Stats to be left behind.

Top Line: We can talk forever about the relative and absolute benefits of adjuvant radiation for breast cancer across various scenarios, but it seems less often we weigh individualized risks.

The Study: The WECARE study is here to show we care about risks, too. This is really an epidemiologic study at heart, pun intended. In its first phase, conducted from 2001-2012, data was collected on women who received breast radiation at an age <55 years between 1985-2008. In its second phase, conducted 2013-2015, these women were contacted again to collect nonfatal cardiac events. The reported analysis is on 972 women without preexisting cardiac disease who completed both phases of the study. The crux is not a comparison to women who did not receive radiation, but rather a comparison of those who received radiation to the right versus left breast. Indeed, at a median follow-up of 14 years, the cumulative incidence of coronary artery disease was 5.8% after right breast treatment versus 10.5% after left breast treatment. The takeaway in 2021? Well, probably not that our women with left-sided breast radiation are at higher risk with modern techniques using deep inspiratory breath hold, especially in light of more modern data, further supported by no difference in risk per laterality in EORTC 22922.

TBL: Techniques such as DIBH and IMRT to lower cardiac dose for left-sided breast cancer closer to what has been historically achieved with right-sided breast cancer should have a clinically meaningful impact on long term cardiac disease risk. | Carlson, JACC CardioOncol 2021