Breast cancer treatments can raise heart risks, doctors warn

Heart disease and cancer are the top two leadin...

Posted: Feb 2, 2018 7:45 AM
Updated: Feb 2, 2018 7:45 AM

Heart disease and cancer are the top two leading causes of death in the United States -- and a new paper highlights how these major health concerns can intertwine.

A scientific statement from the American Heart Association, published Thursday in the journal Circulation, warns that breast cancer patients may be at an increased risk of cardiovascular diseases and could benefit from discussing those risks with their doctors.

Some breast cancer therapies can pose heart risks, the American Heart Association warns

Patients should undergo lifesaving treatments but protect their hearts, doctors say

"For older women, (cardiovascular disease) poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer," the statement says.

Cardiovascular disease and breast cancer already have several overlapping risk factors, such as age and obesity, and current lifesaving breast cancer treatments could have negative impacts on heart health, according to the statement.

"We hate to trade one disease for another," said Dr. Laxmi Mehta, an author of the statement and director of the Women's Cardiovascular Health Program at The Ohio State University Wexner Medical Center.

"We are still recommending that patients do get their breast cancer treatment. They should get the best treatment that's necessary for their breast cancer," she said, but patients should try to prevent or reduce those risks to their heart health by maintaining a healthy diet, exercising, and monitoring their blood pressure and cholesterol.

The intersection of cardiovascular disease and breast cancer is nothing new to oncologists, said Dr. Otis Brawley, chief medical and scientific officer and executive vice president of the American Cancer Society, who was not involved in the statement.

"We have taught and seen these problems. The report may bring this problem to the front of mind among emergency medicine and internal medicine doctors who are caring for these women," he said. "Let's give these drugs and treatments to people who need them -- the risk-benefit is more favorable -- and let's do all we can to determine who is unlikely to benefit from the drugs and spare them the risks."

Globally, breast cancer is the top cancer impacting women's health, in both the developed and the developing worlds, according to the World Health Organization.

In the US and the United Kingdom, about 12% of women will develop breast cancer at some point in their lifetimes, according to the National Cancer Institute and the organization Cancer Research UK.

There are many types of cancer treatment, including surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplant and precision medicine.

The new statement noted that radiation and chemotherapies can pose a risk to cardiovascular health.

A study published in the New England Journal of Medicine in 2013 found that exposing the heart to radiation during radiotherapy could increase the rate of heart disease among breast cancer patients later in life.

The study involved 2,168 women who underwent radiotherapy for breast cancer between 1958 and 2001. It showed that the rate of major coronary events among the women increased 7.4% for each additional gray, or unit, in the average radiation dose delivered to the heart.

Women irradiated for cancer of the left breast, near the heart, had higher rates of major coronary events than women irradiated for cancer of the right breast, the study found.

"It is less a problem today than 20 years ago, because we started aiming the beam to miss the heart about 20 years ago, but we occasionally see a woman who had lumpectomy and radiation, and the radiation beam caught part of the heart and a coronary artery," Brawley said. "This can cause isolated coronary artery disease in that portion of the artery."

Coronary heart disease is the most common cause of cardiac death after radiotherapy, according to a paper published in the Cleveland Clinic Journal of Medicine in 2016.

"Radiation therapy does have that risk of developing coronary artery disease, and it can be several years to a decade or more later," Mehta said.

Yet "one of the well-known treatments to potentially cause heart problems are anthracyclines," she said of chemotherapy drugs. "Anthracyclines have been shown to result in weakening of the heart muscle and heart failure, which can be irreversible. Oncologists and cardiologists are well aware of this and minimize the dosage as possible to reduce the potential of heart failure."

One observational study of 1,263 breast cancer patients in Dundee, Scotland, found that among those who received anthracyclines alone for treatment, 6.7% developed left ventricular systolic dysfunction, a common cause of heart failure. Among those who received a combination of anthracycline and trastuzumab, another chemotherapy drug, 12.5% developed that systolic dysfunction.

So the study, published in the journal Heart in 2016, suggests that a single chemotherapy drug is associated with less damage to the heart compared with combining drugs.

"Adriamycin, or doxorubicin, and trastuzumab, or Herceptin, are the big causes of heart failure," Brawley said.

"Adriamycin-induced congestive heart failure symptoms can show up three to five years after treatment and easily be missed by an internist or ER doctor who does not see a lot of these patients," he said. "Health care is changing such that a cancer patient often does not see an oncologist after completion of therapy."

In general, the impact of both cardiovascular disease and breast cancer among women can be significant, and Mehta hopes the new statement raises this awareness, especially among older women.

"Older breast cancer survivors are more likely to die from other diseases and not breast cancer, and cardiovascular disease is the most frequent cause," she said.

The American Heart Association's statement is "long overdue," said Dr. Lewis Kuller, a professor and past chair of the department of epidemiology at the University of Pittsburgh Graduate School of Public Health, who was not involved in the statement.

