Avoiding heart disease should be considered during breast cancer treatments

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Avoiding heart disease should be considered during breast cancer treatment

By AMERICAN HEART ASSOCIATION NEWS

Older women who survive cancer are at much higher risk of death from heart disease, according to a panel of experts who are working to lessen that double whammy.

In its first scientific statement on cardiovascular disease and breast cancer, the American Heart Association reported about heart tissue damage, coronary events and reduced heart function that may be associated with state-of-the-art breast cancer treatment.

It’s not just possible damage caused by treatment -- the risk factors for breast cancer and heart disease also overlap and include age, tobacco use, diet, obesity and sedentary lifestyle.

As medical experts find overlapping care and treatment issues, the result is that a new emerging medical specialty is evolving for patients.

At the heart of the issue is that many women believe breast cancer poses a bigger risk than heart disease.

They are wrong.

For women overall, heart disease poses a bigger risk than breast cancer.

About 40,000 women die of breast cancer every year in the U.S., according to the Centers for Disease Control and Prevention. Meanwhile, roughly 10 times that number die from heart disease, according to heart disease and stroke statistics released in January and published in Circulation.

“When you're diagnosed, the first thing you worry about is, 'Am I going to live?’ ” said Michelle LeBaron of Northern Utah, now 58, who was diagnosed and treated for stage 3B inflammatory breast cancer in 2004. “The doctors say they’re going to give you things to help you live longer.”

The possible side effects from the treatment don’t sink in when you’re fighting for your life, she said.

Patients can find it difficult to focus on the crossover effects when facing radiation, surgery or chemotherapy.

The statement, published Thursday in Circulation, advises that both diseases be considered together during breast cancer treatment since cancer outcomes can be influenced by heart health. In addition, cardiovascular health can affect cancer treatment selection, since some types can result in heart damage.

Statement author and cardiologist Dr. Laxmi Mehta and colleagues wrote that cancer treatment can result in a wide range of heart damage, including left ventricular systolic dysfunction; overt heart failure; hypertension; arrhythmias; myocardial ischemia; valvular disease; thromboembolic disease; pulmonary hypertension; and pericarditis.

Two drugs commonly used against breast tumors are doxorubicin and trastuzumab. Heart failure and left ventricular dysfunction can be adverse effects of both drugs.

LeBaron, who was diagnosed with dilated cardiomyopathy after completing her cancer treatment and in later years found her left ventricle pumping capacity was 25 percent or less, said she was told her heart damage was due to the treatments.

“I always refer to it as my little broken heart,” she said. “It’s kept me alive, even though I've had cardiomyopathy and a leaky mitral valve — and even atrial fibrillation. To me, it's 'the little engine that could.' I love my little heart.”

Jessica Rhee, clinical trials medical director at the University of Hawaii Cancer Center, said she puts together a care plan for all of her patients, including how often they should see each doctor and for which tests.

“I've seen the full spectrum of those leaving cancer care: the patients who don't tend to worry about every symptom, to the patient who sees every little symptom and thinks that the cancer is back,” said Rhee, who was not involved in writing the statement.

Rhee has witnessed more precise radiation therapy in the past 18 years, which may result in fewer cases of heart and valve disease in the future than was caused by heavier doses of radiation spread broadly across patients’ torsos and chests.

The American Society of Clinical Oncology also now has guidelines in place for oncologists to consider regarding chemotherapy drugs and heart health, Rhee said.

If you have questions or comments about this story, please email  editor@heart.org.

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