Heart Disease Risk Associated with Breast Radiotherapy

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Based on a study published in JAMA Internal Medicine, patients who are in the early stages of breast cancer and receive radiation treatments on the left side of their body in a facing-up position were shown to be at a greater risk of contracting heart disease.

Researchers from the Columbia University Medical Center in New York say that prior research has suggested a connection between breast cancer radiation and long-term cardiovascular-related deaths.

In fact, earlier this year a study that was published in the New England Journal of Medicine, suggested that breast cancer patients who receive radiation therapy are at a slightly higher risk of contracting heart disease within 5 years of treatment.

According to this most recent study, researchers analyzed 48 patients with stage 0 breast cancer, which is the earliest form of the disease, up to stage IIA breast cancer. This is a stage of breast cancer in which no tumors are detected; however, cancer is noticeable in 1 to 3 axillary lymph nodes.

All patients were treated after 2005 at the New York University Department of Radiation Oncology, and the patients' cardiac risks were measured over a 20-year period after radiotherapy. According to the researchers, this is the estimated average life expectancy after early stage breast cancer.

The researchers determined the connection between radiotherapy and heart disease by taking the following the determinants into account:

? Mean cardiac radiation dose

? Cardiac risk of each patient (smoking, cholesterol and hypertension)Breast radiotherapy linked to increased heart disease risk

? Side of the body that received radiation

? Body position

? Coronary events induced by radiation therapy

The study’s discoveries showed that women who had the highest baseline cardiac risk, who underwent radiation therapy on the left side of their body while in a face-up position, demonstrated the greatest risk for contracting heart disease.

Women who had low cardiac risk at the baseline of the study, who underwent radiation therapy on the right side of their body exhibited the lowest risk of heart disease.

The researchers discovered that patients who were administered radiation therapy on the left side of their body while in the prone position, lying down and facing down , had reduced radiation dosage and reduced cardiac risk.

Body positioning had little to no effect on cardiac risk on right-sided therapy, the researchers note, as the heart is always out of the area of radiation.

Ultimately the researchers conclude that breast cancer patients receiving radiation therapy could significantly cut the risk of developing heart disease by reducing other cardiovascular risk factors.

"Because the effects of radiation exposure on cardiac disease risk seem to be multiplicative, the highest absolute radiation exposure risks correspond to the highest baseline cardiac risk. Consequently, radiotherapy-induced risks of major coronary events are likely to be reduced in these patients by targeting baseline cardiac risk factors (cholesterol, smoking, hypertension), by lifestyle modification, and/or by pharmacological treatment,” they wrote.


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