As anyone who has had chemotherapy or radiation knows, cancer treatments and collateral damage go hand-in-hand. For quite some time, one of the consequences we’ve been most concerned about is the effect that radiation can have on the heart. A new study in New England Journal of Medicine tells us more about that risk—and how long it lasts.

The study followed 2168 women with breast cancer who were treated with radiation between 1958 and 2001 in Sweden and Denmark. During that time, 963 of these women developed a serious heart problem and some died from heart disease. But not all women were equally at risk. The risk rose in proportion to the amount of radiation they had received and was higher in women who had cancer in their left breast (which is closer to the heart) than in women who had cancer in their right breast. It was also higher in women who were overweight, had diabetes, or smoked—other known risk factors for heart disease. Most interesting was the fact that the risk persisted long after the radiation exposure with 33 percent of the women developing heart problems 10 to 19 years after their breast cancer treatment and 23 percent not experiencing problems until 20 or more years later.

This study should not dissuade women from getting radiation for breast cancer or DCIS. Much of the radiation given to these women was 10 or 20 years ago, when the technology was more primitive. But even today women should make sure that the facility that is doing the radiation is up to date on the latest techniques. For example, the USA Today article about this study notes that M. D. Anderson Cancer Center (and probably other centers as well) are trying a new technology that times the radiation dose to a woman’s breathing, delivering the radiation as she inhales, which pushes the heart down, and stops it as she exhales.

Other researchers are investigating whether having women lay on their stomachs, rather than on their backs (so that the breast hangs down away from the heart) can reduce this risk.

In an editorial accompanying the published study, Dr. Javid Moslehi, co-director of the Cardio-Oncology Program at Brigham and Women’s Hospital in Boston, bring up another important point: more effort needs to be made to bring cardiologists into discussions about radiation, so that they can provide their expertise during treatment planning and add previous radiation therapy to their list of risk factors for heart disease.

By no means do I think that a woman should avoid getting radiation therapy for her breast cancer because of the possible future risk of heart disease. But she should be aware of the risk herself and remind her doctors in the future. In addition we all should look to radiation therapists to continue to develop ways of delivering life-saving radiation that decreases or eliminates the collateral damage it can cause.

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35 Responses to First Cancer, Then Heart Disease?

  1. I remember when I had my radiation, the doctor was debating between standard course and a new technique that followed the contours of the body more carefully. In the end, I he went for the better one, but he had seriously considered not doing it in the interest of time! It really makes me shake my head that I wasn’t more adamant about getting the best options.

    Thanks for this explanation. I’d seen that article headline, and it’d Madame go – “ohhhh no.” So the explanation is very helpful. ~Catherine

  2. sonaamisece says:

    The next time I read a weblog, I hope that it doesnt disappoint me as significantly as this 1. I mean, I know it was my choice to read, but I actually thought youd have something interesting to say. All I hear is a bunch of whining about something that you could fix for those who werent too busy looking for attention.

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  3. cheryl says:

    I am not even sure what the above poster meant? But I found the article informative. It is ALWAYS good to know the risks and benefits of any procedure you have had or will have. That is just smart. Thank you and keep these articles coming! I had radiation and would happily have it again, knowing that radiation will keep me alive long enough to have the honor of worrying about heart disease :)

  4. Denise says:

    My radiation doctor did tell me about the issues of heart disease before I had radiation, (of course she was a woman). She left shortly after and I did not have another appointment with her. The other doctors were male and I did not care for them. They never asked me any questions about my heart or issues regarding it. Of course, the cancer was in my left breast. I do see a cardiologist regularly and he is keeping a close eye on my heart, knowing that I’ve had radiation therapy. I really think that doctors should not just follow the status quo of breast cancer treatment, such as chemotherapy and radiation. Everyone is different and treatments should be tailored to meet the patient’s needs and lifestyle. I am not overweight, nor do I have diabetes. I exercise regularly and try to eat right. My immune system was solid as a rock when I was diagnosed. Having treatments, “just in case”, seems stupid to me considering all of the side affects. Things need to change.

