RACE stands for "Radiotherapy for Breast Cancer and Subsequent Risk of Cardio-Vascular Events". Since the prevalence of cancer survivors is increasing, late adverse health effects is becoming an increasingly important problem.
Since the prevalence of cancer survivors is increasing, late adverse health effects is becoming an increasingly important problem. Many patients experience sequels to therapy such as anxiety, depression, dementia, second cancers, and cardiovascular events. Several studies have shown an increased risk of cardiovascular events, including myocardial infarction, in women given radiotherapy for breast cancer. Few of these studies have taken absorbed heart dose into consideration and no studies have looked into the detailed interaction between ionizing radiation and tobacco use. Other risk factors for cardiovascular disorders, such as high BMI, and previous cardiovascular disorders have not been taken into consideration.
The overall aim of this project is to study the risk of cardiovascular disorders in women given radiotherapy for breast cancer. The more specific aim is to identify a threshold dose, that is, a dose range where the risk of myocardial infarction is very low. This threshold level will most certainly be influenced by previous disorders, BMI and tobacco use.
The study participants are Danish and Swedish breast cancer patients. In both countries, large cohorts consisting of women diagnosed with breast cancer the last 30 years has been created. From these cohorts we are conducting a nested case-control study aiming at including 1,000 cases and 1,000 controls. Cases consist of women with breast cancer and a subsequent myocardial infarction. Controls consist of women with breast cancer without a later myocardial infarction. Controls are matched on the age and calendar period. Detailed information on tumour characteristics therapy and tobacco history is currently abstracted from the case records. Abstraction includes copying of radiotherapy treatment charts. Under the supervision of Prof. Andrew Nisbeth, Oxford, Radcliff Hospital, Oxford, radiation doses to different parts of the heart are calculated.
Main financing: The European Commission, 6th framework programme, RAD PROT-2004-220.127.116.11-2
|Marianne Ewertz||Professor, Department of Oncology, Aalborg Hospital, Denmark|
|Sarah Darby||Professor, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, United Kingdom|
|Andrew Nisbet||Professor, Oxford Radcliff Hospitals, NHS Trust, Oxford, United Kingdom|
- Mortality from cardiovascular disease more than 10 years after radiotherapy for breast cancer: nationwide cohort study of 90 000 Swedish women.
BMJ 2003 Feb;326(7383):256-7
- Cardiac doses from Swedish breast cancer radiotherapy since the 1950s.
Radiother Oncol 2009 Jan;90(1):127-35
- Darby SC, Bronnum D, Correa C, Ewertz M, Gagliardi G, Gigante B, McGale P, Nisbet A, Taylor C, Hall P. A dose-response relationship for the incidence of radiation-related heart disease. In: Int J Radiat Oncol Biol Phys; 2010:S49-S50.
- Cardiac dose estimates from Danish and Swedish breast cancer radiotherapy during 1977-2001.
Radiother Oncol 2011 Aug;100(2):176-83
- Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden.
Radiother Oncol 2011 Aug;100(2):167-75
- Risk of ischemic heart disease in women after radiotherapy for breast cancer.
N. Engl. J. Med. 2013 Mar;368(11):987-98