The heart of the matter.

Radiation always seems to catch way more than its share of blame for adverse long-term outcomes from breast cancer treatment. The Pathways Heart Study matched >13,000 women treated for breast cancer between 2005 and 2013 with >68,000 controls to examine the risks of cardiovascular disease and mortality after treatment. After an average 7 years follow-up, those who received anthracyclines (HR 1.84), trastuzumab (2.53), or both (HR 3.68) had the highest risk of heart failure or cardiomyopathy relative to controls. While radiation was also associated with an increased risk of heart failure and/or cardiomyopathy (HR 1.38), that risk was comparable to the increased risk seen with aromatase inhibitors (1.31). Non-anthracycline chemotherapy was not associated with increased risk of heart disease. | Greenlee, J Clin Oncol 2022