Maintaining a healthy lifestyle and treating cardiovascular risk factors aggressively can help prevent heart attack, stroke and disability, said Kuller, who also has studied cardiovascular disease and breast cancer.

Overall, "one of the great things about the cancer world right now is that there are more and more survivors," Mehta said.

"Oncologists are doing a terrific job of increasing survival rates by advancing the science and improving cancer treatments. This is much better than a few decades ago," she said. "But there are side effects from these cancer treatments, and we're trying to recognize it in the very early phases so that we may be able to mitigate the heart effects and avoid significant heart damage."

Minnesota Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 142311

Reported Deaths: 2472
CountyConfirmedDeaths
Hennepin35484995
Ramsey14726372
Dakota10271139
Anoka9344155
Washington636273
Stearns625550
Scott360436
Olmsted340230
St. Louis325874
Wright273116
Clay252944
Nobles234318
Blue Earth21147
Carver18887
Sherburne183122
Kandiyohi18215
Rice170210
Mower154518
Winona133619
Chisago11562
Crow Wing114322
Benton103311
Lyon10306
Beltrami9618
Otter Tail9508
Waseca94510
Todd8967
Polk8364
Morrison8259
Steele8013
Itasca78817
Douglas7744
Nicollet77118
Freeborn7185
Le Sueur6646
Goodhue65111
Martin62618
Becker6214
McLeod6214
Isanti5995
Watonwan5824
Pine5770
Carlton5092
Chippewa4733
Mille Lacs44918
Hubbard4344
Cass4225
Wabasha4141
Dodge4130
Pipestone36617
Meeker3593
Rock3595
Brown3483
Roseau3300
Redwood29912
Yellow Medicine2986
Murray2973
Cottonwood2950
Fillmore2770
Renville27213
Sibley2663
Wadena2643
Faribault2520
Houston2381
Unassigned23853
Kanabec23710
Swift2252
Jackson2211
Pennington2181
Aitkin1982
Stevens1941
Lincoln1930
Koochiching1755
Pope1680
Big Stone1591
Marshall1511
Lac qui Parle1453
Wilkin1454
Clearwater1381
Norman1340
Lake1330
Mahnomen1292
Grant1054
Red Lake822
Traverse590
Kittson530
Lake of the Woods441
Cook190

Iowa Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 122218

Reported Deaths: 1691
CountyConfirmedDeaths
Polk19732289
Woodbury743799
Linn6038133
Johnson602431
Black Hawk5974102
Dubuque550658
Scott487343
Story411118
Dallas357347
Pottawattamie337845
Sioux254417
Buena Vista230212
Marshall212236
Webster196015
Plymouth172831
Wapello158962
Clinton156228
Muscatine153958
Des Moines151611
Cerro Gordo150227
Crawford138714
Warren13137
Carroll120413
Jasper119734
Henry11245
Marion106811
Lee101312
Tama100538
Delaware82713
Dickinson7939
Wright7591
Boone7509
Mahaska73824
Bremer7199
Harrison69716
Washington69311
Jackson6853
Benton6482
Lyon5688
Clay5574
Louisa54415
Winnebago52119
Cedar5087
Winneshiek5079
Hardin5017
Jones5004
Kossuth4970
Clayton4923
Buchanan4875
Hamilton4825
Poweshiek47611
Floyd46211
Emmet45321
Iowa4429
Cass4233
Mills4233
Guthrie42015
Page4200
Cherokee4122
Sac4114
Butler4083
Fayette4064
Shelby4022
Allamakee3999
Franklin39518
Madison3743
Chickasaw3731
Hancock3676
Humboldt3593
Clarke3573
Grundy3406
Palo Alto3292
Calhoun3264
Osceola3020
Mitchell2961
Howard2879
Monroe27212
Union2645
Taylor2602
Jefferson2591
Appanoose2503
Monona2492
Pocahontas2442
Fremont2152
Lucas2136
Ida2122
Adair1971
Greene1930
Montgomery1907
Davis1884
Van Buren1882
Keokuk1731
Decatur1620
Audubon1601
Worth1470
Wayne1373
Ringgold992
Adams841
Unassigned60
Rochester
Clear
44° wxIcon
Hi: 45° Lo: 32°
Feels Like: 39°
Mason City
Clear
45° wxIcon
Hi: 44° Lo: 34°
Feels Like: 39°
Albert Lea
Clear
45° wxIcon
Hi: 46° Lo: 35°
Feels Like: 38°
Austin
Clear
45° wxIcon
Hi: 46° Lo: 34°
Feels Like: 42°
Charles City
Clear
43° wxIcon
Hi: 45° Lo: 34°
Feels Like: 37°
Tracking a breezy weekend
KIMT Radar
KIMT Eye in the sky

Community Events