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NEWS & VIEWS |
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Women treated with radiotherapy for cancer of the left breast are more likely to develop cardiac disease years later than women whose right breast was irradiated, according to a study in the Journal of Clinical Oncology (2006;24:4100–4106).
Researchers from the University of Pennsylvania noted significantly higher rates of chest pain (P < 0.001), coronary artery disease (P < 0.001), and myocardial infarction (P = 0.002) in left breast patients (484 women) compared to right breast patients (477 women). Participants were treated at the institution between 1977 and 1994 with lumpectomy and radiation for Stage I or II breast cancer. All were free of heart disease when diagnosed.
Women in both groups had a higher risk of developing coronary artery disease if they also had hypertension, and those with left breast cancer and hypertension had the highest risk of all (hazard ratio [HR] = 11.4).
Nevertheless, women in the study group had lower rates of coronary artery disease than women in the general US population, and the study found no significantly increased risk of cardiac death among left breast cancer patients, even after 20 years.
Lead study author Eleanor Harris, MD, says the higher rate of cardiac morbidity seen in the research should not discourage women and physicians from using adjuvant radiation, but should spur radiation oncologists to strive even harder to protect the heart during treatment.
"Fortunately, we do have new technology and new treatment modalities, so we are better able to do that now than during the era of the study," said Harris, who is now Clinical Director of Radiation Oncology at the H. Lee Moffitt Cancer Center and Research Institute in Florida.
As examples, she cited 3-dimensional planning with CT scans and intensity modulated radiation therapy (IMRT). Partial breast radiation may also be appropriate, she said, particularly once results of the NSABP B-39/RTOG 0413 trial give a better indication of which patients are best suited to this treatment.
On the other hand, Harris also noted that cardiotoxic drugs like Adriamycin and Herceptin are more commonly used today than during the study period. "What we need to do is look at that issue and see if there's any interaction, but to be cautious I would assume that anyone who had a cardiotoxic drug might be at higher risk for heart disease as well," she said.
Edward Yeh, MD, Chair of Cardiology at The University of Texas MD Anderson Cancer Center, agreed that minimizing radiation exposure of the heart is important. But it's equally critical to continue monitoring and treating patients for other cardiac risk factors (smoking, diabetes, etc.) during cancer treatment, he said.
Harris said women treated for breast cancer do not need any more intense cardiac surveillance than other women, but that they should be screened for cardiac symptoms and risk factors, such as blood pressure, cholesterol, and smoking, according to routine recommendations.
Yeh emphasized that regular checkups are important for breast cancer survivors regardless of whether they had radiation therapy because all women should be monitored for heart disease as they age.
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