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Fission and radiation protection

Radiotherapy for Breast Cancer and Subsequent Risk of Cardiovascular Events: Calculating Cardiac Risk

Breast cancer is the most common cancer amongst women throughout the world with approximately 1 million cases diagnosed annually. Survival rates for women with breast cancer are constantly improving, making any late occurrence of adverse health effects, such as cardiovascular disorders, that are related to the therapy itself an increasingly significant problem.

Understanding risk factors and radiation response

The RACE project aims to study the risk of cardiovascular disorders developing in women with breast cancer. It is well established that ionising radiation can induce cardio-vascular disorder, but little has been done to quantify the effect. The aim of RACE is to acquire information on dose-response relationships, and the interaction of factors such as previous cardiovascular disorders, tobacco and other therapeutic modalities.

Patient studies and accurate dose estimation

The project will collect information on approximately 60 000 Danish and Swedish women who have been diagnosed with breast cancer. It will study the occurrence of cardiovascular disorders within this group and determine the relationship with their administered treatment. Then, using a subset of the group, the project will carefully scrutinise the case records and extract information on factors that could influence the risk of cardiovascular disorders. In order to calculate valid results, RACE will focus on estimating the correct doses received from the radiotherapy.

The RACE team includes experts on radiation epidemiology and studies aimed at quantifying the effects of ionising radiation, together with scientists and doctors with appropriate scientific and clinical backgrounds who have expertise in performing the necessary dose estimations. The results of the studies will be presented at international congresses and published in peer-reviewed journals. As is customary today, results will also be published on the websites of the universities involved in the study. In addition, the project will set up its own open-access website in order to facilitate the objective of making results quickly available for clinicians and radiation physicists.

A better knowledge of the risk

Over the years, numerous studies have addressed the possible adverse health effects of breast cancer treatment on patients. Any detrimental effects become increasingly important in light of the increased survival rate of diagnosed individuals that has been achieved as a consequence of intensified screening campaigns and increasing use of adjuvant therapy - treatment such as chemo- or hormone therapy, which is used to eliminate cancer cells that may have spread from the original cancer site.

The results from RACE will give patients and clinicians the possibility to include factors such as dose, previous disorders, other treatments and lifestyle factors into their calculations when they estimate the cost-benefit value of post-surgical radiotherapy. In addition, the outcomes could have a bearing on exposure to ionising radiation outside the medical field, although it is unlikely that exposures of this magnitude will be seen in the workplace or the environment.

Better information for patients and clinician decisions

The findings emanating from the project will have only a small influence on society at large, although the focus - to prolong a healthy life for women struck by breast cancer and (apparently) cured after an appropriate course of radiotherapy for the disease - should have a major impact on the individuals, their families and on the medical teams involved. The RACE project will provide information that makes it easier for the clinician to decide on the potential adverse late health effect of additional treatment, taking several 'lifestyle' and medical factors into consideration. The results will also make it easier for the patients to weigh the benefits of further treatment against the risk of a possible subsequent heart attack.

There will be little obvious environmental or economical advantages to the European Union (EU). The main effect will be seen in better overall survival and patient care - which again will have an impact at the local/individual level. The results should also be of interest to industry insofar as safer radiotherapy techniques and treatment regimes are being developed in collaboration with radiotherapy units within the EU.