The Risk of Cancer-Associated and Radiotherapy-Associated Cardiovascular Diseases among Patients with Breast Cancer

Cheng-Tzu Hsieh; Wen-Chung Lee; Chun-Ju Chiang; Chia-Chun Wang; Hsin-Yin Hsu; Hung-Ju Lin; Tzu-Lin Yeh; Ming-Chieh Tsai; Jing-Rong Jhuang; Bo-Yu Hsiao; Kuo-Liong Chien

doi:10.1016/j.clbc.2023.11.002

The Risk of Cancer-Associated and Radiotherapy-Associated Cardiovascular Diseases among Patients with Breast Cancer

Clin Breast Cancer. 2024 Feb;24(2):131-141.e3. doi: 10.1016/j.clbc.2023.11.002. Epub 2023 Nov 17.

Authors

Affiliations

¹ Department of Epidemiology, University of California, Los Angeles, CA.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Taiwan Cancer Registry, Taipei City, Taiwan.
³ Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Family Medicine, Taipei MacKay Memorial Hospital, Taipei City, Taiwan; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan.
⁵ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁶ Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan.
⁷ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Endocrinology, Department of Internal Medicine, Taipei Mackay Memorial Hospital, Taipei City, Taiwan,; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan.
⁸ Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
⁹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
¹⁰ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Population Health Research Center, National Taiwan University. Electronic address: klchien@ntu.edu.tw.

PMID: 38052665
DOI: 10.1016/j.clbc.2023.11.002

Abstract

Background: The cardio-related issues should be emphasized as the survival rates of breast cancer increased. We investigated the risk of coronary artery disease (CAD) and stroke due to breast cancer or radiotherapy.

Methods: In this retrospective cohort study, breast cancer patients diagnosed between 2007 and 2016 were recruited from Taiwan Cancer Registry Database and were followed until the end of 2018 by linking with the Taiwan National Health Insurance Database. The general population was randomly selected from the whole population in 2007. Standardized incidence ratios (SIR) were calculated to compare the risk of CAD and stroke between patients and the general population. Within the cohort, we included the patients diagnosed between 2011 and 2016. Cox proportional hazards model and subdistribution hazard function were used to investigate the associations of radiotherapy with the risk of CAD and stroke.

Results: Overall SIR of CAD was 0.82 (95% confidence interval [CI]: 0.78-0.86), while were 1.43 and 1.08 (95% CI: 1.30-1.55 and 1.00-1.16) 1 and 2 years after diagnosis, respectively. Overall SIR of stroke was 0.63 (95% CI: 0.60-0.67), the results were similar after considering the time since diagnosis. The adjusted hazard ratios (HR) for the associations of radiotherapy with CAD and stroke risk were 0.91 (95% [CI] = 0.76-1.09) and 0.84 (95% CI = 0.68-1.04), respectively. The results were similar by using subdistribution hazard function.

Conclusions: The risk of CAD was higher within the first 2 years of breast cancer diagnosis. We found no association between radiotherapy and the risk of CAD and stroke.

Keywords: Breast cancer; Coronary heart disease; Radiotherapy; Retrospective cohort; Stroke.

MeSH terms

Breast Neoplasms* / epidemiology
Breast Neoplasms* / radiotherapy
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Coronary Artery Disease* / diagnosis
Coronary Artery Disease* / epidemiology
Female
Humans
Incidence
Proportional Hazards Models
Retrospective Studies
Risk Factors
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology