TY - JOUR
T1 - Cardiovascular Disease Risk in a Large, Population-Based Cohort of Breast Cancer Survivors
AU - Boekel, Naomi B.
AU - Schaapveld, Michael
AU - Gietema, Jourik A.
AU - Russell, Nicola S.
AU - Poortmans, Philip
AU - Theuws, Jacqueline C. M.
AU - Schinagl, Dominic A. X.
AU - Rietveld, Derek H. F.
AU - Versteegh, Michel I. M.
AU - Visser, Otto
AU - Rutgers, Emiel J. T.
AU - Aleman, Berthe M. P.
AU - van Leeuwen, Flora E.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Purpose: To conduct a large, population-based study on cardiovascular disease (CVD) in breast cancer (BC) survivors treated in 1989 or later.Methods and Materials: A large, population-based cohort comprising 70,230 surgically treated stage I to III BC patients diagnosed before age 75 years between 1989 and 2005 was linked with population-based registries for CVD. Cardiovascular disease risks were compared with the general population, and within the cohort using competing risk analyses.Results: Compared with the general Dutch population, BC patients had a slightly lower CVD mortality risk (standardized mortality ratio 0.92, 95% confidence interval [CI] 0.88-0.97). Only death due to valvular heart disease was more frequent (standardized mortality ratio 1.28, 95% CI 1.08-1.52). Left-sided radiation therapy after mastectomy increased the risk of any cardiovascular event compared with both surgery alone (subdistribution hazard ratio (sHR) 1.23, 95% CI 1.11-1.36) and right-sided radiation therapy (sHR 1.19, 95% CI 1.04-1.36). Radiation-associated risks were found for not only ischemic heart disease, but also for valvular heart disease and congestive heart failure (CHF). Risks were more pronounced in patients aged = 1997 (ie, anthracyline-based chemotherapy) increased the risk of CHF (sHR 1.35, 95% CI 1.00-1.83).Conclusion: Radiation therapy regimens used in BC treatment between 1989 and 2005 increased the risk of CVD, and anthracycline-based chemotherapy regimens increased the risk of CHF. (C) 2016 Elsevier Inc. All rights reserved.
AB - Purpose: To conduct a large, population-based study on cardiovascular disease (CVD) in breast cancer (BC) survivors treated in 1989 or later.Methods and Materials: A large, population-based cohort comprising 70,230 surgically treated stage I to III BC patients diagnosed before age 75 years between 1989 and 2005 was linked with population-based registries for CVD. Cardiovascular disease risks were compared with the general population, and within the cohort using competing risk analyses.Results: Compared with the general Dutch population, BC patients had a slightly lower CVD mortality risk (standardized mortality ratio 0.92, 95% confidence interval [CI] 0.88-0.97). Only death due to valvular heart disease was more frequent (standardized mortality ratio 1.28, 95% CI 1.08-1.52). Left-sided radiation therapy after mastectomy increased the risk of any cardiovascular event compared with both surgery alone (subdistribution hazard ratio (sHR) 1.23, 95% CI 1.11-1.36) and right-sided radiation therapy (sHR 1.19, 95% CI 1.04-1.36). Radiation-associated risks were found for not only ischemic heart disease, but also for valvular heart disease and congestive heart failure (CHF). Risks were more pronounced in patients aged = 1997 (ie, anthracyline-based chemotherapy) increased the risk of CHF (sHR 1.35, 95% CI 1.00-1.83).Conclusion: Radiation therapy regimens used in BC treatment between 1989 and 2005 increased the risk of CVD, and anthracycline-based chemotherapy regimens increased the risk of CHF. (C) 2016 Elsevier Inc. All rights reserved.
KW - CAUSE-SPECIFIC MORTALITY
KW - LONG-TERM SURVIVORS
KW - HEART-DISEASE
KW - LUNG-CANCER
KW - RADIOTHERAPY
KW - WOMEN
KW - ANTHRACYCLINE
KW - CHEMOTHERAPY
KW - CHILDHOOD
KW - FAILURE
U2 - 10.1016/j.ijrobp.2015.11.040
DO - 10.1016/j.ijrobp.2015.11.040
M3 - Article
SN - 0360-3016
VL - 94
SP - 1061
EP - 1072
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -