Women advised to hold their breath to protect their heart

WOMEN who have breast cancer on their left side are potentially exposed to radiation that increases their risk of heart disease. New research shows that when a woman undergoing this treatment uses a simple technique – holding her breath during radiation pulses – can greatly reduce radiation exposure to the heart.

 

In the largest prospective study to date, following women for 8 years post treatment, 81 women were asked to hold their breath during radiation treatment for breast cancer – a process that was repeated until therapeutic dose was reached. The researchers found that patients capable of holding their breath over the course of treatment had a 90% disease-free survival, and a 96% overall survival, with a median reduction in radiation dose to the heart of 62 percent. The findings* were published online this week in the journal Practical Radiation Oncology.

 

Since previous studies have shown that the risk of heart disease is higher in women with cancer in the left breast after radiation treatment, a number of techniques have been developed to reduce exposure to the heart. These include prone positioning (lying flat on the belly on a bed that only exposes the left breast), intensity-modulated radiation therapy (IMRT), and accelerated partial breast irradiation. 

 

The advantage of the breath-hold technique is that it allows doctors to monitor a patient’s breath for the position that shifts the heart out of the range of the radiation beam.

 

“Given that this technique helps to shield the heart during radiation treatment for breast cancer,” said Rani Anne, M.D., associate professor of Radiation Oncology at Thomas Jefferson University and senior author on the study, “we routinely offer breast cancer treatment with the breath hold technique at Jefferson.”

 

Additional work recently presented at the 2014 American Society for Radiation Oncology in San Francisco, showed that patients who held their breath during radiation therapy had only a 1.4% rate of ischemic heart disease after 8 years of follow up, and an estimated rate of 3.6 percent after 10 years. Dr. Anne, together with first author Harriet Eldredge-Hindy, M.D., a chief resident and researcher in the Department of Radiation Oncology at Jefferson, showed that this same cohort of patients will likely have a reduced risk of ischemic heart disease after 10 years. 

 

* H. Eldredge-Hindy, et al., “Active Breathing Coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: Report of a prospective trial,” Practical Radiation Oncology, DOI:, 2014.