Analysis of 10-year cause-specific mortality of patients with breast cancer treated in New South Wales in 1995

Wang, Wei; O’Connell, Dianne; Stuart, Kirsty; Boyages, John

doi:10.1111/j.1754-9485.2011.02304.x

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…Although our finding of no increase in CVD mortality among those receiving radiation therapy was in agreement with some previous studies, 33,34 this result lies in contrast to others. 9,35-39 Radiation therapy, in particular to the left side of the chest wall, may increase CVD risk through injury to cardiac muscle or the surrounding vasculature.…”

Section: Discussionsupporting

confidence: 91%

Cardiovascular Disease Mortality Among Breast Cancer Survivors

Bradshaw¹,

et al. 2016

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Background Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown. Methods We compared deaths due to CVD in a population-based sample of 1,413 women with incident breast cancer diagnosed in 1996-1997, and 1,411 age-matched women without breast cancer. Date and cause of death through December 31, 2009 were assessed through the National Death Index and covariate data was gathered through structured interviews and medical record abstraction. Hazard ratios and 95% confidence intervals (CI) were calculated using Cox regression for overall mortality (HR) and CVD-specific death (cause-specific HR). Subdistribution hazard ratios (sHR) for CVD death were estimated from the Fine-Gray model. Results Risk of death was greater among breast cancer survivors compared to women without breast cancer [HR: 1.8 (1.5, 2.1)]. An increase in CVD-related death among breast cancer survivors was evident only 7 years after diagnosis [years 0-7, cause-specific HR: 0.80 (0.53, 1.2), subdistribution HR: 0.59 (0.40, 0.87)]; years 7+, cause-specific HR: 1.8 (1.3, 2.5), subdistribution HR: 1.9 (1.4, 2.7); p-interaction: 0.001]. An increase in CVD-related mortality was observed among breast cancer survivors receiving chemotherapy. Conclusions Breast cancer survivors are at greater risk for CVD-related mortality compared to women without breast cancer and this increase in risk is manifest approximately 7 years after diagnosis. Efforts should be made to identify risk factors and interventions that can be employed during this brief window to reduce the excess burden of CVD in this vulnerable population.

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Section: Discussionsupporting

confidence: 91%

Cardiovascular Disease Mortality Among Breast Cancer Survivors

Bradshaw¹,

et al. 2016

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“…Several studies include patients in the era of modern radiotherapy, and the results demonstrate that the risk of cardiac-related mortality does not increase in patients receiving left-sided PORT compared to right-sided PORT, with the exception of women with a history of cardiac disease. 12 , 15 , 16 , 19 A population-based study also confirmed that the 10-year cardiac-related mortality rate in left- and right-sided tumors following PORT was only 2.4% and 1.9%, respectively, 19 which was similar to our study. However, our study also found that the risk of cardiac-related mortality steadily declined over the study period.…”

Section: Discussionsupporting

confidence: 90%

No association between tumor laterality and cardiac-related mortality in breast cancer patients after radiotherapy: a population-based study

Li¹,

Zhang²,

Huang³

et al. 2018

CMAR

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IntroductionTo assess the effect of tumor laterality to cardiac-related deaths of breast cancer in the current radiation practices using a large modern population-based study.MethodsWomen diagnosed with breast cancer from 2000 to 2008 were included using the current Surveillance, Epidemiology, and End Results database. The primary outcome of this study was the cardiac-related mortality. Multivariate analysis was performed using the Cox proportional hazards model to analyze the cardiac-related mortality including demographic, clinicopathologic, and treatment factors.ResultsWe identified 168,761 breast cancer patients, including 85,006 (50.4%) patients with left-sided tumors and 83,755 (49.6%) patients with right-sided tumors. The median follow-up period was 8.8 years. The 10-year cardiac-related mortality was 2.3% and 2.3% in left- and right-sided tumors, respectively (P=0.685). The results indicated that patients with older age, non-Hispanic Black, receipt of mastectomy, and married status were the independent adverse factors for cardiac-related mortality. However, left-sided tumors were not associated to a higher risk of cardiac-related mortality than right-sided tumors following postoperative radiotherapy (right vs left, hazard ratios 1.025, 95% CI 0.856–1.099, P=0.484). The risk of cardiac-related mortality in the entire cohort was increased with the extension of follow-up time. However, there was still not significantly different between left- and right-sided tumors. Subgroup analysis also found no association between tumor laterality and cardiac-related mortality after postoperative radiotherapy based on various demographics and treatment factors.ConclusionWith a median follow-up of 8.8 years, no significant differences were found in cardiac-related mortality between left- and right-sided tumors under current radiation practices of breast cancer patients.

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“…A total of 1 191 371 individuals were enrolled in 39 eligible studies, including 11 randomized controlled trials, 13 cancer registry database studies, and 15 single‐ and multi‐institutional trials . Twenty‐two studies were based in Europe, 13 in North America, 1 in Australia and 3 were multinational; 16 studies recruited participants from population registers, and 23 were hospital based (Table ).…”

Section: Resultsmentioning

confidence: 99%

Long‐Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer

Cheng

Nie²,

et al. 2017

JAHA

201

142

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BackgroundRadiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of heart disease is uncertain. We performed a meta‐analysis to investigate the link between radiotherapy and long‐term cardiovascular morbidity and mortality in patients with breast cancer.Methods and ResultsWe performed a literature search using MEDLINE (January 1966 to January 2015) and EMBASE (January 1980 to January 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95%CIs for the associations of interest were included. Pooled effect estimates were obtained by using random‐effects meta‐analysis. Thirty‐nine studies involving 1 191 371 participants were identified. Patients who received left‐sided radiotherapy, as compared with those receiving right‐sided radiotherapy, experienced increased risks of developing coronary heart disease (RR 1.29, 95%CI 1.13‐1.48), cardiac death (RR 1.22, 95%CI 1.08‐1.37) and death from any cause (RR 1.05, 95%CI 1.01‐1.10). In a comparison of patients with radiotherapy and without radiotherapy, the RRs were 1.30 (95%CI 1.13‐1.49) for coronary heart disease and 1.38 (95%CI 1.18‐1.62) for cardiac mortality. Radiotherapy for breast cancer was associated with an absolute risk increase of 76.4 (95%CI 36.8‐130.5) cases of coronary heart disease and 125.5 (95%CI 98.8‐157.9) cases of cardiac death per 100 000 person‐years. The risk started to increase within the first decade for coronary heart disease and from the second decade for cardiac mortality.ConclusionsExposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent risk of coronary heart disease and cardiac mortality.

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Analysis of 10-year cause-specific mortality of patients with breast cancer treated in New South Wales in 1995

Abstract: There is no excess cardiac mortality due to RT within the first decade in a population series of patients with breast cancer treated with modern radiotherapy.

Cited by 12 publications

References 18 publications

Cardiovascular Disease Mortality Among Breast Cancer Survivors

Cardiovascular Disease Mortality Among Breast Cancer Survivors

No association between tumor laterality and cardiac-related mortality in breast cancer patients after radiotherapy: a population-based study

Long‐Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer

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