Abstract | BACKGROUND: Recent concerns about potential overdiagnosis and overtreatment of ductal carcinoma in situ of the breast ( DCIS) render evaluation of late effects of treatment, such as cardiovascular disease (CVD), of great importance. We studied cardiovascular morbidity and mortality in a large population-based cohort of DCIS patients. METHODS: Data on all incident DCIS case patients in the Netherlands between 1989 and 2004 who were diagnosed before the age of 75 years were obtained (n = 10468). CVD data was acquired through linkage with population-based registries. Standardized mortality ratios were calculated by comparing mortality in our cohort with that in the Dutch female population, taking into account person-years of observation. Within-cohort comparisons were based on multivariable competing-risk regression. RESULTS: Compared with the general population, 5-year survivors of DCIS had a similar risk of dying due to any cause (standardized mortality ratio [SMR] = 1.04; 95% confidence interval [CI] = 0.97 to 1.11) but a lower risk of dying of CVD (SMR = 0.77; 95% CI = 0.67 to 0.89). No difference in CVD risk was found when comparing 5-year survivors treated with radiotherapy with those treated with surgery only. Left-sided vs right-sided radiotherapy also did not increase this risk (hazard ratio [HR] = 0.94; 95% CI = 0.67 to 1.32). In a subgroup analysis of all DCIS patients diagnosed between 1997 and 2005, we were able to account for history of CVD and did not observe a risk difference between treatment groups (left-sided vs right-sided radiotherapy: HR = 0.94; 95% CI = 0.68 to 1.29). CONCLUSIONS: After a median follow-up of 10 years, we did not find an increased risk for cardiovascular morbidity or mortality after radiotherapy for DCIS when comparing surgery and radiotherapy vs surgery only, nor when comparing radiotherapy for left-sided vs right-sided DCIS. Compared with the general population, DCIS patients have a decreased risk of cardiovascular death, independent of treatment.
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Authors | Naomi B Boekel, Michael Schaapveld, Jourik A Gietema, Emiel J T Rutgers, Michel I M Versteegh, Otto Visser, Berthe M P Aleman, Flora E van Leeuwen |
Journal | Journal of the National Cancer Institute
(J Natl Cancer Inst)
Vol. 106
Issue 8
(Aug 2014)
ISSN: 1460-2105 [Electronic] United States |
PMID | 25128694
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © The Author 2014. Published by Oxford University Press. |
Topics |
- Adult
- Aged
- Breast Neoplasms
(radiotherapy, surgery)
- Carcinoma, Intraductal, Noninfiltrating
(radiotherapy, surgery)
- Cardiovascular Diseases
(epidemiology, etiology, mortality)
- Confounding Factors, Epidemiologic
- Dose Fractionation, Radiation
- Female
- Follow-Up Studies
- Humans
- Mastectomy
(methods)
- Medical Record Linkage
- Middle Aged
- Morbidity
- Netherlands
(epidemiology)
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
(adverse effects)
- Registries
- Risk Assessment
- Time Factors
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