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Long-term risk of ischemic heart disease after adjuvant radiotherapy in breast cancer: results from a large population-based cohort.
Breast Cancer Research ( IF 7.4 ) Pub Date : 2020-01-22 , DOI: 10.1186/s13058-020-1249-2
Anna-Karin Wennstig 1, 2 , Charlotta Wadsten 1, 3 , Hans Garmo 4, 5 , Irma Fredriksson 6, 7 , Carl Blomqvist 8 , Lars Holmberg 5, 9 , Greger Nilsson 10, 11, 12 , Malin Sund 1
Affiliation  

BACKGROUND Adjuvant radiotherapy (RT) for breast cancer (BC) has been associated with an increased risk of ischemic heart disease (IHD). We examined the incidence of IHD in a large population-based cohort of women with BC. METHODS The Breast Cancer DataBase Sweden (BCBaSe) includes all women diagnosed with BC from 1992 to 2012 (n = 60,217) and age-matched women without a history of BC (n = 300,791) in three Swedish health care regions. Information on comorbidity, educational level, and incidence of IHD was obtained through linkage with population-based registries. The risk of IHD was estimated by Cox proportional hazard regression analyses and cumulative incidence by the Kaplan-Meier method. RESULTS Women with BC had a lower risk of IHD compared to women without BC with a hazard ratio (HR) of 0.91 (95% CI 0.88-0.95). When women with left-sided BC were compared to right-sided BC, an increased HR for IHD of 1.09 (95% CI 1.01-1.17) was seen. In women receiving RT, a HR of 1.18 (95% CI 1.06-1.31) was seen in left-sided compared to right-sided BC, and the HRs increased with more extensive lymph node involvement and with the addition of systemic therapy. The cumulative IHD incidence was increased in women receiving left-sided RT compared to right-sided RT, starting from the first years after RT and sustained with longer follow-up. CONCLUSIONS Women given RT for left-sided BC during 1992 to 2012 had an increased risk of IHD compared to women treated for right-sided BC. These women were treated in the era of three-dimensional conformal RT (3DCRT), and the results emphasize the importance of further developing and implementing RT techniques that lower the cardiac doses, without compromising the beneficial effects of RT.

中文翻译:

乳腺癌辅助放疗后缺血性心脏病的长期风险:基于大量人群的研究结果。

背景技术针对乳腺癌(BC)的辅助放疗(RT)与缺血性心脏病(IHD)的风险增加相关。我们检查了大量以人群为基础的女性BC人群中IHD的发生率。方法瑞典乳腺癌数据库(BCBaSe)包括1992年至2012年所有诊断为BC的妇女(n = 60,217)和三个瑞典卫生保健地区无BC病史的年龄匹配妇女(n = 300,791)。通过与基于人口的注册管理机构的联系获得有关合并症,教育水平和IHD发生率的信息。通过Cox比例风险回归分析评估IHD的风险,并通过Kaplan-Meier方法评估累积发生率。结果与不具有BC的女性相比,具有BC的女性患IHD的风险较低(HR)为0.91(95%CI 0.88-0.95)。当将左侧BC的女性与右侧BC的女性进行比较时,发现IHD的HR增加了1.09(95%CI 1.01-1.17)。在接受RT的女性中,与右侧BC相比,左侧的HR为1.18(95%CI 1.06-1.31),并且随着淋巴结的广泛浸入和全身治疗的增加,HR升高。与接受右侧放疗相比,接受左侧放疗的女性的IHD累积发生率从放疗后的头几年开始一直持续随访。结论在1992年至2012年间接受左BC放疗的女性与接受右BC的女性相比,发生IHD的风险增加。这些妇女在三维适形放疗(3DCRT)时代得到了治疗,
更新日期:2020-04-22
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