- NEW YORK (Reuters
Health) - Treatment with radiation can help prevent breast cancer from
returning, but for older women and those who have a low risk of a relapse,
the risks of radiation may outweigh its benefits in the long run, researchers
- Even though radiation can reduce the risk of dying from
breast cancer, it may increase the risk of dying from other causes, particularly
heart disease, results of a study suggest.
- Radiation has been shown to prevent breast cancer from
returning in the short term, but the long-term benefits of the treatment
have been less clear, according to a team of researchers led by Dr. Rory
Collins, from the Clinical Trials Services Unit at Radcliffe Infirmary
in Oxford, England. To see whether women who undergo radiation fare better
decades after treatment, the researchers reviewed 40 studies that followed
nearly 20,000 women.
- Overall, radiation prevented breast cancer from returning
in about two thirds of the women, Collins told Reuters Health in an interview.
When the results of all studies were combined, radiation did not improve
the death rate from breast cancer during the first 2 years after treatment,
but afterwards, women who underwent radiation were about 13% less likely
to die from breast cancer each year than women who did not have the treatment.
The findings are published in the May 20th issue of The Lancet.
- But the benefits of radiation came with a cost, the authors
note. The death rate from causes other than breast cancer was actually
higher in women who underwent radiation. Beginning 2 years after treatment,
the annual rate of deaths not related to breast cancer was about 21% higher
in women treated with radiation. According to Collins, most of this increased
risk was heart-related, probably caused by radiation damage to the heart
- Overall, the 20-year survival rate was about 1% higher
in women treated with radiation, 37.1% versus 35.9%.
- In the interview, Collins said that the benefits and
costs of radiation varied among different groups of women. Referring to
women whose cancer has spread to the lymph nodes, he said, ''There's a
modest benefit (of radiation) for younger women with node-positive disease
under age 50.'' But for women whose cancer has not spread to the lymph
nodes, whose risk of a relapse of breast cancer is low, the benefits of
radiation are small, improving survival odds by less than 1%, according
- For older women whose cancer has spread to the lymph
nodes, making a decision about radiation is difficult, Collins said. He
noted that older women already have a greater risk of heart disease, so
radiation treatment may increase this risk even more, possibly outweighing
any benefits of the treatment.
- In an accompanying editorial, Dr. John M. Kurtz from
University Hospital in Geneva, Switzerland, states that the report may
actually be ``good news'' for radiation therapy, since it shows that the
treatment can prevent breast cancer from returning and reduce breast cancer
- As for the increased risk of heart-related deaths, Kurtz
notes that newer radiation techniques that spare the heart and arteries
as much as possible have not been shown to damage the heart.
- But in the interview, Collins said that most of the increased
heart risk does not appear until 20 years or so after treatment, and the
effects of heart-sparing radiation have not yet been followed for that
- SOURCE: The Lancet 2000;355:1739-1740, 1757-1770.
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