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

Lauren E Carlson; Gordon P Watt; Emily S Tonorezos; Eric J Chow; Anthony F Yu; Meghan Woods; Charles F Lynch; Esther M John; Lene Mellemkjӕr; Jennifer D Brooks; Julia A Knight; Anne S Reiner; Xiaolin Liang; Susan A Smith; Leslie Bernstein; Lawrence T Dauer; Laura I Cerviño; Rebecca M Howell; Roy E Shore; John D Boice; Jonine L Bernstein; Marinela Capanu; Irene Orlow; Mark Robson; Jørgen H Olsen; Kathleen E Malone; Marilyn Stovall; Kristina Blackmore; Irene Harris; Rikke Langballe; Cecilia O'Brien; Rita Weathers; Michele West; Lisa Hunter; Judy Goldstein; Elaine Ramos; WECARE Study Collaborative Group

doi:10.1016/j.jaccao.2021.07.008

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

Journal article

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

Lauren E Carlson, Gordon P Watt, Emily S Tonorezos, Eric J Chow, Anthony F Yu, Meghan Woods, Charles F Lynch, Esther M John, Lene Mellemkjӕr, Jennifer D Brooks, …

JACC CardioOncology, Vol.3(3), pp.381-392

09/01/2021

DOI: 10.1016/j.jaccao.2021.07.008

PMCID: PMC8463731

PMID: 34604798

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Abstract

BackgroundRadiation 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. ObjectivesThe purpose of this study was to report CAD risk among participants in the Women's Environmental Cancer and Radiation Epidemiology Study. MethodsA 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. ResultsIn 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 (P = 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. ConclusionsYoung 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.

Details

Title: Subtitle: Coronary Artery Disease in Young Women After Radiation Therapy for Breast Cancer: The WECARE Study
Creators: Lauren E Carlson - Memorial Sloan Kettering Cancer Center
Gordon P Watt - Memorial Sloan Kettering Cancer Center
Emily S Tonorezos - National Cancer Institute, Division of Cancer Control and Population Sciences
Eric J Chow - Fred Hutchinson Cancer Research Center
Anthony F Yu - Memorial Sloan Kettering Cancer Center
Meghan Woods - Memorial Sloan Kettering Cancer Center
Charles F Lynch - University of Iowa
Esther M John - Stanford School of Medicine
Lene Mellemkjӕr - Danish Cancer Society Research Center
Jennifer D Brooks - University of Toronto, Dalla Lana School of Public Health Sciences
Julia A Knight - University of Toronto, Dalla Lana School of Public Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
Anne S Reiner - Memorial Sloan Kettering Cancer Center
Xiaolin Liang - Memorial Sloan Kettering Cancer Center
Susan A Smith - University of Texas MD Anderson Cancer Center
Leslie Bernstein - Beckman Research Institute, City of Hope National Medical Center
Lawrence T Dauer - Memorial Sloan Kettering Cancer Center
Laura I Cerviño - Memorial Sloan Kettering Cancer Center
Rebecca M Howell - Lunenfeld-Tanenbaum Research Institute, Sinai Health System
Roy E Shore - New York University Grossman School of Medicine
John D Boice - National Council on Radiation Protection and Measurements, Vanderbilt University
Jonine L Bernstein - Memorial Sloan Kettering Cancer Center
Marinela Capanu
Irene Orlow
Mark Robson
Jørgen H Olsen
Kathleen E Malone
Marilyn Stovall
Kristina Blackmore
Irene Harris
Rikke Langballe
Cecilia O'Brien
Rita Weathers
Michele West
Lisa Hunter
Judy Goldstein
Elaine Ramos
WECARE Study Collaborative Group
Resource Type: Journal article
Publication Details: JACC CardioOncology, Vol.3(3), pp.381-392
DOI: 10.1016/j.jaccao.2021.07.008
PMID: 34604798
PMCID: PMC8463731
NLM abbreviation: JACC CardioOncol
ISSN: 2666-0873
eISSN: 2666-0873
Grant note: DOI: 10.13039/100000054, name: National Cancer Institute, award: CA008748, CA168339, CA206464, R01CA129639; DOI: 10.13039/100001316, name: Abbott Laboratories
Language: English
Date published: 09/01/2021
Academic Unit: Epidemiology
Record Identifier: 9984214706702771

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