Cardiovascular Risks Associated With Breast Cancer and Its Treatments
Posted: Thursday, July 5, 2018
Breast cancer survivors are at increased risk of developing cardiovascular disease, with increased morbidity and mortality, compared with the general population, according to systematic reviews. A new study, led by Bonnie Ky, MD, MSCE, of the University of Pennsylvania, Philadelphia, explored the epidemiology of disease in breast cancer survivors and the cardiovascular concerns observed with common cancer therapies. The study offered possible strategies that may improve early detection and treatment of cardiovascular disease among breast cancer survivors.
“There is a critical need to attentively prevent, diagnose, and treat both risk factors and disease,” noted Dr. Ky, in the study published in the Journal of Oncology Practice. “The role of clinical risk scores, biologic markers, and imaging measures to improve upon the diagnosis and prediction of cardiovascular disease is an area of active study, with the ultimate goal of focusing on robust strategies that are feasible and effective in identifying high-risk cardiovascular survivors.”
Approximately 10% of patients may experience left ventricular ejection fraction, cardiomyopathy, or heart failure when treated with doxorubicin. The incidence jumps up to 65% when the dosage is increased from 250 to 550 mg/m2. Clinical trials have shown about a 10% increase in the incidence of cardiac dysfunction with the combination of anthracyclines and HER2-targeted therapy with trastuzumab. Radiation therapy and tamoxifen may also increase cardiovascular morbidity and mortality risk among patients.
In addition to history and physical examinations, Dr. Ky suggested that cardiovascular biomarkers may prove to be helpful in detecting cardiac dysfunction in cancer survivors, although they require further study. The role of imaging strategies in assessing cardiac structure and function is explored by Dr. Ky as well.