Radiation-induced heart disease in breast cancer patients: a narrative review of epidemiology, risk factors, radiotherapy parameters, and prevention

Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin 73:17–48

Article  PubMed  Google Scholar 

Cancer burden statistics and trends across Europe | ECIS. https://ecis.jrc.ec.europa.eu/. Accessed 3 Nov 2023

McGale P, Taylor C, Correa C et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135

Article  CAS  PubMed  Google Scholar 

Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716

Article  CAS  PubMed  Google Scholar 

Maliko N, Stam MR, Boersma LJ, Vrancken Peeters MJTFD, Wouters MWJM, KleinJan E, Mulder M, Essers M, Hurkmans CW, Bijker N (2022) Transparency in quality of radiotherapy for breast cancer in the netherlands: a national registration of radiotherapy-parameters. Radiat Oncol. https://doi.org/10.1186/S13014-022-02043-0

Article  PubMed  PubMed Central  Google Scholar 

Bouillon K, Haddy N, Delaloge S et al (2011) Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 57:445–452

Article  PubMed  Google Scholar 

Jacobs JEJ, L’Hoyes W, Lauwens L et al (2023) Mortality and major adverse cardiac events in patients with breast cancer receiving radiotherapy: the first decade. J Am Heart Assoc. https://doi.org/10.1161/JAHA.122.027855

Article  PubMed  PubMed Central  Google Scholar 

Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998

Article  CAS  PubMed  Google Scholar 

Errahmani MY, Locquet M, Spoor D et al (2022) Association between cardiac radiation exposure and the risk of arrhythmia in breast cancer patients treated with radiotherapy: a case-control study. Front Oncol. https://doi.org/10.3389/FONC.2022.892882

Article  PubMed  PubMed Central  Google Scholar 

Marinko T (2018) Pericardial disease after breast cancer radiotherapy. Radiol Oncol 53:1–5

Article  PubMed  PubMed Central  Google Scholar 

Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE (2007) Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol 25:3031–3037

Article  PubMed  Google Scholar 

Milo MLH, Thorsen LBJ, Johnsen SP, Nielsen KM, Valentin JB, Alsner J, Offersen BV (2021) Risk of coronary artery disease after adjuvant radiotherapy in 29,662 early breast cancer patients: a population-based danish breast cancer group study. Radiother Oncol 157:106–113

Article  PubMed  Google Scholar 

Nilsson G, Holmberg L, Garmo H, Duvernoy O, Sjögren I, Lagerqvist B, Blomqvist C (2012) Distribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol 30:380–386

Article  PubMed  Google Scholar 

Tagami T, Almahariq MF, Balanescu DV, Quinn TJ, Dilworth JT, Franklin BA, Bilolikar A (2021) Usefulness of coronary computed tomographic angiography to evaluate coronary artery disease in radiotherapy-treated breast cancer survivors. Am J Cardiol 143:14–20

Article  PubMed  Google Scholar 

Laugaard Lorenzen E, Rehammar CJ, Jensen MB, Ewertz M, Brink C (2020) Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in denmark, 1977–2005. Radiother Oncol 152:103–110

Article  PubMed  Google Scholar 

Saiki H, Petersen IA, Scott CG, Bailey KR, Dunlay SM, Finley RR, Ruddy KJ, Yan E, Redfield MM (2017) Risk of heart failure with preserved ejection fraction in older women after contemporary radiotherapy for breast cancer. Circulation 135:1388–1396

Article  PubMed  PubMed Central  Google Scholar 

Lim YJ, Koh J (2021) Heart-related mortality after postoperative breast irradiation in patients with ductal carcinoma in situ in the contemporary radiotherapy era. Sci Rep. https://doi.org/10.1038/S41598-021-82263-8

Article  PubMed  PubMed Central  Google Scholar 

Roychoudhuri R, Robinson D, Putcha V, Cuzick J, Darby S, Møller H (2007) Increased cardiovascular mortality more than fifteen years after radiotherapy for breast cancer: a population-based study. BMC Cancer. https://doi.org/10.1186/1471-2407-7-9

Article  PubMed  PubMed Central  Google Scholar 

Darby SC, McGale P, Taylor CW, Peto R (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol 6:557–565

Article  PubMed  Google Scholar 

Harris EER, Correa C, Hwang WT, Liao J, Litt HI, Ferrari VA, Solin LJ (2006) Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J Clin Oncol 24:4100–4106

Article  PubMed  Google Scholar 

Greenlee H, Iribarren C, Rana JS et al (2022) Risk of cardiovascular disease in women with and without breast cancer: the pathways heart study. J Clin Oncol 40:1647–1658

Article  PubMed  PubMed Central  Google Scholar 

Meattini I, Poortmans PM, Aznar MC, Becherini C, Bonzano E, Cardinale D, Lenihan DJ, Marrazzo L, Curigliano G, Livi L (2021) Association of breast cancer irradiation with cardiac toxic effects: a narrative review. JAMA Oncol 7:924–932

Article  PubMed  Google Scholar 

Gaasch A, Schönecker S, Simonetto C et al (2020) Heart sparing radiotherapy in breast cancer: the importance of baseline cardiac risks. Radiat Oncol. https://doi.org/10.1186/S13014-020-01520-8

Article  PubMed  PubMed Central  Google Scholar 

Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998

Article  CAS  PubMed  Google Scholar 

Jacobse JN, Duane FK, Boekel NB et al (2019) Radiation dose-response for risk of myocardial infarction in breast cancer survivors. Int J Radiat Oncol Biol Phys 103:595–604

Article  PubMed  PubMed Central  Google Scholar 

Chung SY, Oh J, Chang JS, Shin J, Kim KH, Chun KH, Keum KC, Suh CO, Kang SM, Kim YB (2021) Risk of cardiac disease in patients with breast cancer: impact of patient-specific factors and individual heart dose from three-dimensional radiation therapy planning. Int J Radiat Oncol Biol Phys 110:473–481

Article  PubMed  Google Scholar 

Van Den Bogaard VAB, Ta BDP, Van Der Schaaf A et al (2017) Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. J Clin Oncol 35:1171–1178

Article  PubMed  PubMed Central  Google Scholar 

Milo HML, Slot Møller D, Bisballe Nyeng T et al (2023) Radiation dose to heart and cardiac substructures and risk of coronary artery disease in early breast cancer patients: a DBCG study based on modern radiation therapy techniques. Radiother Oncol. https://doi.org/10.1016/J.RADONC.2022.109453

Article  PubMed  Google Scholar 

Jacob S, Camilleri J, Derreumaux S et al (2019) Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study). Radiat Oncol. https://doi.org/10.1186/S13014-019-1234-Z

Article  PubMed  PubMed Central  Google Scholar 

Taylor C, McGale P, Brønnum D et al (2018) Cardiac structure injury after radiotherapy for breast cancer: cross-sectional study with individual patient data. J Clin Oncol 36:2288–2296

Article  PubMed  PubMed Central  Google Scholar 

van Velzen SGM, Gal R, Teske AJ, van der Leij F, van den Bongard DHJG, Viergever MA, Verkooijen HM, Išgum I (2022) AI-based radiation dose quantification for estimation of heart disease risk in breast cancer survivors after radiation therapy. Int J Radiat Oncol Biol Phys 112:621–632

Article  PubMed  Google Scholar 

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