Radiation a risk to women

Women treated with radiation for breast cancer are more likely to develop heart problems later, even with the lower doses used today, troubling new research suggests. The risk comes from any amount of radiation, starts five years after treatment and lasts for decades, doctors found.

Patients shouldn’t panic – radiation has improved cancer survival, and that is the top priority, doctors say. The chance of suffering a radiation-induced heart problem is fairly small.

For example, 4 to 5 of every 100 women who are 50 years old and free of heart risks will develop a major cardiac problem by age 80, and radiation treatment would add one more case, the research suggests.

Women also can do a lot to cut their risk by keeping weight, cholesterol and blood pressure under control.

Still, the study reveals that the potential harm from radiation runs deeper than many medical experts may have realized, especially for women who already have cardiac risk factors such as diabetes.

And it comes amid greater awareness of overtreatment – that many women are being treated for cancers that would never prove fatal, leading to trouble down the road such as heart disease.

Some chemotherapy drugs are known to harm the heart muscle, but the new study shows radiation can hurt arteries, making them prone to harden and clog and cause a heart attack. Women who receive both treatments have both types of risk.

The study “will raise the antenna” about the need to do more to prevent this, said Dr. David Slosky, a cardiologist at Vanderbilt University, one of the growing number of medical centers with special “cardio-oncology” programs for cancer survivors.

With today’s lower radiation doses, “it is less of a problem, but it is not going away,” he said.

The artery-related problems that the study tracked may be just the most visible of many risks because radiation also can cause valve, rhythm and other heart troubles, said Dr. Javid Moslehi. He is co-director of the cardio-oncology program at Boston’s Dana-Farber Cancer Institute.

Like cancer, heart disease develops after “a number of strikes that go against you,” such as high cholesterol, he said. “The radiation is just another hit.”

He wrote in an editorial that appears with the study in today’s New England Journal of Medicine.

What to do?

Don’t forgo radiation if it’s recommended because it is lifesaving and doctors increasingly have ways to shield the heart from exposure, said Dr. Bruce Haffty, associate director of the Cancer Institute of New Jersey and president-elect of ASTRO, the American Society for Radiation Oncology.

“Whatever cardiac risks may be there, they are outweighed by the cancer benefit,” he said.

Some centers have special tables that women lie on face-down with holes for the breast to hang through. That allows radiation to be delivered just to that tissue rather than the wider chest area.

Women need to tell any doctor treating them about radiation they have received in the past. It may mean they should avoid diagnostic tests that use radiation and instead have ultrasounds and MRI, or magnetic resonance imaging, whenever possible, Slosky said.