  5. Sue Beem says:

    Now that the information is out, it makes choices more difficult. The two “newer techniques” are studies, and in only two locations and no guarantee that they will reduce heart damage. I am glad someone is looking at long term side effects of radiation. I hope some radiation oncologists read these items and realize that what they do has effect for years other than pain and skin changes.
    There also needs to be more research into the response of tumors based on type (ie lobular vs ductal) and by grade ( ie 1 vs 3-4). I opted to not have radiation: my tumor was 5 cm across and grade 1 (not uncommon for lobular invasive because of its pattern of growth). They would have to shield part of the tumor bed to protect the heart, which means a portion of my tumor site goes untreated. Radiation is more precisely given than in the era that the women in above study underwent treatment, but there is scatter still. Radiation causes damage to tissue, including skin, bone, blood and lymphatic tissues, and other organs in the chest. The radiation oncology community is through seeing us after 6 months as a rule, but their treatments keep on giving!
    This is another reason anyone reading this blog should be participating in research into the causes of breast cancer so we do not have to have discussions like this.

  6. Carol Bowa says:

    It has been 20 years since my breast cancer. I had radiation to the left breast. I am now 74 years old & after reading this article I am concerned about heart disease. Should I see a cardiologist & discuss this issue with him? I have been experiencing heart flutters recently.

  7. Nancy M says:

    This may explain why a MD recently noted that I have a small heart murmur. This was noted for the 1st time last summer, 2012. I thought surely that was a mistake, but my new MD confirmed it but said it was minor and not to worry. I had radiation on my left breast Fall of 2007. Thank you very much for this new information. I will be sure to give my Internal Med and Oncology doctors this new information. My Oncology MD gave me a lot of info about the risks of chemo – which I chose not to have. He used good web tools to access my risk and benefits. My Radiation MD. only mentioned the risk of later lung cancer. That info got me to quick smoking immediately. Glad I quit smoking but wish I had had more info on the risks. I think that the radiation equipment that was used was near the end of its life. About a year later the hospital opened a new cancer treatment facility – with I believe all new equipment. Since I was, and still am, in an HMO I did not have a financially viable alternative facility. Oh well, I will hope for the best. Maybe there is a statistical tool for radiation that also takes into account tumor grade, size, medical history, etc. If not yet – that would be a good project. Thanks again for the information.

  8. Marcia Seligson says:

    I had mammocite radiation 5 years ago for a left breast cancer — twice a day for 5 days. There were only two places in L.A. that were doing it and my docs said I was a good candidate because of the small estrogen-positive nature of the tumor, my being post-menopausal and the location of the tumor. Since then, I’ve heard a read a few articles about mammocite that were somewhat negative — it’s too new to have good data, etc. Now, I’m wondering if it makes me more susceptible or less to heart disease. Does anybody have any info about this? I’d be grateful.

  9. Sue says:

    It disappoints me that the article didn’t cover chemotherapy at all. Just radiation. I did the full dealio – chemotherapy, radiation and heceptin. I’m young and in shape. I always knew I was shaving time off the back end with this aggressive treatment choice. What I’d really like to know – is what I am doing now really making a long term difference – working out, eating right – or will my heart never really regenerate? I get conflicting answers to this question.

  10. Gail Lee says:

    Did the study you refer to indicate what type of heart issues were more prevalent? It would be nice to know if there are specific things we should be watching for or if this is a generalized observation. I have had bilateral breast cancer treated with surgery and radiation so my chest area has been radiated on both sides. Seems to me I need to be extra concerned.

  11. Jill Morris says:

    Thankful that I did not have radiation, only lumpectomy, but just writing to warn about hysterectomies too…in fact, ANY operation! You better watch out. Most doctors will not do ANY research for you on the hazards of your treatment. They are just doing their job, so YOU need to be the one to do the research and make the decisions about your health. I haven’t gone back for other mammograms after my 6 month all clear one after my lumpectomy because I didn’t want to EVER go through that again unless I FELT a lump. I asked myself, if they did find a micron, would I opt for lumpectomy. When MY answer was NO, (your body might get rid of the micron itself, if not, it will become a lump, which then would need surgery) I decided that I did not want doctors telling me what was going on in my body in the invisible…I think that if I feel bad or know something is wrong, then I will go to a doctor, otherwise, I stay away…no more tests. Why? I would rather have a quality life NOW…tests stress me out, and stress will kill you too!

  12. Judy C. says:

    Are there any studies being conducted on the effects of radiation therapy and lung problems that arise from the radiation treatment? I believe this should also be looked into for possible problems with pulmonary fibrosis developing after radiation treatments.

  13. Phyliss R-F says:

    Now I know why the technicians asked me to hold my breath during radiation. They sure were on top of things, and I am grateful. Very helpful article.

