Cardiac morbidityIncidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden
Section snippets
Materials
Since the late 1970s, the Danish Breast Cancer Cooperative Group has recorded details of all women diagnosed with breast cancer in Denmark [6], while in Sweden the Stockholm and Umeå Breast Cancer Care Programs have done likewise for women in their catchment areas. Lists of women with breast cancer were cross-matched with the Danish hospital-inpatient and outpatient registers [7] and with the Swedish national patient register [8], and the main diagnosis was obtained for each discharge. These
Characteristics of study population
Overall 48% of the 72,134 women in the study received radiotherapy (Table 1). This percentage varied by country, with calendar year of breast cancer diagnosis, age at breast cancer diagnosis, and whether or not the woman received breast-conserving surgery, hormonal therapy or chemotherapy (p < 0.00001 for all differences). For each of these characteristics the percentage of women irradiated was virtually identical for left-sided and right-sided breast cancer. Only for the few women known to have
Discussion
This is the first large population-based study of the incidence of radiation-related heart disease in women with breast cancer for which cardiac dose estimates are available. Women with left-sided breast cancer received substantial cardiac doses, with mean dose to the whole heart above 5 Gy and mean dose to the LAD coronary artery above 15 Gy throughout the study period, while for women with right-sided breast cancer mean dose to the whole heart was lower, in the range 2–4 Gy, and mean dose to the
Conflict of Interest
The authors declare that they have no financial or personal relationships with other people or organisations that could inappropriately influence their work.
Funding sources
This study was funded by the European Commission (Grant FI6R-012796), the UK Department of Health (Grant RRX 108), the British Heart Foundation (CRE Grant RE/08/004) and by Cancer Research UK (Grant to CTSU). The funders had no role in the study design, the data collection, the analysis and interpretation of the data, in the writing of the manuscript, or in the decision to submit for publication.
Acknowledgements
We thank Jill Boreham for calculating the national mortality rates and many colleagues for helpful discussions and comments on earlier drafts of this paper.
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