CarDI Trial

In April 2026, the ARTILLERY-CarDI trial enrolled its first breast cancer patient. This marked the start of a multinational decision impact study investigating whether information from routine breast cancer radiotherapy planning scans can help identify patients at increased risk of cardiovascular disease.

Breast cancer survival has improved substantially, and more people are living many years beyond their diagnosis. As a result, long-term health has become an increasingly important part of breast cancer care. One important concern is cardiovascular disease. Some breast cancer survivors have a higher risk of cardiovascular disease than women in the general population. Several risk factors may contribute to this increased risk, including physical inactivity, smoking and some cancer treatments.

Making better use of existing scans

Around 65% of people with breast cancer receive radiotherapy, which routinely involves a planning CT scan. These scans are used to plan radiotherapy, but they also contain information about the main coronary arteries of the heart. In particular, the scans can be used to measure calcification in the coronary arteries (CAC). CAC is a recognized marker of cardiovascular risk and can be quantified using the Agatston score.

ARTILLERY-CarDI will investigate whether measuring CAC on these existing radiotherapy planning CT scans can help identify cardiovascular risk and support more personalized care. Participants will be assigned to low, moderate or high cardiovascular risk based on their Agatston score. When a moderate or high risk is identified, patients will receive a corresponding management recommendation, which may include lifestyle counselling or referral to a general practitioner.

Understanding the patient’s perspective

The CarDI research team is interested not only in identifying cardiovascular risk, but also in what happens when patients and their doctors receive this information. The researchers will examine whether cardiovascular risk assessment and disclosure influences patients’ lifestyle and health or leads to further care such as a referral to a general practitioner or cardiologist. They will also evaluate patients’ satisfaction with their decision to receive their cardiovascular risk, patient reported outcomes like anxiety and quality of life, management of cardiovascular risk profile and cardiovascular risk factors.

This is important because information about health risks can be helpful and empowering, but it can also cause concern. Understanding both the benefits and potential disadvantages of communicating cardiovascular risk will therefore be an important part of the study.

A European collaboration

ARTILLERY-CarDI is a prospective, decision impact trial involving six centers in four European countries: the Netherlands, Germany, Portugal and Denmark. The study aims to enrol 1,000 people with breast cancer over approximately 18 months, with each participant followed for six months. The inclusion of the first patient in April marks an important milestone for the research team and the beginning of this European effort to make cardiovascular health a more central part of breast cancer care.

By making use of information already available from radiotherapy planning scans, ARTILLERY-CarDI could help answer an important question for modern cancer care: can we use the data collected during routine breast cancer care to identify and address other health risks — and ultimately help people live not only longer after breast cancer, but healthier lives?