{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T03:18:47Z","timestamp":1778901527375,"version":"3.51.4"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n External beam radiation therapy (EBRT) for left-sided breast cancer historically increased the risk of cardiovascular disease (CVD). Advances in EBRT have reduced mean heart dose, but contemporary population-level data on long-term cardiovascular outcomes remain limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether contemporary left-sided EBRT is associated with different long-term CVD risk than right-sided EBRT among women with breast cancer.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based, retrospective cohort study used linked administrative health databases in Ontario, Canada, to identify women who received EBRT after a diagnosis of unilateral breast cancer between April 1, 2002, and December 31, 2017. Patients were followed up through February 28, 2025, for most outcomes and December 31, 2022, for cause-specific mortality. Data analysis was completed in August 2023 (with revisions in August 2025).<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Tumor laterality (left vs right).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was hospitalization with a most responsible diagnosis of CVD. Secondary outcomes included all-cause mortality, cardiovascular mortality, hospitalizations for specific CVD diagnoses, coronary revascularization, and new diagnoses of ischemic heart disease, heart failure, and atrial fibrillation. Cumulative incidence functions estimated the 15-year risk of outcomes accounting for the competing risk of death; event rates per 100 person-years captured recurrent events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 76\u202f586 women (mean [SD] age, 59 [12] years; 38\u202f427 [50.2%] with left-sided tumors) followed up for a median (IQR) of 10.9 (7.7-15.2) years, the 15-year cumulative incidence of first CVD hospitalization did not differ by laterality (left: 13.8% [95% CI, 13.4%-14.2%]; right: 13.5% [95% CI, 13.1%-13.9%];\n P<\/jats:italic>\n \u2009=\u2009.43). In women without preexisting CVD, new diagnoses of heart failure (10.2% [95% CI, 9.9%-10.6%] vs 9.6% [95% CI, 9.2%-10.0%];\n P<\/jats:italic>\n \u2009=\u2009.01) and ischemic heart disease (13.6% [95% CI, 13.2%-14.0%] vs 12.8% [95% CI, 12.4%-13.2%];\n P<\/jats:italic>\n \u2009=\u2009.03) were slightly more frequent after left-sided EBRT. The rate of CVD hospitalizations when including recurrent events was modestly higher for left-sided disease (1.72 vs 1.63 per 100 person-years;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Among women with preexisting CVD, there were no differences in all-cause mortality or recurrent CVD hospitalizations.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of women treated with EBRT for breast cancer in the past 2 decades, left-sided breast cancer radiation therapy was associated with minimal increases in long-term cardiovascular risk. These findings suggest that contemporary photon-based EBRT techniques have substantially reduced the cardiovascular risk historically associated with left-sided breast cancer radiation therapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.4098","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:31:25Z","timestamp":1775057485000},"page":"e264098","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Risk of Cardiovascular Disease After Contemporary Left-Sided Breast Radiation Therapy"],"prefix":"10.1001","volume":"9","author":[{"given":"Erika","family":"Nakajima","sequence":"first","affiliation":[{"name":"Women\u2019s College Hospital, Toronto, Ontario, Canada"},{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena","family":"Nguyen","sequence":"additional","affiliation":[{"name":"ICES (formerly known as the Institute 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