Research We're Watching

Radiation for breast cancer linked to heart problems

Radiation therapy is an effective treatment for breast cancer, but concerns have been raised that the radiation exposure women receive during this therapy might put them at greater risk for heart disease, especially because the radiation is delivered so close to the heart.

Researchers in Europe investigated this connection in more than 2,000 women who underwent radiation treatment for breast cancer between 1958 and 2001. The study, which was published March 14 in The New England Journal of Medicine, found that women's risk of ischemic heart disease (caused by reduced blood flow to the heart) began rising five years after their radiation treatment, and it continued for 20 or more years after this therapy. The more radiation the women received, the greater their heart risks—especially if they had radiation to the left breast, which is closest to the heart. The authors say today's radiation treatments deliver lower doses than in the past, and because their study included women treated more than 10 years ago, they can't know for sure how more current treatments might affect women's heart disease risk. Regardless, Dr. ­Javid Moslehi of Harvard-affiliated Dana-Farber Cancer Institute stressed in an accompanying editorial that it's important for cancer and heart doctors to work together when caring for women who receive radiation for breast cancer.

A colonoscopy can help prevent the diagnosis of late-stage colon cancer. Research suggests that the test can reduce the likelihood of advanced colorectal cancer diagnosis by 70% in adults with average risk.

The idea of having a knee replaced is daunting. But what if both of your knees need repairing? Is one visit to the operating room better than two?

If you are otherwise in good health, it's a conversation worth having with your doctor and rehabilitation team. There are some benefits to replacing both joints during a single surgery (called simultaneous replacement). These include undergoing anesthesia only once, fewer days in the hospital, and only one (albeit prolonged) rehabilitation that lets you resume normal activities sooner than two separate ones. 

Heart tests help show artery blockage and assess the risk of heart attack

If you are at high risk for heart disease or have a symptom such as shortness of breath or discomfort in your chest, your doctor may order certain heart tests. But there's more to testing than simply finding out if you have heart disease. Your doctor may also want to determine whether the fatty plaques inside your blood vessels pose a high, medium, or low risk for a heart attack. The answer will help determine whether you need treatment, and if so, which type of treatment will be best.

No single test is better than another, and no test is appropriate for everyone. "The best test for an individual is the one that provides the information needed to guide management," says Dr. Ron Blankstein, a cardiovascular imaging specialist at Harvard-affiliated Brigham and Women's Hospital.

Q. I have a heart murmur that my doctor says is caused by a leaky mitral valve. I feel perfectly fine, am an active gardener, and enjoy playing with my grandchildren. My last echocardiogram showed that my heart is getting bigger, and my doctor says it is time to operate on the valve. Isn't this suggestion a bit drastic?

A. Your heart is enlarging because it has to pump blood twice: that is, every time your heart beats, some blood shoots in the wrong direction, back toward the lungs. That blood must re-enter the left ventricle and get pumped a second time in the right direction, which is out the aorta and into the body. Over time, the extra work takes a toll on your heart. If your heart is enlarging, it may mean that it is on its way to becoming permanently damaged.

The surgery can be a better option for some with this condition.

For people who have both diabetes and several blocked heart arteries, bypass surgery (rerouting blood flow around a clogged artery) may have a better result than stenting (widening a heart artery by inserting a wire mesh tube called a stent near the blockage). A study published in a recent issue of The New England Journal of Medicine found that bypass surgery resulted in fewer heart attacks and deaths than stenting. Bypass also reduced the likelihood of return trips to the hospital to fix new blockages.

When the minimally invasive procedure is warranted.

Arthroscopy is a popular technique for shoulder surgery because it involves a small incision. While it used to be the case that surgeons could see the shoulder tissues better with traditional open (large-incision) surgery, that has changed. "Our techniques have advanced to the point where sometimes we can see what's happening better with the scope than with open surgery," says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital. But when your surgeon will use arthroscopy depends on the particular condition that requires surgery.

The surgery

With arthroscopy, the surgeon makes a small incision and inserts long, thin surgical instruments—including one with a video camera that provides the inside view. "Because you can see better with arthroscopy, you can accomplish a repair without risking damage to the nearby deltoid muscle," says Dr. Berkson. "That cuts down on complications."

Eliminating four risk factors can reduce PAD cases.

When it comes to peripheral artery disease (PAD) among men, common risk factors have a strong cumulative effect. That's among the findings of a recent Harvard study published in The Journal of the American Medical Association. "The more risk factors one accumulates, the higher the risk, and the severity of risk factors increases risk," says author Dr. Ken Mukamal, associate professor of medicine at Harvard Medical School.

PAD and its risks

PAD is caused by plaque buildup in the walls of the arteries in your limbs, especially your legs. These clogged arteries put you at risk for ulcers and even gangrene. In addition, people with PAD are at an increased risk for heart attack or stroke.

The easy fix that millions of people may be ignoring.

Each year millions of people struggle with painful, debilitating venous leg ulcers and the stages leading up to the condition. But prevention is simple. That's why doctors are now campaigning to reduce venous ulcers by 50%. "This is a longstanding problem that needs our attention," says Dr. Sherry Scovell, a vascular surgeon and instructor in surgery at Harvard Medical School.

Could this experimental treatment reverse damage caused by a heart attack?

The heart muscle relies on a steady flow of oxygen-rich blood to nourish it and keep it pumping. During a heart attack, that blood flow is interrupted by a blockage in an artery. Without blood, the area of heart fed by the affected artery begins to die and scar tissue forms in the area. Over time, this damage can lead to heart failure, especially when one heart attack comes after another.