Journal of Women's Health Care
Open Access
ISSN: 2167-0420
ISSN: 2167-0420
Review Article - (2016) Volume 5, Issue 4
Triple diagnosis of breast cancer is based on (a) Clinical examination, (b) Histology/cytology and (c) Mammography/Breast ultrasound. The introduction of breast cancer (BC) screening programs results the early diagnosis of non-invasive BC substantially. Radiotherapy is important for the management of early detected breast cancer. Breast cancer survivors are in greater risk for cardiovascular disease (CVD)-related mortality. Though breast radiotherapy is beneficial for early treatment of breast cancer, it is also cause of CVD among the breast cancer survivors. In this article we present an overview based on current knowledge about the management of early detected breast cancer with radiotherapy and the occurrences of CVD among those survivors. Thus this brief hypothesis had driven analysis of the breast cancer, radiotherapy and occurrences of CVD in the breast cancer survivors.
Keywords: Triple diagnosis; Breast cancer; Radiotherapy; Cardiovascular disease
The early stage detection of cancer is helpful for the treatment among the cancer survivors. Cancer detected by screening would be expected to require less treatment because it is diagnosed at an earlier stage. Several screening method have been employed, including clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging. The use of mammography is increased day by day [1]. The introduction of breast screening programme results the increase in the diagnosis of early stage of breast cancer. It was reported that patient with screen detected cancer have been found to improved overall survival and distant recurrence rate when compared to those with non-screen detected cancer [2]. Radiotherapy is an important part of management of all stage of breast cancer (0, I, II, III) [3,4]. But there were several incidence of cardiovascular disease (CVD) after the irradiation.
Breast radiotherapy is well tolerated by woman. There are two option of early detected breast cancer. It include breast conserving treatment and total mastectomy [5].
• Breast conserving treatment helps to preserve the patient's native breast. Breast conserving treatment removes breast cancer with normal breast tissue, sentinel lymph node biopsy, followed by whole breast radiotherapy. It is feasible and curative treatment option.
• In contrast, patients treated by total mastectomy, who wish to restore normal breast shape need to undertake lengthy breast reconstructive surgery with either breast implant or immediately during mastectomy.
Previous studies showed that the risk of recurrence after breast conserving treatment was slightly higher compared with mastectomy [6].
Patient with lymph node related to breast cancer size>5 cm needs to surgery [7]. The risk of recurrence is still high despite total mastectomy and axillary clearance. However, though there is a controversy, patients with one to three lymph nodes, post mastectomy radiotherapy were routinely recommended. Post mastectomy radiotherapy is reported to reduce the risk of locoregional recurrence [8].
Breast radiotherapy is commonly tolerated by women. But some side effect also generated. Common side effects such as fatigue, skin erythema etc. These symptoms are also reversible within a few weeks from the completion of radiotherapy.
Radiation therapy is essential for the management of breast cancer [9]. Treatment of radiotherapy of breast cancer patient was reported to reduce the mortality rate. There are several incidence of heart failure after the treatment of radiotherapy of breast cancer patient [10]. The breast cancer survivors had an increase risk of heart attack, angina and heart failure, infarction [11,12].
It was observed that patients who were received the treatment of radiation therapy had a greater risk of cardiovascular disease compared with those who received only surgery. The region of the body that received radiation influenced the risk of heart disease as well. Women who had received radiation therapy to left or right side of the area between the ribs and the breastbone had a higher risk of heart attacks, heart failure compared with patients who received little or no radiation to the heart.
The incidence of death in breast cancer irradiated patent is mostly due to heart disease [13-16] (Figure 1) (Table 1).
Figure 1: Analytical study and Pliliminary Overview (till 2016 march) of breast cancer survivors with the occurrances of CVD, undergone radiotherapy/Not undergone radiotherapy.
| References | No of patient | Result |
|---|---|---|
| Serra [13] | 1138 female patients with Breast Cancer, No irradiation | Manifestations of CVD ,heart problem |
| Mc Gale [14] | 72,134 women diagnosed with breast cancer, 34,825 women received radiation therapy. | Increased the risk of developing ischaemic heart disease, pericarditis, and infarction, those receive irradiation. |
| Tan[15] | 5514 breast cancer patients identified, 110 (5.7%) from the surgery-alone group, 24 (4.1%) from the RT group, 79 (4.6) from the CT group, and 76 (5.8%) from the CRT group | Breast cancer patients receiving CT and/or CRT have a higher risk of CVD, especially younger patients (aged < 55 years) |
| Borger [16] | CVD in 1601 patients with T1-2N0 breast cancer (BC) | Patients irradiated for left-sided BC with tangential fields resulted to have a higher incidence of CVD |
Table 1: Trials with references containing risk of cardiovascular disease (CVD) among breast cancer survivors with received radiotherapy/without received radiotherapy
It was found that when detection and treatment are started at early time, breast cancer is less important to be the primary cause of death among the majority of breast cancer survivors. There are several factors; CVD is a major cause of death among breast cancer survivors. After irradiation the major survivors have a risk of heart disease- which is not only dangerous but also an adverse effect of radiotherapy. Proper interventions for the primary management of CVD, like diet, physical activity, cessation of smoking and aspirin can reduce the risk of heart disease among the breast cancer survivors. But it should also be a challenging item to scientist and technologist if radiotherapy can be developed in such a manner, where cardiovascular disease risk will be reduced. Currently the management of CVD risk factors is increasing with importance in the management of breast cancer survivors. Therefore more research and technical development is needed to manage the occurrences of CVD among breast cancer survivors.
This article is completely dedicated to my Respected Sir Prof. Asru K. Sinha., D.Sc. where I got the fast platform of my first research life. I am extremely thankful to my senior researcher in my lab Mr. Sarbashri Bank for his valuable suggestion, support, encouragement, sometime guidance to write properly this important article. I am also thankful to Mr. Pradipta Jana, Mr. Suman Bhattacharyya.