Rapid Responses to:

LETTERS: Ian H Kunkler and Adrian N Harnett Cardiovascular mortality after radiotherapy for breast cancer BMJ 2003; 326: 983 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Cardiovascular mortality after radiotherapy for breast cancer

Robert Wood   (2 May 2003)

Cardiovascular mortality after radiotherapy for breast cancer 2 May 2003
Robert Wood, Retired Consultant Physician Abernethy, Perthshire, PH2 9LD Send response to journal: Re: Cardiovascular mortality after radiotherapy for breast cancer	As a physician I became accustomed to looking after a steady trickle of women in the 50-60 age group who had minor anterior myocardial infarction and who had had irradiation a decade or more before for left sided breast cancer. A personal recollection was that death was never the outcome, the implication possibly being that relatively smaller and more distal coronary arteries were those being occluded. All of the episodes recalled predated the eras of anthracycline chemotherapy and oestrogen antagonism and the only factor, other than those which routinely cause coronary disease, was previous radiotherapy. When non diabetic non smoking women with normal lipids have heart attacks in middle age something unusual is happening. Retrospective epidemiological studies of mortality are likely to show less of a problem than similar studies, far harder to complete, of morbidity. The recollection is of women with visible cutaneous evidence of their previous radiotherapy and there is some reason to believe that modern radiotherapy will not have cardiac consequences. However, it does seem important to be sure what late ill effects will result, if any, from modern practices, and a large prospective study with age matched controls who have not had radiotherapy or tamoxifen is clearly well worth doing. I do appreciate that medicine has moved on and that the convictions of retired physicians are not scientifically valid ; however, busy clinicians recognise patterns and history suggests that pattern recognition is often valid. One final thought is that the women recalled had not died from breast cancer and there are many contexts in which it remains proper to undertake treatments with long term downsides in order to reduce the mortality of diseases with a capacity for serious life reduction. Two women are recalled who themselves said that they expected that their previous X-ray treatment had caused their problem , it is of course not at all unusual for patients to trigger thinking by those who attend them. Robert Wood , professor Competing interests:   None declared