6. Recht A: Which breast cancer patients should really worry about radiation-induced heart disease—and how much? J Clin Oncol 24:4059-4061, 2006[Free Full Text]

7. Gyenes G: Radiation-induced heart disease in early breast cancer: Problem solved? Breast Diseases: A Yearbook Quarterly 16:19-21, 2005[CrossRef]

8. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 285:2486-2497, 2001[Free Full Text]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gyenes, G. Search for Related Content PubMed PubMed Citation Articles by Gyenes, G. Social Bookmarking                            What's this?