Long-Term Cardiovascular Mortality After Radiotherapy for Breast Cancer

• Published in: Journal of the American College of Cardiology Vol. 57; no. 4; pp. 445 - 452
• Main Authors: Bouillon, Kim, MD, MPH, Haddy, Nadia, PhD, Delaloge, Suzette, MD, Garbay, Jean-Remy, MD, Garsi, Jerome-Philippe, PhD, Brindel, Pauline, MD, PhD, Mousannif, Abdeddahir, MSc, Lê, Monique G., MD, Labbe, Martine, BSc, Arriagada, Rodrigo, MD, PhD, Jougla, Eric, MD, Chavaudra, Jean, PhD, Diallo, Ibrahima, PhD, Rubino, Carole, MD, PhD, de Vathaire, Florent, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 25-01-2011; Elsevier; Elsevier Limited
• Subjects: Adult; Age; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - radiotherapy; Cancer Care Facilities; Cancer therapies; cardiac disease; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; causes of death; Chemotherapy, Adjuvant; Chest; Cohort Studies; Female; Follow-Up Studies; France; Gynecology. Andrology. Obstetrics; Heart; Heart - radiation effects; Heart diseases; Histology; Humans; Internal Medicine; long-term mortality; long-term risk; Mammary gland diseases; Mastectomy, Segmental - methods; Medical prognosis; Medical records; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Multivariate analysis; Patients; Radiation Injuries - mortality; Radiation therapy; Radiotherapy; Radiotherapy Dosage; Radiotherapy, Adjuvant; Retrospective Studies; Risk Assessment; Risk factors; Statistical methods; Surgery; Survival Analysis; Time Factors; Tumors; Vascular diseases; Womens health; France; International Classification of Diseases; causes of death; long-term risk; breast cancer; cardiac disease; cardiovascular diseases; ICD; Institut Gustave Roussy; IGR; internal mammary chain; long-term mortality; radiotherapy; IMC; Mammary gland diseases; Breast disease; Treatment; Cardiovascular disease; Breast cancer; Malignant tumor; Circulatory system; Cardiology; Radiotherapy; Long term; Cancer
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2010.08.638

Objectives This study sought to investigate long-term cardiovascular mortality and its relationship to the use of radiotherapy for breast cancer. Background Cardiovascular diseases are among the main long-term complications of radiotherapy, but knowledge is limited regarding long-term risks because published studies have, on average, <20 years of follow-up. Methods A total of 4,456 women who survived at least 5 years after treatment of a breast cancer at the Institut Gustave Roussy between 1954 and 1984 were followed up for mortality until the end of 2003, for over 28 years on average. Results A total of 421 deaths due to cardiovascular diseases were observed, of which 236 were due to cardiac disease. Women who had received radiotherapy had a 1.76-fold (95% confidence interval [CI]: 1.34 to 2.31) higher risk of dying of cardiac disease and a 1.33-fold (95% CI: 0.99 to 1.80) higher risk of dying of vascular disease than those who had not received radiotherapy. Among women who had received radiotherapy, those who had been treated for a left-sided breast cancer had a 1.56-fold (95% CI: 1.27 to 1.90) higher risk of dying of cardiac disease than those treated for a right-sided breast cancer. This relative risk increased with time since the breast cancer diagnosis (p = 0.05). Conclusions This study confirmed that radiotherapy, as delivered until the mid-1980s, increased the long-term risk of dying of cardiovascular diseases. The long-term risk of dying of cardiac disease is a particular concern for women treated for a left-sided breast cancer with contemporary tangential breast or chest wall radiotherapy. This risk may increase with a longer follow-up, even after 20 years following radiotherapy.