Abstract
The internal mammary arteries (IMA's) are historically recognized to be protected against atherosclerosis. Whether chest wall-irradiation for breast cancer leads to significant IMA damage remains unclear. The utility of computed tomography (CT) and mammography to detect radiation-induced damage to the IMA's and its branches is not known. The objective of this study is to assess the susceptibility of IMA's to radiation-induced atherosclerosis, and the utility of CT scan and mammography in the assessment of IMA and its branches. A retrospective analysis of breast cancer patients who received chest wall-radiotherapy was performed. Patients with CT scans and/or mammograms ≥5 years post-radiotherapy were included. Baseline characteristics, coronary artery calcification (CAC), the presence of IMA damage assessed by CT scan, and IMA branch calcifications by mammography were recorded. None of the 66 patients with CT scans post-radiotherapy revealed IMA atherosclerosis. There were 28 (42.4%) patients with CAC, of which four (14.3% of CAC subgroup or 6.1% of the total cohort) had calcifications on either side on mammogram (Chi-square test, p = 0.74). Out of the 222 patients with mammograms, 36 (16.2%) had IMA branch calcifications. Two hundred and ten patients received unilateral radiotherapy, and 27 (12.9%) of these patients had calcifications on the irradiated side, and 26 patients (12.4%) had calcifications on the contralateral side (OR = 1.0). IMA's do not exhibit signs of radiation-induced atherosclerosis when evaluated by CT scan. In addition, there is no association between radiotherapy for breast cancer and the presence of IMA branch calcification on mammograms.
Highlights
An expanded role for radiation therapy in the management of breast cancer has come at the cost of radiationinduced coronary artery disease (RICAD)
One hundred and ninety (74%) of them had follow up mammograms only, 34 (13%) had chest computed tomography (CT) scans only, and 32 (12%) had both, mammograms and CT chest as follow up imaging modalities
This study provides a novel outlook in evaluating the radiographic assessment of internal mammary arteries (IMA’s) with CT scans and mammograms in breast cancer patients exposed to chest wallradiation
Summary
An expanded role for radiation therapy in the management of breast cancer has come at the cost of radiationinduced coronary artery disease (RICAD). Compared to non-irradiated patients, patients who underwent chest wallradiotherapy for breast cancer have a higher absolute risk of cardiac morbidity and death, with the increase in risk being proportional to the radiation dose [1]. In left-sided breast cancer, the anterior and apical wall of the heart, and the internal mammary arteries (IMA) can be in the radiation field. The frequency of IMA graft failure after coronary artery bypass grafting (CABG) is common (8.6%) [5], and the question of whether chest wall irradiation for the treatment of breast cancer leads to IMA damage remains unclear. There is a paucity of data demonstrating radiographically that the IMA can be affected by radiation, or if it is inherently protected against atherosclerosis
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