How is radiation-induced heart disease monitored in patients with breast cancer?

Updated: Dec 27, 2019
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

According to a new consensus statement from the European Association of Cardiovascular Imaging and the American Society of Echocardiography, patients treated with radiotherapy to the chest for Hodgkin's disease, or breast, lung, or esophageal cancer, should have an echocardiogram every 5 to 10 years to detect radiation-induced heart disease (RIHD). The relative risk of RIHD is 2- to 5.9 times higher in patients treated with radiation for breast cancer. [171, 172]

Recommendations of the statement include the following [171, 172] :

  • Before starting radiotherapy to the chest, patients should have a baseline echocardiogram to evaluate cardiac morphology and function, and identify any abnormalities

  • After radiotherapy, patients should have a yearly physical exam

  • Modifiable CVD risk factors should be corrected

  • Patients who have a cardiac abnormality or are asymptomatic but at high risk of CVD should have an initial transthoracic echocardiogram screening test five years after radiation treatment

  • Asymptomatic patients who are not at high risk of CVD should have an initial screening echocardiogram 10 years after radiation treatment

  • After an initial screening electrocardiogram, patients should have an echocardiogram every five years

  • When the findings from an echocardiogram are equivocal, cardiac computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear cardiology can be used to confirm and evaluate the extent of RIHD


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