title: Preradiotherapy calcium scores of the coronary arteries in a cohort of women with early-stage breast cancer: a comparison with a cohort of healthy women.
abstract: OBJECTIVE
  Breast cancer radiotherapy has been associated with an increased risk of cardiac toxicity. However, no data are available on the probability of developing coronary artery disease (CAD) in breast cancer patients when compared with healthy women. Therefore, baseline coronary artery calcium (CAC) scores, as an accepted tool to predict CAD, were determined and compared with the CAC scores of a healthy, asymptomatic cohort, the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
  
  
  METHODS
  Eighty consecutive patients with ductal carcinoma in situ or infiltrative breast cancer referred for radiotherapy after breast-conserving surgery were included in our study. Their cardiovascular risk profile was registered, and a 64 multislice CT scan was performed. The CAC scores of an unselected (Caucasian only) Radiotherapy Centre West (RCWEST) cohort, as well as of those of a selected (comorbidity and race adjusted) RCWEST cohort, were determined. The scores of both cohorts were compared with those of the female (Caucasian only) MESA cohort.
  
  
  RESULTS
  For the unselected RCWEST cohort (n = 62) we found significant (p < .01) higher scores for women in the 55-64 age category compared with those of the MESA cohort. In the selected cohort (n = 55) the CAC scores of the women in the age category 55-64 were significantly (p = .02) higher compared with the MESA cohort. No significant differences were noted in the other age categories.
  
  
  CONCLUSIONS
  Both cohorts revealed that CAC scores in the 55-64 age category were significantly higher than the CAC scores in the asymptomatic (female) MESA population. These data suggest that breast cancer patients bear a higher risk of developing coronary heart disease before the start of radiotherapy. Therefore, measures to decrease cardiac dose further in breast cancer radiotherapy are even more important.
authors.affiliation: Radiotherapy Centre West, The Hague, The Netherlands. m.mast@mchaaglanden.nl
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Mast
authors.forename: Mark W
authors.initials: MW
authors.lastname: Heijenbrok
authors.forename: Anna L
authors.initials: AL
authors.lastname: Petoukhova
authors.forename: Astrid N
authors.initials: AN
authors.lastname: Scholten
authors.forename: Joop H M
authors.initials: JH
authors.lastname: Schreur
authors.forename: Henk
authors.initials: H
authors.lastname: Struikmans
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology / Q000528:radiation effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D018570:Risk Assessment