TY - JOUR
T1 - Mortality and major adverse cardiac events in patients with breast cancer receiving radiotherapy
T2 - The first decade
AU - Jacobs, Johanna E.J.
AU - L’Hoyes, Wouter
AU - Lauwens, Lieselotte
AU - Yu, Yu Ling
AU - Brusselmans, Marius
AU - Weltens, Caroline
AU - Voigt, Jens Uwe
AU - Wildiers, Hans
AU - Neven, Patrick
AU - Herrmann, Joerg
AU - Thijs, Lutgarde
AU - Staessen, Jan A.
AU - Janssens, Stefan
AU - Van Aelst, Lucas N.L.
N1 - Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/4/18
Y1 - 2023/4/18
N2 - BACKGROUND: Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for this interval is unclear. METHODS AND RESULTS: We aimed to study cardiovascular event rates in the first decade following curative radiotherapy for BC. We compared mortality and cardiovascular event rates with an age-and risk factor-matched control population. We included 1095 patients with BC (mean age 56±12 years). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality caused 107 (49.1%) and 22 (10.1%) deaths, respectively. A total of 904 cases were matched to female FLEMENGHO (Flemish Study on Environment, Genes and Health Outcomes) participants. Coronary artery disease incidence was similar (risk ratio [RR], 0.75 [95% CI, 0.48–1.18]), yet heart failure (RR, 1.97 [95% CI, 1.19–3.25]) and atrial fibrillation/flutter (RR, 1.82 [95% CI, 1.07–3.08]) occurred more often in patients with BC. Age (hazard ratio [HR], 1.033 [95% CI, 1.006–1.061], P=0.016), tumor grade (HR, 1.739 [95% CI, 1.166–2.591], P=0.007), and neoadjuvant treatment setting (HR, 2.782 [95% CI, 1.304–5.936], P=0.008) were risk factors for mortality. Risk factors for major adverse cardiac events were age (HR, 1.053 [95% CI, 1.013–1.093]; P=0.008), mean heart dose (HR, 1.093 [95% CI, 1.025–1.167]; P=0.007), history of cardiovascular disease (HR, 2.386 [95% CI, 1.096–6.197]; P=0.029) and Mayo Clinic Cardiotoxicity Risk Score (HR, 2.664 [95% CI, 1.625–4.367]; P<0.001). CONCLUSIONS: Ten-year mortality following curative treatment for unilateral BC was mainly cancer related, but heart failure and atrial fibrillation/flutter were already common in the first decade following irradiation. Mean heart dose, pre-existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for cardiac adverse events. These results suggest a need for early dedicated cardio-oncological follow-up after radiotherapy.
AB - BACKGROUND: Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for this interval is unclear. METHODS AND RESULTS: We aimed to study cardiovascular event rates in the first decade following curative radiotherapy for BC. We compared mortality and cardiovascular event rates with an age-and risk factor-matched control population. We included 1095 patients with BC (mean age 56±12 years). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality caused 107 (49.1%) and 22 (10.1%) deaths, respectively. A total of 904 cases were matched to female FLEMENGHO (Flemish Study on Environment, Genes and Health Outcomes) participants. Coronary artery disease incidence was similar (risk ratio [RR], 0.75 [95% CI, 0.48–1.18]), yet heart failure (RR, 1.97 [95% CI, 1.19–3.25]) and atrial fibrillation/flutter (RR, 1.82 [95% CI, 1.07–3.08]) occurred more often in patients with BC. Age (hazard ratio [HR], 1.033 [95% CI, 1.006–1.061], P=0.016), tumor grade (HR, 1.739 [95% CI, 1.166–2.591], P=0.007), and neoadjuvant treatment setting (HR, 2.782 [95% CI, 1.304–5.936], P=0.008) were risk factors for mortality. Risk factors for major adverse cardiac events were age (HR, 1.053 [95% CI, 1.013–1.093]; P=0.008), mean heart dose (HR, 1.093 [95% CI, 1.025–1.167]; P=0.007), history of cardiovascular disease (HR, 2.386 [95% CI, 1.096–6.197]; P=0.029) and Mayo Clinic Cardiotoxicity Risk Score (HR, 2.664 [95% CI, 1.625–4.367]; P<0.001). CONCLUSIONS: Ten-year mortality following curative treatment for unilateral BC was mainly cancer related, but heart failure and atrial fibrillation/flutter were already common in the first decade following irradiation. Mean heart dose, pre-existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for cardiac adverse events. These results suggest a need for early dedicated cardio-oncological follow-up after radiotherapy.
KW - Breast cancer
KW - Cardio-oncology
KW - Cardiovascular diseases
KW - Epidemiology
KW - Radiation therapy
KW - Risk factors
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U2 - 10.1161/JAHA.122.027855
DO - 10.1161/JAHA.122.027855
M3 - Article
C2 - 37026536
AN - SCOPUS:85152635244
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 8
M1 - e027855
ER -