Preventing Vascular Calcification in Breast Cancer Treatment: A Policy Brief on Revising Radiotherapy Protocols to Reduce Cardiovascular Risks

Hassanshahi, Jalal

doi:doi: 10.66224/jrums.25.3.319

Journal of Rafsanjan University of Medical Sciences

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Volume 25, Issue 3 (6-2026) JRUMS 2026, 25(3): 319-328 | Back to browse issues page

‎ doi: 10.66224/jrums.25.3.319

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Hassanshahi J. Preventing Vascular Calcification in Breast Cancer Treatment: A Policy Brief on Revising Radiotherapy Protocols to Reduce Cardiovascular Risks. JRUMS 2026; 25 (3) :319-328
URL: http://journal.rums.ac.ir/article-1-8000-en.html

Preventing Vascular Calcification in Breast Cancer Treatment: A Policy Brief on Revising Radiotherapy Protocols to Reduce Cardiovascular Risks

Jalal Hassanshahi

Rafsanjan University of Medical Sciences

Abstract: (21 Views)

Background and Objectives: Radiotherapy for breast cancer saves lives but often harms the heart. Our systematic review and meta‑analysis of eight studies (1,972 patients) shows that one in four treated women develops new or worsening coronary artery calcification—a direct predictor of heart attack and death. This risk is twice as high with left‑sided radiation as with right‑sided (32.3% vs. 16.1%). Critically, even standard low radiation doses increase this complication, so simply lowering the dose is not enough. We urge health policymakers to mandate three evidence-based actions: pre-radiotherapy cardiac screening using coronary artery calcium scoring, particularly for patients with cardiovascular risk factors or those receiving left-sided treatment; the use of heart-sparing techniques during radiotherapy; and regular post-treatment monitoring of coronary artery calcium scores. Implementing these recommendations through national cardio‑oncology protocols, with sustainable funding and appropriate insurance coverage, can prevent thousands of avoidable cardiac events, improve survival and quality of life for breast cancer survivors, and reduce the high costs of hospitalizations and vascular interventions.
Keywords: Coronary artery calcification, Breast cancer, Radiotherapy, Cardio-oncology, Policy brief

Funding: This study did not receive any funds.
Conflict of interest: None declared.
Ethical considerations: This study was conducted based on the results of a systematic review and meta-analysis of previously published studies and did not require re-approval of an ethics committee. However, the main study upon which this policy brief is based was conducted in compliance with ethical principles regarding publication and citation of original sources.
Authors’ contributions:
- Conceptualization: Jalal Hassanshahi
- Methodology: Jalal Hassanshahi
- Data collection: Jalal Hassanshahi
- Formal analysis: Jalal Hassanshahi
- Supervision: Jalal Hassanshahi
- Project administration: Jalal Hassanshahi
- Writing – original draft: Jalal Hassanshahi
- Writing – review & editing: Jalal Hassanshahi

Citation: Hassanshahi J. Reducing Cardiovascular Risks in Breast Cancer Treatment: The Need to Revise Radiotherapy Protocols to Prevent Vascular Calcification: A Policy Brief. J Rafsanjan Univ Med Sci 2026; 25 (3): 319-28. doi: 10.66224/jrums.25.3.319. [Farsi]

- Writing - review and editing: Mohammad Mehdi Heidari and Mehri Khatami

Keywords: Coronary artery calcification, Breast cancer, Radiotherapy, Cardio-oncology, Policy brief

Full-Text [PDF 268 kb] (10 Downloads) | | Full-Text (HTML) (9 Views)

Type of Study: Applicable | Subject: cardiology
Received: 2026/05/28 | Accepted: 2026/08/22 | Published: 2026/06/20

References

1. Petrudi NR, Petroudi SR, Rajabi MR, Farshidi H, Hassanshahi J. Radiation-induced coronary artery calcification in breast cancer: insights from a systematic review and meta-analysis. Coronary Artery Disease 2026; 37: 142-48.

2. Onnis C, Virmani R, Kawai K, Nardi V, Lerman A, Cademartiri F, et al. Coronary artery calcification: current concepts and clinical implications. Circulation 2024; 149: 251-66.

3. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New England Journal of Medicine 2013; 368:987-98.

4. Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, et al. Past, present, and future of radiation-induced cardiotoxicity: refinements in targeting, surveillance, and risk stratification. Cardio Oncology 2021; 3: 343-59.

5. Bell KJ, White S, Hassan O, Zhu L, Scott AM, Clark J, et al. Evaluation of the incremental value of a coronary artery calcium score beyond traditional cardiovascular risk assessment: a systematic review and meta-analysis. JAMA Internal Medicine 2022; 182: 634-42.

6. Lancellotti P, Suter TM, Lopez-Fernandez T, Galderisi M, Lyon AR, Van der Meer P, et al. Cardio-oncology services: rationale, organization, and implementation: a report from the ESC Cardio-Oncology council. European heart journal 2019; 40: 1756-63.

7. Honaryar MK, Allodji R, Ferrières J, Panh L, Locquet M, Jimenez G, et al. Early coronary artery calcification progression over two years in breast cancer patients treated with radiation therapy: association with cardiac exposure (BACCARAT study). Cancers 2022; 14: 5724.

8. Meattini I, Poortmans PM, Aznar MC, Becherini C, Bonzano E, Cardinale D, et al. Association of breast cancer irradiation with cardiac toxic effects: a narrative review. JAMA oncology 2021; 7: 924-32.

9. Milgrom SA, Varghese B, Gladish GW, Choi AD, Dong W, Patel ZS, et al. Coronary artery dose-volume parameters predict risk of calcification after radiation therapy. Journal of Cardiovascular Imaging 2019; 27: 268.

10. Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Annals of Oncology 2020; 31: 171-90.

11.

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