***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Radiotherapy for early breast cancer can decrease breast cancer mortality but increase other mortality , mainly from heart disease and lung cancer . The mean cardiac dose from irradiation of a left-sided breast cancer can be two or three times that for a right-sided breast cancer . The mean ipsilateral ( ie , on the same side as the breast cancer ) lung dose can also be two or three times the mean contralateral lung dose . Particularly during the 1970s , when typical heart and lung exposures were greater than now , the laterality of an irradiated breast cancer could measurably affect cardiac mortality and mortality from cancer of the right or the left lung decades later . This study aim ed to assess the hazards in the general US population from routine cancer-registry and death-certificate data . METHODS We analysed data for 308 861 US women with early breast cancer of known laterality ( left-sided or right-sided ) who were registered in the US Surveillance Epidemiology and End Results ( SEER ) cancer registries during 1973 - 2001 and followed prospect ively for cause-specific mortality until Jan 1 , 2002 . FINDINGS 115 165 ( 37 % ) received radiotherapy . Among those who did not , tumour laterality was of little relevance to subsequent mortality . For women diagnosed during 1973 - 82 and irradiated , the cardiac mortality ratio ( left versus right tumour laterality ) was 1.20 ( 95 % CI 1.04 - 1.38 ) less than 10 years afterwards , 1.42 ( 1.11 - 1.82 ) 10 - 14 years afterwards , and 1.58 ( 1.29 - 1.95 ) after 15 years or more ( trend : 2p=0.03 ) . For women diagnosed during 1983 - 92 and irradiated , the cardiac mortality ratio was 1.04 ( 0.91 - 1.18 ) less than 10 years afterwards and 1.27 ( 0.99 - 1.63 ) 10 or more years afterwards . For women diagnosed during 1993 - 2001 and irradiated the cardiac mortality ratio was 0.96 ( 0.82 - 1.12 ) , with none yet followed for 10 years . Among women irradiated for breast cancer who subsequently developed an ipsilateral or contralateral lung cancer , the lung cancer mortality ratio ( ipsilateral versus contralateral ) for women diagnosed during 1973 - 82 and irradiated was 1.17 ( 0.62 - 2.19 ) , 2.00 ( 1.00 - 4.00 ) , and 2.71 ( 1.65 - 4.48 ) , respectively , less than 10 years , 10 - 14 years , and 15 or more years afterwards ( trend : 2p=0.04 ) . For women irradiated after 1982 there is , as yet , little information on lung cancer risks more than 10 years afterwards . INTERPRETATION US breast cancer radiotherapy regimens of the 1970s and early 1980s appreciably increased mortality from heart disease and lung cancer 10 - 20 years afterwards with , as yet , little direct evidence on the hazards after more than 20 years . Since the early 1980s , improvements in radiotherapy planning should have reduced such risks , but the long-term hazards in the general population s of various countries still need to be monitored directly PURPOSE To study incidence of radiation-related heart disease in a large population of breast cancer patients followed for up to 30 years . MATERIAL AND METHODS 72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976 - 2006 and followed prospect ively . Radiation-related risk was studied by comparing women with left-sided and right-sided tumours . RESULTS 34,825 women ( 48 % ) received radiotherapy . Among unirradiated women tumour laterality had little relevance to heart disease . Among irradiated women mean dose to the whole heart was 6.3 Gy for left-sided tumours and 2.7 Gy for right-sided tumours . Mortality was similar in irradiated women with left-sided and right-sided tumours , but incidence ratios , left-sided versus right-sided , were raised : acute myocardial infa rct ion 1.22 ( 95 % CI 1.06 - 1.42 ) , angina 1.25 ( 1.05 - 1.49 ) , pericarditis 1.61 ( 1.06 - 2.43 ) , valvular heart disease 1.54 ( 1.11 - 2.13 ) . Incidence ratios for all heart disease were as high for women irradiated since 1990 ( 1.09 [ 1.00 - 1.19 ] ) as for women irradiated during 1976 - 1989 ( 1.08 [ 0.99 - 1.17 ] ) , and were higher for women diagnosed with ischaemic heart disease prior to breast cancer than for other women ( 1.58 [ 1.19 - 2.10 ] versus 1.08 [ 1.01 - 1.15 ] , p for difference=0.01 ) . CONCLUSIONS Breast cancer radiotherapy has , at least until recently , increased the risk of developing ischaemic heart disease , pericarditis and valvular disease .  Women with ischaemic heart disease before breast cancer diagnosis may have incurred higher risks than others CONTEXT Heart failure incidence increases with advancing age , and approximately half of patients with heart failure have preserved left ventricular ejection fraction . Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction , little is known about age-dependent longitudinal changes in diastolic function in community population s. OBJECTIVE To measure changes in diastolic function over time and to determine the relationship between diastolic dysfunction and the risk of subsequent heart failure . DESIGN , SETTING , AND PARTICIPANTS Population -based cohort of participants enrolled in the Olmsted County Heart Function Study . R and omly selected participants 45 years or older ( N = 2042 ) underwent clinical evaluation , medical record abstract ion , and echocardiography ( examination 1 [ 1997 - 2000 ] ) . Diastolic left ventricular function was grade d as normal , mild , moderate , or severe by vali date d Doppler techniques . After 4 years , participants were invited to return for examination 2 ( 2001 - 2004 ) . The cohort of participants returning for examination 2 ( n = 1402 of 1960 surviving [ 72 % ] ) then underwent follow-up for ascertainment of new-onset heart failure ( 2004 - 2010 ) . MAIN OUTCOME MEASURES Change in diastolic function grade