The Cleveland Clinic suggests it particularly affects four groups, and research shows complications extending 20 years post-exposure.
Cancer treatments has come a long way, from immunotherapy to oncology massage at centers like the Cleveland Clinic. Amid the advancements, radiation therapy remains a cornerstone of cancer treatment for several forms of the disease—that’s despite a recent trend toward reduced use. But for those who receive radiation close to the chest—most often individuals with breast cancer, esophageal cancer, Hodgkin lymphoma, and lung cancer, according to the Cleveland Clinic—there may be a rarely discussed risk that could warrant a conversation with your doctor before beginning treatment.
While radiation can be effective in destroying cancer cells, the American College of Cardiology (ACC) has pointed out in recent years that those who receive radiation on the left side of the chest can also see a doubled risk of coronary artery disease—the most common form of heart disease, according to national sources—compared to those who receive radiation on the right side.
Cleveland Clinic experts suggest that’s because radiating the chest area can injure multiple cardiac structures, including the coronary arteries, heart muscle, valves, tissue surrounding the heart known as the pericardium, and the heart’s electrical conduction system. The closer the cancer-destroying beams come to the heart, the more likely they are to cause a problem.
These injuries may first appear as short-term inflammation, but the Cleveland Clinic emphasizes that some complications develop slowly over years or even decades, with risks reportedly extending up to 20 years after therapy. In addition to coronary artery disease, these late effects can include:
- Congestive heart failure: An inability to pump enough blood to meet the body’s needs;
- Cardiomyopathy: Chronic disease of the heart muscle;
- Heart arrhythmias: Abnormal heart rhythm;
- Constrictive pericarditis: The sac around the heart stiffens or thickens;
- Valve disease: Damage to the valves which strains blood flow.
Radiation delivered to the left or right side of the chest can potentially affect long-term cardiac risk. However, in a large analysis published in JACC: CardioOncology, women treated for left-sided breast cancer between 1985 and 2008 experienced more than double the risk of coronary artery disease compared with those treated on the right side.
Over a follow up period of 28 years, those researchers found that 10.5% of women receiving left-sided radiation developed coronary artery disease versus 5.8% of women treated on the right. The difference was even more striking in younger women: those diagnosed between ages 25 to 39 had a 5.9% incidence after left-sided radiation, while no cases occurred in the right-sided group.
Both health authorities stress the need for ongoing cardiological surveillance following radiation treatment. The ACC study found that 91% of coronary events occurred more than five years after therapy, aligning with the Cleveland Clinic’s warning that radiation-associated heart disease may not emerge until many years later. “Given the latency between radiation exposure and development of cardiovascular events, it is important that young women who have received left breast radiation therapy be considered at higher risk over their lifetime,” the study authors wrote in a corresponding editorial.
Fortunately, they also both note that modern radiation techniques significantly reduce incidental heart exposure, better protecting today’s compared to the past. And, while the increased risk of heart complications certainly merits a conversation with your doctor and a plan for future monitoring, the absolute risk is still relatively low—and steadily improving with technological advancements.
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