Breast cancer patients may experience a higher risk for cardiovascular disease, including heart failure, according to a recent scientific statement published by the American Heart Association.
When making decisions about breast cancer therapies, researchers say patients and doctors should evaluate the benefits and potential risks for heart health.
“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects of the treatments on their heart,” Laxmi Mehta, MD, chair of the writing group for the new scientific statement, said in a press release.
“This should not deter or scare patients from undergoing breast cancer treatment, but should allow them to make informed decisions with their doctor on the best cancer treatment for them,” added Mehta, who is director of the Women’s Cardiovascular Health Program and an associate professor of medicine at The Ohio State University in Columbus, Ohio.
The statement, “Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association,” was published in the journal Circulation.
In older breast cancer survivors, the risk for cardiovascular disease is higher than the risk of disease recurrence. This suggests that therapies for breast cancer can lead to secondary cardiac effects.
Therapies against HER2-positive breast cancer, for example, can cause a weakening of the heart muscle. While in many patients this is a temporary effect that improves after treatment is ended, some patients experience permanent heart failure.
Early signs of heart failure signal that patients should slow down treatment or change to another therapy to prevent escalating damage to the heart. One previous study showed that slowly administering a common chemotherapy drug, doxorubicin, rather than all at once, may decrease the risk of heart damage in some patients.
The U.S. Food and Drug Administration approved dexrazoxane hydrochloride, sold as Zinecard or Totect, as a therapy to reduce heart damage in metastatic breast cancer patients treated with high doses of doxorubicin.
Another class of treatments used in chemotherapy called anthracyclines can affect patients’ heart rhythm. Anti-cancer therapies using so-called antimetabolites — which affect cancer cell division — and radiotherapy can also affect the heart. Both may affect the large vessels (arteries) or the heart, leading to spasms and coronary artery disease or blockages, respectively.
Breast cancer and heart disease share common risks factors, including advanced age and family history of disease. Life habits, including poor diet, physical inactivity, and tobacco use, also affect both diseases, suggesting that lifestyle interventions may halt their progression.
The researchers suggest that adherence to the American Heart Association’s Life’s Simple 7, a list of steps that improve lifestyle habits, could reduce the risk of both heart disease and breast cancer.
“Fortunately, with the advances in breast cancer treatment, there has been a growing number of survivors. However, during and after the treatment of breast cancer, having optimal control of heart disease risk factors is important, because older breast cancer survivors are more likely to die of heart disease than breast cancer,” Mehta said. “And that’s why Life’s Simple 7 is important for all patients with and without breast cancer.”