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Heart Disease is Late Stage Side Effect of Radiation for Breast Cancer

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“Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease”

Diagram Of Atrial Fibrillation

My mom and I both live with atrial fibrillation. My a-fib is chronic aka 24/7 and mom’s a-fib comes and goes. Both of our heart damage came as side-effects from cancer therapy.

I was diagnosed with a blood cancer called multiple myeloma in early 1994. Mom was diagnosed with DCIS (BC stage 0) at the age of 75.

My heart disease came as late stage side-effect caused by cardio-toxic chemotherapy (adriamycin, melphalan, busulphan, cytoxan) and mom’s heart disease was caused by radiation from early breast cancer.

Two very different types of cancer. Two very different people. Two completely different oncologic therapies. Same long-term side effect. 

The study linked and excerpted below says that the if you undergo radiation as a breast cancer therapy there is a real risk of heart damage. The more radiation you undergo, the greater the risk. The heart damage may show up after only a few years after radiation therapy (long-term) or 20 years after radiation therapy (late stage).

The point of this post is to draw attention to the damage to the human heart when a person undergoes either chemotherapy and or radiation. Further, as the research below indicates, this collateral damage can be reduced or eliminated.

Yes, I pursue several of these therapies. But no, I haven’t completely healed my chemo-induced heart damage yet. I did manage to stop the worsening of my heart damage in 2016, according to diagnostic testing such as regular echo cardiograms.

For more information about evidence-based, non-conventional therapies to prevent or reduce the risk of chemo and radiation-induced heart damage scroll down the page, post a question and I will reply ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Efficacy of Coenzyme Q10 for Improved Tolerability of Cancer Treatments: A Systematic Review

“Six studies were included in the review, including three randomized clinical trials and three nonrandomized clinical trials. Patients in five of six studies received anthracyclines. The results suggested that CoQ10 provides some protection against cardiotoxicity or liver toxicity during cancer treatment…”

Radiation for Breast Ca Takes Toll on Heart

“Radiation therapy has value in breast cancer, but the benefit comes at the price of an increased risk of ischemic heart disease later, researchers reported.

In a population-based case control study, the risk of major coronary events rose after radiation therapy by a mean of 7.4% for every gray (Gy) of exposure to the heart, with no apparent threshold, according to Sarah Darby, PhD, of the Clinical Trial Service Unit in Oxford, England, and colleagues.

The increase in risk was greatest in the first 5 years after radiotherapy but persisted for at least 2 decades, Darby and colleagues reported in the March 14 issue of the New England Journal of Medicine.

In addition, women with preexisting cardiac risk factors had greater absolute increases in risk, the researchers reported.

“Clinicians may wish to consider cardiac dose and cardiac risk factors as well as tumor control when making decisions about the use of radiotherapy for breast cancer,” Darby and colleagues concluded.

The study – among 2,168 breast cancer survivors in Sweden and Denmark — is a wake-up call for physicians, commented Jean-Bernard Durand, MD, of the MD Anderson Cancer Center in Houston.

“We have to be extra vigilant with women, making sure we assess them. We make sure they’re on correct medicines and we make sure they gain all of the benefits from surviving breast cancer,” he told MedPage Today.

Durand noted that in the U.S., women are much less likely than men to receive preventive cardiovascular care; changing that would help to mitigate the risk highlighted by Darby and colleagues.

“Follow their cholesterol, watch for diabetes, manage their blood pressure – all those things can be done to lower their risk of a cardiovascular event,” he said.

The study also highlights the importance of good post-cancer follow-up, he said.

Doctors “have an opportunity to intervene in a young woman and really change the course of her life rather than wait for an event and try to change the course of her life when she’s older,” Durand said.

Radiotherapy for early-stage breast cancer has been shown to reduce both recurrence and death, the researchers noted, but the effect of incidental exposure to the heart has not been clear.

They looked at women with breast cancer who had radiotherapy between 1958 and 2001, including 963 women with major coronary events and 1,205 controls.

Case patients had no recurrence of the breast cancer or incidence of any other cancer before they suffered a major coronary event, defined as myocardial infarction, coronary revascularization, or death from ischemic heart disease.

Controls were matched for country of residence, age at diagnosis, and year of diagnosis, and also had not had a recurrence of their breast cancer or any new malignancy.

Of the major coronary events among women in the study, 44% occurred less than 10 years after the breast cancer diagnosis, 33% occurred in the next decade, and the remaining 23% occurred still later.

The average dose to the heart was 6.6 Gy for women with left breast tumors, 2.9 Gy for those with cancer in the right breast, and 4.9 Gy overall.

