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Focus of RACE

In the project we aim to study the risk of developing cardiovascular disorders in women with breast cancer. It is well established that ionising radiation induces cardiovascular disorder but little has been done to quantify the effect. Our aim is to add information on dose-response relationship, the interaction of factors such as previous cardiovascular disorders, tobacco, and other therapeutic modalities such as chemotherapy. We will collect information on approximately 60,000 Danish and Swedish women diagnosed with breast cancer and study the occurrence of cardiovascular disorders. In a second step we will, for a subset of the individuals, carefully scrutinise the case records and abstract information on factors that could influence the risk of cardiovascular disorders. In order to calculate valid results we focus on estimating cardiac doses from each woman's radiotherapy.


The team includes Per Hall, Professor of Radiation Epidemiology, Karolinska Institutet and Professor Sarah Darby, Professor of Medical Statistics, Oxford University, both with a long experience of studies aiming to quantify the effect of ionizing radiation. The third partner is Professor Marianne Ewertz, Dept of Oncology, Odense University Hospital, who has the scientific and clinical background needed. The fourth (no-cost) partner, Professor Andrew Nisbet, is the medical physicist who will oversee the necessary dose estimations.


September 2007. We are using the remarkable possibilities in Denmark and Sweden to identify women with breast cancer through the national cancer registries, medical records from the national health care systems and cardio-vascular events from the cause of death and hospital discharge registries. In a first phase we will study the risk of cardio-vascular disorders contrasting left and right-sided breast cancer in approximately 60,000 women with breast cancer. In a second phase we will conduct a so-called case-control study. This means that we select approximately 1,000 women with breast cancer and ischaemic heart disease and 1,000 controls, that is women with breast cancer but no subsequent diagnosis of ischaemic heart disease. For both cases and controls we will reconstruct heart doses in detail. We will also scrutinise the medical records for information on other treatments, previous disorders, and life style factors.


Results achieved so far:  

Cohorts of women with breast cancer have been established in both Denmark and Sweden. These cohorts have been matched to the national cause of death and hospital discharge registries in the two countries for identification of patients with ischemic heart diseases. The data sets have been sent to Oxford for analyses.


From the cohorts described above cases, women with breast cancer and an ischemic heart disease, and controls, women with breast cancer only, have been identified. Web based questionnaires have been created and abstraction of case record information is ongoing. No problems have so far been identified.

In order to reach correct risk estimates valid cardiac doses are crucial. We thus spend a substantial effort in establishing accurate heart doses.

Abstraction of information from case records is ongoing in both Denmark and Sweden and we have not identified any problems in retrieving the information we believe is essential for the success of RACE. However, the large amount of time spent identifying case records eligible for the study was not anticipated. This is explained by the study design, i.e. to only include women who received radiotherapy. Since approximately one third of the women received radiotherapy, a large number of case records have to be scrutinized first and later excluded.





Sixth Framework Programme

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