  14. Marcy says:

    Had radiation, no chemo, just Arimidex after a lumpectomy of my right breast 6 years ago. Was not aware at that time of possible heart damage. Sorry to say I had a heart attack 3 months ago. 95% blockage .Had stent put in. Now taking multiple medications that affect my quality of living. Extremely weak – not able to do too much. Think that perhaps radiation in facility where breasts are downward (I know there are facilities that do this) would be best.

  15. DeeDee says:

    I had chemo & radiation in 2007 for invasive lobular breast cancer. I recently heard of a link between chemo & heart disease so my oncologist referred me to a cardiologist. The cardiologist told me heart damage from chemo would have occurred during or within 6 months of treatment. He said I will need to be monitored yearly due to the radiation as heart problems can occur years after treatment. I have done so for 3 yrs. & have increasing aortic stenosis (narrowing of the aortic valve). The cardiologist says I will probably need an aortic valve replacement sometime down the road. I was surprised by this as my radiation was on my right side but he said scatter does occur. I did have spacers with metal (for breast reconstruction) at the time which probably contributed to increased scatter of the radiation. I wish I had known about this issue at the time so I could have asked for a spacer without metal. This points out the need for a team approach to treatment where all the doctors (oncologist, surgeon, radiologist, plastic surgeon, & maybe consulting cardiologist) are all aware & involved in the steps of each patient’s treatment options so the patient can make INFORMED decisions. I probably would have still done the radiation but I would have either asked for a spacer without metal or delayed reconstruction or radiation. Thanks for getting the word out about the link between radiation & heart problems.

  16. Debbie Evans says:

    Re: Jill Morris comments on physicians doing research on hazards of treatment. I am sorry that you have had a bad experience with your health providers. My oldest son, as well as two nephews, and a brother-in-law are all physicians. I have seen up close the excessive amount of time and committment that they make to stay current on the lastest advances in treatment for their patients. They maintain continuing education through attendance at seminars and required readings of professional journals. They consult and are carefully monitored by hospital boards and accreditating agencies. Now, all that said, 1.) you surely may still see a physician who may not be implementing these standards fully, and 2.) even with all the research and implementation of the lastest advances in medicine, the patient may die. I know this very well, as my sister, the wife of the physician brother-in-law died after a nine year battle with breast cancer. He did everything possible – – the best doctors in the country – – money was absolutely no obstacle, and my sister stilled died. I hope, Jill, that you will not give up on medical providers and will find one that you like, trust, and can work together as “partners” in your health care.

  17. Esta says:

    Forty years ago I received a massive dose of radiation to treat Hogdkin’s Disease.
    I was cured.
    Yet in the time since I have had bilateral breast cancer, aortic valve replacement and coronary artery disease, and now diffuse B-cell lymphoma. My oncologist immediately stated that my subsequent diagnoses are all related to the initial radiation. I am a survivor.

  18. Denise says:

    All excellent comments. I do believe that most doctors (even the best), have a CYA mentality, which is why they recommend the treatments that they prescribe. I did have a choice and did not have to have chemo or radiation. It’s just a shame that we have to live in this “sue everyone” society. I signed my life away (I felt), before having chemo. I would never sue any of my doctors for malpractice especially knowing that I made my own, informed decisions. Like I said, it’s a shame. So let’s find the cause, and we really won’t need a “cure”.

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  31. Carol says:

    I too had a lumpectomy in my left breast after a DCIS diagnosis. The lumpectomy was followed by radiation. This has been 2 years ago. I kept asking the doctor for complications, she kept telling me only skin discoloration. I have periodic fluttering of the heart since the treatments. I would ask about the amount of radiation and I was told “oh slight amounting to nothing”. Now I guess my heart and stomach problems are nothing, especially to them. I wish I only had the lumpectomy not radiation, but that was not even suggested at the time. It will take a lot for me to go for my yearly mammogram, after the six month mammogram is over. The stress of going for the mammogram is not worth it.

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  33. Cj says:

    Last Monday I woke up having a heart attack! So I am only now researching the connection to breast cancer treatment. In 2005 I was treated w/radiation & Arimidex (5 years) for stage II (L) breast cancer along w/bi-lateral lumpectomy. At the time not one of my doctor’s expressed the heart risk involved, or that I might have a better chance of preventing future problems by knowing what health issues to keep a closer watch on. Thank you for keeping this blog active. I am not alone.

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