and incident heart failure . RESULTS During the 4 ( SD , 0.3 ) years between examinations 1 and 2 , diastolic dysfunction prevalence increased from 23.8 % ( 95 % confidence interval [ CI ] , 21.2%-26.4 % ) to 39.2 % ( 95 % CI , 36.3%-42.2 % ) ( P < .001 ) . Diastolic function grade worsened in 23.4 % ( 95 % CI , 20.9%-26.0 % ) of participants , was unchanged in 67.8 % ( 95 % CI , 64.8%-70.6 % ) , and improved in 8.8 % ( 95 % CI , 7.1%-10.5 % ) . Worsened diastolic dysfunction was associated with age 65 years or older ( odds ratio , 2.85 [ 95 % CI , 1.77 - 4.72 ] ) . During 6.3 ( SD , 2.3 ) years of additional follow-up , heart failure occurred in 2.6 % ( 95 % CI , 1.4%-3.8 % ) , 7.8 % ( 95 % CI , 5.8%-13.0 % ) , and 12.2 % ( 95 % CI , 8.5%-18.4 % ) of persons whose diastolic function normalized or remained normal , remained or progressed to mild dysfunction , or remained or progressed to moderate or severe dysfunction , respectively ( P < .001 ) . Diastolic dysfunction was associated with incident heart failure after adjustment for age , hypertension , diabetes , and coronary artery disease ( hazard ratio , 1.81 [ 95 % CI , 1.01 - 3.48 ] ) . CONCLUSIONS In a population -based cohort undergoing 4 years of follow-up , prevalence of diastolic dysfunction increased . Diastolic dysfunction was associated with development of heart failure during 6 years of subsequent follow-up PURPOSE To assess cardiac mortality , coronary artery disease , myocardial dysfunction , and valvular heart disease in women younger than 65 years of age , at least 10 years after adjuvant radiotherapy following mastectomy in early breast cancer . METHODS AND MATERIAL S Ninety women ( 45 - 64 years old ) with Stage II breast cancer without relapse , included in the South Sweden Breast Cancer Trial ( premenopausal arm ) , with or without adjuvant postoperative radiotherapy + /- cyclophosphamide  were examined with myocardial scintigraphy and echocardiography/Doppler , 10 - 17 years after radiotherapy .  Thirty-four patients had been irradiated for left-sided tumors , 33 for right-sided tumors , and 23 patients had not been treated with radiotherapy . The radiotherapy ( conventional roentgen , electron beams , and high-energy photon beams combined , in each patient ) included the chest wall and the regional lymph nodes , with a specified target dose of 38 - 48 Gy , administered in daily fractions of 1.9 - 2.4 Gy , 5 days/week . RESULTS No cardiac deaths were found among the original 275 patients r and omized to adjuvant therapy . In the 90 patients examined , abnormal findings were recorded for ECG ( 14 patients ) , exercise test ( 5 patients ) , myocardial scintigraphy ( 6 patients ) , thickening of valve cusps ( 14 patients ) , and mild valvular regurgitation ( 20 patients ) . All patients had normal systolic function . Diastolic dysfunction was observed in 6 patients ( abnormal relaxation in 4 patients and restrictive filling abnormality in 2 patients ) . Although no significant differences were found between the 3 study groups , there was a tendency to more abnormal findings after radiotherapy . CONCLUSION Women younger than 50 years of age at the time of adjuvant radiotherapy following mastectomy in early breast cancer , had no serious cardiac sequelae 13 years ( median ) later , despite partly old-fashioned radiation techniques We evaluated the long-term effects of combined modality therapy ( CMT ) with adriamycin , bleomycin , vinblastine , dacarbazine ( ABVD ) or mechlorethamine , vincristine , prednisone , procarbazine (MOPP)/ABVD plus adjuvant low-dose ( < 30 Gy ) involved-field radiation therapy ( LDRT ) on cardiac and pulmonary functions in adult patients with Hodgkin 's disease ( HD ) .  Adjuvant LDRT ( mean dose , 2340 cGy ) to the mediastinum was administered to 24 patients after chemotherapy with MOPP/ABVD ( n = 10 ) and ABVD ( n = 14 ) . The mean doses of doxorubicin and bleomycin were 233 mg/m2 and 92 IU/m2 , respectively . Cardiac and pulmonary function tests were performed in all patients and , when available , were compared with pretreatment studies . After a median follow-up of 6.3 years , none of the patients had cardiac or pulmonary symptoms . A 4.7 % overall decrease in left ventricular ejection fraction ( LVEF ) was observed ( p = 0.03 ) , but only one patient had a mildly decreased LVEF ( 47 % ) . Diastolic function , LVEF , and left ventricular volume remained within the normal range in the other 23 patients . Mild pulmonary function study abnormalities occurred in 8 of 24 patients , 6 of whom were cigarette smokers . There were no significant changes in total lung capacity and forced vital capacity ( FVC ) values , but there was a 3 % overall decrease in FEV1/FVC ratio ( p = 0.05 ) . In adult patients with HD , adjuvant LDRT after chemotherapy with ABVD or MOPP/ABVD did not result in a significant incidence of permanent pulmonary or cardiac toxicity after more than 6.3 years of median follow-up . Further studies are warranted to fully evaluate the impact of such therapy on cardiopulmonary function Purpose Whereas earlier research focused on specific patient groups , this study assessed the risk of cardiovascular disease ( CVD ) in an unselected population curatively treated for breast cancer ( BC ) , compared with an age-matched r and om sample of controls . Methods Risks were determined in BC survivors and controls . CVD was divided into three categories : congestive heart failure , vascular cardiac diseases , and “ other ” cardiac 
    Output:
    
This might have implication s for the selection of patients for cardioprotection .
Despite common emphasis , diastolic functional abnormalities were infrequent in the long term .
A limited amount of data suggest that right ventricular dysfunction is important in this population .