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Stroke Rates Higher in Postradiation Breast Cancer Patients: Presented at SABCS

By Ed Susman

SAN ANTONIO, TX -- December 12, 2005 -- Women who undergo radiation as part of treatment for stage I and stage II breast cancer have an increased risk of stroke or other cerebrovascular accident, but that risk does not reach statistical significance when multivariate analyses are performed.

"We observed a 60% increased risk of stroke among the women we followed at our institution," said Lori Pierce, MD, professor of radiation oncology, University of Michigan, Ann Arbor, Michigan.

"However, when we looked at the variables associated with stroke, it appears that the only truly significant factors for cerebrovascular accidents are high blood pressure and advanced age," she said at her poster presentation on December 10^th at the 28^th Annual San Antonio Breast Cancer Symposium (SABCS).

Researchers headed by Reshma Jagsi, MD, PhD, visiting research investigator in radiation oncology, University of Michigan, Ann Arbor, Michigan, identified 867 consecutive patients who were treated with breast conserving surgery for stage I/II breast cancer at University of Michigan Hospital from 1984 to 2000.

Dr. Jagsi, who was unable to attend the San Antonio conference, and her team said 20 of the 867 women later suffered at least 1 cerebrovascular accident -- about a 2.4% incident -- and 35 patients or 4.2% of the group had either a cerebrovascular accident or a transient ischemic attack.

Compared with government statistics on incidence of stroke, Dr. Pierce said there was an apparent 60% higher risk of stroke and a 52% higher risk of stroke or transient ischemic attack. "At 10 years of follow-up, the cumulative risk of cerebrovascular accident in the University of Michigan series was 2.7%," Dr. Pierce said.

The radiation risk factor was diminished when researchers added in factors such as hypertension, age, history of coronary artery disease, atrial fibrillation, and supraclavicular radiation therapy that was in use during the time frame for women with positive lymph nodes.

"Only age, with a P < .001 value, and hypertension, with a P = .003 value, remained significant predictors of cerebrovascular accident of transient ischemic attack," Dr. Pierce said. For just stroke, age was the only significant factor she said.

"Concerns about potential cerebrovascular toxicity should not appear to justify withholding appropriate treatments for breast cancer, including supraclavicular radiation therapy and tamoxifen, when indicated," Dr. Pierce said.


[Presentation title: Stroke Rates and Risk Factors in Patients Treated With Radiation Therapy for Early Stage Breast Cancer. Abstract 4036]

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