Risk of Cardiovascular Disease in Survivors of Breast Cancer 


With respect to the conclusions of our study, we should make a distinction between patients treated in the past and patients of the present. For patients treated in the 1970s/1980s we found moderately increased risk of myocardial infarction, angina pectoris and congestive heart failure in comparison with the general female population in the Netherlands. Risk of heart disease depended on the type of treatment received. In general, irradiated patients experienced higher risk of cardiac disease than patients who underwent surgery only. Speaking in absolute numbers: if we would follow 1000 women from our study for 10 years, we would have expected 215 cardiac events to occur (based on incidence rates of the Dutch population) while we found 70 more events among the irradiated breast cancer patients, a 33% increase in risk. Our advice to women who had radiotherapy during the "higher risk" years would be to control and/or treat any existing cardiovascular risk factors, like high blood pressure, diabetes mellitus, hypercholesterolemia, and of course, to stop smoking.
We cannot simply translate the results of our study to the treatment regimens of today's practice. Over the past years new techniques have been developed to treat target volumes more precisely and to spare normal tissues more effectively. With "Intensity Modulated Radiotherapy" the target organ is optimally irradiated by making use of varying intensity of radiation, while the surrounding tissues will be spared. "Image Guided Radiotherapy" enables us to depict the target organ plus surrounding tissues directly. Whether treatment with modern techniques will prevent all late cardiac toxicity, must be evaluated in another 15 - 20 years.

				 

Bibliographic reference: 

Hooning MJ et al.: "Long-term risk of cardiovascular disease in 10-year survivors of breast cancer", J Natl Cancer Inst. 2007 Mar 7;99(5):365-75

 

Maartje J. Hooning
Department of Medical Oncology, Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam, The  Netherlands