{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:47:01Z","timestamp":1774439221758,"version":"3.50.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T00:00:00Z","timestamp":1659398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100001502","name":"Blue Cross Blue Shield of Michigan","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Blue Care Network of Michigan"},{"name":"BCBSM Value Partnerships Program"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Racial disparities in survival of patients with cancer motivate research to quantify treatment disparities and evaluate multilevel determinants. Previous research has not evaluated cardiac radiation dose in large cohorts of breast cancer patients by race nor examined potential causes or implications of dose disparities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used a statewide consortium database to consecutively sample 8750 women who received whole breast radiotherapy between 2012 and 2018. We generated laterality- and fractionation-specific models of mean heart dose. We generated patient- and facility-level models to estimate race-specific cardiac doses. We incorporated our data into models to estimate disparities in ischemic cardiac event development and death. All statistical tests were 2-sided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Black and Asian race independently predicted higher mean heart dose for most laterality-fractionation groups, with disparities of up to 0.42\u2009Gy for Black women and 0.32\u2009Gy for Asian women (left-sided disease and conventional fractionation: 2.13\u2009Gy for Black women vs 1.71\u2009Gy for White women, P\u2009&amp;lt;\u2009.001, 2-sided; left-sided disease and accelerated fractionation: 1.59\u2009Gy for Asian women vs 1.27\u2009Gy for White women, P\u2009=\u2009.002). Patient clustering within facilities explained 22%-30% of the variability in heart dose. The cardiac dose disparities translated to estimated excesses of up to 2.6 cardiac events and 1.3 deaths per 1000 Black women and 0.7 cardiac events and 0.3 deaths per 1000 Asian women vs White women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and facility-level availability and use of radiation technologies.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jnci\/djac120","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T16:05:37Z","timestamp":1659456337000},"page":"1646-1655","source":"Crossref","is-referenced-by-count":12,"title":["Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients"],"prefix":"10.1093","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-5398","authenticated-orcid":false,"given":"Christina Hunter","family":"Chapman","sequence":"first","affiliation":[{"name":"Rogel Comprehensive Cancer Center at the University of Michigan , Ann Arbor, MI, USA"},{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, 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Ford Hospital , Detroit, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dominello","sequence":"additional","affiliation":[{"name":"Karmanos Cancer Institute, Wayne State University , Detroit, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyad","family":"Abu-Isa","sequence":"additional","affiliation":[{"name":"Ascension Providence Hospital , Southfield, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Hayman","sequence":"additional","affiliation":[{"name":"Rogel Comprehensive Cancer Center at the University of Michigan , Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna M","family":"Laucis","sequence":"additional","affiliation":[{"name":"Rogel Comprehensive Cancer Center at the University of Michigan , Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Mietzel","sequence":"additional","affiliation":[{"name":"Rogel Comprehensive Cancer Center at the University of Michigan , Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3734-5710","authenticated-orcid":false,"given":"Lori","family":"Pierce","sequence":"additional","affiliation":[{"name":"Rogel Comprehensive Cancer Center at the University of Michigan , Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,8,2]]},"reference":[{"issue":"11","key":"2023022317344708300_","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa1209825","article-title":"Risk of ischemic heart disease in women after radiotherapy for breast cancer","volume":"368","author":"Darby","year":"2013","journal-title":"N Engl J 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