Coronary Artery Disease in Young Women After Radiation Therapy for Breast Cancer: The WECARE Study

Overview

Journal JACC CardioOncol

Specialty Cardiology & Vascular Diseases

Date 2021 Oct 4

PMID 34604798

Citations 24

Authors

Lauren E Carlson

Gordon P Watt

Emily S Tonorezos

Eric J Chow

Anthony F Yu

Meghan Woods

Charles F Lynch

Esther M John

Lene Mellemkjr

Jennifer D Brooks

Julia A Knight

Anne S Reiner

Xiaolin Liang

Susan A Smith

Leslie Bernstein

Lawrence T Dauer

Laura I Cervino

Rebecca M Howell

Roy E Shore

John D Boice Jr

Jonine L Bernstein

Affiliations

Soon will be listed here.

Abstract

Background: Radiation therapy (RT) for breast cancer increases risk of coronary artery disease (CAD). Women treated for left- vs right-sided breast cancer receive greater heart radiation exposure, which may further increase this risk. The risk of radiation-associated CAD specifically among younger breast cancer survivors is not well defined.

Objectives: The purpose of this study was to report CAD risk among participants in the Women's Environmental Cancer and Radiation Epidemiology Study.

Methods: A total of 1,583 women who were <55 years of age when diagnosed with breast cancer between 1985 and 2008 completed a cardiovascular health questionnaire. Risk of radiation-associated CAD was evaluated by comparing women treated with left-sided RT with women treated with right-sided RT using multivariable Cox proportional hazards models. Effect modification by treatment and cardiovascular risk factors was examined

Results: In total, 517 women who did not receive RT and 94 women who had a pre-existing cardiovascular disease diagnosis were excluded, leaving 972 women eligible for analysis. Their median follow-up time was 14 years (range 1-29 years). The 27.5-year cumulative incidences of CAD for women receiving left- vs right-sided RT were 10.5% and 5.8%, respectively 0.010). The corresponding HR of CAD for left- vs right-sided RT in the multivariable Cox model was 2.5 (95% CI: 1.3-4.7). There was no statistically significant effect modification by any factor evaluated.

Conclusions: Young women treated with RT for left-sided breast cancer had over twice the risk of CAD compared with women treated with RT for right-sided breast cancer. Laterality of RT is independently associated with an increased risk of CAD and should be considered in survivorship care of younger breast cancer patients.

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