While the rate of events rose by 7.4% per Gy of exposure, the rate varied with time — 16.3% in the first 5 years after exposure, 15.5% in the second 5 years, 1.2% in the second decade, and 8.2% in later years.

The only tumor characteristic that significantly affected the risk was location, as women with left breast tumors were more significantly likely to be case patients (P<0.001).

The rate ratio for women who had a history of ischemic heart disease, compared with those who did not, was 6.67 (95% CI from 4.37 to 10.18). Rate ratios were also elevated for women with other circulatory diseases, diabetes, or chronic obstructive pulmonary disease, as well as smokers.

The researchers cautioned that few of the women in the study were under 40, so the results may not apply directly to that age group.

In an accompanying editorial in the journal, Javid Moslehi, MD, of Brigham and Women’s Hospital in Boston commented that the findings may be the “tip of the iceberg.”

“In addition to ischemic cardiac disease,” he wrote, “radiation therapy has been associated with other cardiac conditions, including pericardial disease, peripheral vascular disease, cardiomyopathy, valvular dysfunction, and arrhythmias.

Those diseases were not part of the study, nor were those associated with some forms of chemotherapy, he noted.

One implication for practice, he argued, is that the time to look at cardiovascular issues is at the time of breast cancer diagnosis and before treatment starts.”

Risk of ischemic heart disease in women after radiotherapy for breast cancer.

“Background:Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain…

Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy.

CONCLUSIONS: Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.).

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2 comments
Carol H says 6 years ago

Hi.
My son is 17 years old and is being treated for Osteosarcoma. Rounds of cisplatin, doxorubicin, and high dose Methotrexate. I study natural health and knew of all the risks before he started any treatment but we did not have time to pursue non-conventional avenues. He has osteosarcoma – very rare and his tumor was growing rapidly, he needed surgery to save his leg and he was opposed to alternative methods and truthfully, I do not know if there are any.
I am trying to give him supplements to reduce toxicity and keep him on path to finish on time without harsh side effects. So far, so good.
I have supplemented some with CoQ10 to protect his heart but don’t know how much or how often.. We met with an integrative doc before treatment, but in all honesty, it was a joke. I begged them to check vitamin D level and had to keep reminding. They did not take any of it seriously.. I can sneak some things into the hospital if need be but he is almost finished. They check his heart regularly but I know it can be damaged as a result of the drugs. Thanks for any help.

Reply
    David Emerson says 6 years ago

    Hi Carol-

    I am sorry to read of your son’s osteosarcoma diagnosis. You are to be commended for your learning about and trying to manage his possible long-term side effects. I understand the need to commence therapies immediately. The only thing for you to do now is to try to prevent or minimize the collateral damage due to toxic chemo.

    It is important for me to begin by saying that I also underwent aggressive chemo in ’95. Yes, I struggle with collateral damage from chemo but I got started after my side effects were well entrenched. You are starting prevention efforts before your son’s chemo is finished. Keep in mind also, that your son is only 17. The healing power of young people is a wonderful thing.

    I am not a trained physician. I am a long-term cancer survivor. I will tell you what side effects I deal with based on similar chemos as your son and then link those studies that explain why I do what I do.

    I will list info about one specific long-term health issue and if you are interested in learning more, reply and I will research cisplatin side effects and methotrexate side effects.

    Your biggest challenge (in my opinion) is that the 17 year old brain might think it is invincible. As least my 17 year old son thinks he is…My son’s name is Alex. He is a junior in high school. Great kid. But he and I look at health very differently.

    I don’t know how to handle your son’s attitude. He may want to get beyond (mentally speaking) his cancer as soon as he can…

    1) Cardiotoxicity or heart damage from anthracyclines (doxorubicin)- The best way to determine what, if any, heart damage has taken place is to measure your son’s heart function both before and after his chemo. Otherwise you will have to operate under the assumption that your son’s heart has sustained damage.

    Dox. cardiotoxicity

    The therapies I undergo to keep my heart function as normal as possible. As for doses, I take what the label says.

    1) CoQ10 supplementation- coq10 has been shown to address dox. heart damage

    2) I work out moderately six times per week (30 mins)- 3 of the days are cardio-

    3) I take a supplement that contains both arjuna and hawthorn.

    4) Arjuna for heart damage-

    5) I take an omega 3 fatty acid supplement-

    6) I supplement with vitamin D for several health reasons

    Carol, if you have any questions or would like more info, let me know.

    thanks and hang in there,

    David Emerson

    Reply
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