New findings show that men cured of testicular cancer are more likely to suffer from heart disease later in life

Wednesday 16 April 2003

A study by scientists at The Institute of Cancer Research and doctors at The Royal Marsden Hospital, has found that men who have been successfully treated for testicular cancer using chemo and radiotherapy are at least twice as likely to go on to develop cardiovascular disease. (Journal of Clinical Oncology, 15 April 2003)

This is the largest study ever undertaken to explore long-term risks for men who have been cured of testicular cancer. A total of 992 patients who had been treated for the cancer at The Royal Marsden Hospital between 1982 and 1992 were involved. Of these men, who were on average ten years on from the completion of their treatment, a total of 68 had experienced cardiovascular problems, which included 18 deaths.

The scientists, whose study was funded in part by Cancer Research UK, found that risks to the heart became apparent eight years after treatment. Over a ten-year period, over seven per cent of those men who had received radiotherapy, and nearly three and a half percent of men who had received chemotherapy, had experienced heart problems. This compared with only one and a half per cent of men who had also had testicular cancer, but not received these treatments.

Dr Robert Huddart, the scientist leading the research at The Institute of Cancer Research says: “Treatment for testicular cancer is carefully tailored to each individual case and has a very high success rate, curing nine out of ten patients. However the results of this study show that, over time, a small number of men will go on to develop heart problems. We need more research to discover why this should be, and to continue to develop more effective, targeted treatments.”

Testicular cancer is the most common form of cancer in young men, mostly affecting those between the ages of 20 and 35, when caught early enough it has a 96% cure rate. But the fact that most of the men are young, and potentially have long life expectancies, means that they can be exposed to the toxic effect of treatment over many years, possibly explaining why the risk of heart damage is so apparent among these patients.

The scientists found that the men who had received treatment were no more likely to be in groups considered at high risk of heart disease, (such as smokers, those who suffer hypertension, or who are obese) than men in the surveillance group. This suggests that the testicular cancer treatment itself, either directly or indirectly, increases the risk of heart disease.

However, what is not clear is why the treatment should cause damage to the heart. In cases where patients had been treated with chemotherapy, there was no statistical significance between the risk of a cardiac event * and the type of chemotherapy used or the number of treatments. Those who were treated with the drug carboplatin were at a similar risk to those treated with the drug cisplatin, and it made little difference whether bleomycin was included or not. Also, there was no difference to the risk between men who received more than four treatments than those who had received four or less.

In patients treated with radiotherapy, it is known that direct cardiac irradiation, which is sometimes used in breast cancers or Hodgkins disease, can cause damage and an increased risk of cardiovascular disease. However, with testicular cancer patients, cardiac irradiation treatment is very modest, and it is unlikely that an increased risk or cardiovascular disease can be linked to such low doses.

Dickon Weir-Hughes, Royal Marsden Chief Nurse and Deputy Chief Executive said: “While this research has shown that a small number of men are at an increased risk of heart disease, more research is needed to explore why this should be the case. However, the results of this study strongly support the current policy of vigorously assessing each patient to ensure they receive the most appropriate treatment for their individual case.”

Dr Richard Sullivan, Head of Clinical Programmes at Cancer Research UK, said: “It’s important for men not to be frightened of receiving chemo-radiotherapy for testicular cancer, which has been responsible for a huge leap in cure rates. That said, we are now becoming increasingly aware that many treatments can carry significant, long term toxicity. This work by Dr Robert Huddart and colleagues sheds light on a new area which will help us fine tune effective treatments even further.”

Professor Peter Rigby, Chief Executive at The Institute of Cancer Research says: “These treatments have resulted in the vast number of testicular cancer patients being cured of the disease. However this valuable research has shown that the potential long life expectancy of these men can expose them to other, small but significant risk factors. More research is essential if we are to find out why this should be and how it can be prevented.”

- ends -

For further information, or to arrange interviews, please contact:
Marie MacLean
Press Officer
Institute of Cancer Research
Tel: 020 7153 5359
Out of Office Hours: 07932 561 346
Email: [email protected]

Notes to editors

1. The scientists defined cardiac events as those where a patient had died from a MI or similar cardiac related incident, those where the patient suffered from angina or MI, cardiac surgery for coronary artery disease, or other cardiac abnormality including angina or chest pains reported at long term clinic visits.
2. The Institute of Cancer Research is home to Europe’s only dedicated male cancer research centre and set up the Everyman Campaign in 1997 to raise awareness of and funds for prostate and testicular cancers.
3. The Institute of Cancer Research is a world leader in cancer drug discovery and development. The Institute and the Royal Marsden, the world's oldest cancer hospital, form Europe's largest cancer research, treatment and training centre.
4. The Institute of Cancer Research is a centre of excellence with leading scientists working on cutting edge research. It was founded in 1909 to carry out research into the causes of cancer and to develop new strategies for its prevention, diagnosis, treatment and care.
5. The Royal Marsden is a specialist hospital dedicated to the treatment and care of patients with cancer and to education about cancer and its prevention. It is the world's oldest hospital dedicated completely to the treatment and study of the disease and was named as one of six centres of excellence in the NHS Plan. Over 30,000 patients attend its sites in Chelsea and Sutton each year from all over the UK and abroad.
6. Cancer Research UK is Europe’s leading cancer charity, dedicated to curing, treating and preventing the disease through world-class research. It relies almost entirely on voluntarily donations from the public to fund the vital work of its 3000 scientists, doctors and nurses. Its grants provide approximately 25% of The Institute of Cancer Research’s total income.
   
7. Please note:
   Unfortunately the press office are unable to answer queries from the general public. For general cancer information please refer to The Institute's cancer information page.