Radiation to Left Breast? Take Care of Your Heart
More Coronary Artery Disease Seen With Radiation to Left Breast
September 29, 2006 04:46:11 PM PST

http://health.yahoo.com/news/167231

Yahoo! Health: Breast Cancer News

Summary: Radiation for breast cancer may affect the heart when
treatment is given to the left breast, doctors from the University of
Pennsylvania report. Writing in the Journal of Clinical Oncology, they
say women who have radiation to the left breast are more likely to
develop coronary artery disease than those who get radiotherapy in the
right breast. Consequently, women who require left-breast radiation
should be especially vigilant about reducing their other risks for
heart disease, the researchers say.

Why it's important: The American Cancer Society estimates that nearly
213,000 women will develop breast cancer in 2006. Many of these women
will be diagnosed at an early stage and many will receive a surgical
treatment called lumpectomy, which leaves most of the breast intact.
Breast-conserving surgeries of this type must be followed by radiation
to the remaining breast tissue to reduce the chances of the cancer
coming back. Radiation treatment after breast surgery also has been
shown to help women live longer. But because the heart is on the left
side of the chest, it is vulnerable to damage when radiotherapy is
given to the left breast.

What's already known: In the past, radiation to the left breast was
often very damaging to the heart. Modern techniques have cut down the
amount of radiation that hits the heart, and recent studies have shown
that left-breast radiation can be done without damaging the heart. But
radiation can also damage the arteries that nourish the heart (the
coronary arteries) and this is thought to play a part in the
development of coronary artery disease.
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How this study was done: The University of Pennsylvania researchers
wondered if women who had radiation for left breast cancer were more
likely to develop coronary artery disease. To answer this question,
they reviewed the records of 961 women who had breast-conserving
surgery and radiation therapy between 1977 and 1994. A roughly equal
number of them had left breast cancer (484) versus right breast cancer
(477). Following treatment, these women were monitored for an average
of 12 years for any signs of cardiac problems. The Penn researchers
analyzed the follow-up information to see if there was any difference
in how these two groups fared.

What was found: The researchers found that the women treated for
cancer of the left breast had higher rates of chest pain, heart
attacks and evidence of coronary artery disease. After 20 years, about
25% of women treated for left breast cancer had developed coronary
artery disease compared with only 10% of women treated for cancer of
the right breast. The good news was that radiation to the left breast
did not cause these women to die of heart disease more often than
women with right-breast cancer. The risk of coronary artery disease
was highest in women with high blood pressure.

There were some questions the study could not answer, though. For
instance, none of the women studied had heart disease before their
cancer treatment, so the researchers can't say how radiation to the
left breast might affect women with existing heart problems. And few
of the women in this study received doxorubicin, a type of
chemotherapy that is known to damage the heart. This treatment is more
widely used today than it was during the study period. Further
research is needed to find out if radiation to the left breast worsens
any damage done by this form of chemotherapy.

The bottom line: Although reducing the risk of heart disease is
important for everyone, women who have had radiation therapy to the
left breast need to be especially cautious. The authors urge these
women to try to reduce their risk factors for coronary artery disease.
Abram Recht, MD, a radiation therapy specialist from Harvard Medical
School, drives this point home in an accompanying editorial: "I
strongly urge patients to vigorously treat their hypertension and
[high cholesterol] and for God's sake, stop smoking!"

Citation: "Late Cardiac Mortality and Morbidity in Early-Stage Breast
Cancer Patients After Breast-Conservation Treatment." Published in the
Sep. 1, 2006, Journal of Clinical Oncology (Vol.24, No. 25:
4100-4106). First author: Eleanor E. R. Harris, MD, Moffitt Cancer
Center and Research Institute, Tampa, Fla.

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