Breast Cancer

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TU_10_3419 - Risk of cardiac disease after adjuvant radiation therapy among breast cancer survivors

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Risk of cardiac disease after adjuvant radiation therapy among breast cancer survivors
J. Chang1, J. Shin2, N. Kim1, E. C. Park3, and Y. B. B. Kim4; 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), 2Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY, 3Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), 4Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine,, Seoul, Korea, Republic of (South)

Purpose/Objective(s): Adjuvant radiation therapy (RT) for breast cancer is associated with heart disease, although the impact of patient-specific factors on the interaction between cardiac risk and RT is not well-known. The objective of this study is to compare acute coronary events (ACE) among the general Korean population and women with breast cancer after adjuvant RT. Secondary analysis evaluated whether a healthy lifestyle could protect against RT-related cardiac toxicity.

Materials/Methods: The Korean National Health Insurance Service-Health Screening Cohort (2002–2013) includes 514,866 participants who were randomly selected to account for 10% of all health screenings that were performed during 2002–2003 and were followed-up through 2013. We retrospectively identified 235,741 women, including 1,015 women who underwent adjuvant RT after breast surgery for newly diagnosed breast cancer between 2002 and 2013. Physical activity was evaluated using the following question: “During the past week, on how many days did you perform moderate physical activities that made you breathe heavier than normal?” The responses were categorized as (1) none or (2) at least one day. The risk of developing ACE over time while accounting for competing risks from other causes of death.

Results: 1,015 women with breast cancer who underwent adjuvant RT were matched to 8,120 women without cancer according to age, comorbidities, and smoking history. The cohort contained large proportions of subjects who never smoked (97%), were not obese (body mass index = 30 kg/m2, 96.5%), and performed exercise (83%). During 5.1±3.0 years of follow-up, the 5- and 10-year cumulative incidences of ACE were 5.5% and 11.3%, respectively. The breast cancer survivors and population-based sample had similar risks of ACE (hazard ratio: 0.94, 95% confidence interval: 0.69–1.28). However, in the sensitivity and subgroup analyses, breast cancer survivors had increased risks of ACE if they did not exercise or had a disability.

Conclusion: During the first decade after RT, breast cancer survivors and women from the general Korean population had similar risks of heart disease. Most subjects had healthy lifestyle factors, which may be underrepresented in Western studies. Performing at least moderate physical activity is associated with protection against RT-related cardiac disease. These findings suggest that patients who undergo breast RT should be encouraged to perform exercise and maintain a healthy weight in order to optimize their long-term quality of life.

Author Disclosure: J. Chang: None. J. Shin: None. N. Kim: None.

Jeesuk Chang, MD

Yonsei Cancer Center

Disclosure:
Employment
Yonsei University College of Medicine: Employee: Employee

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