Dr. Clara Massey, professor of internal medicine and director of the division of cardiology at the University of South Alabama, recently attended the 8th annual Heart of Women’s Health Conference in Washington, D.C., where a newly developing field of research was discussed – the effects of breast cancer treatment on the heart.
“The breast cancer survivor rate has improved dramatically over the last 20 years.” Dr. Massey said. “As a result, the collateral damage related to that treatment truly starts to matter. It’s now important to include a discussion of the long term cardiovascular side effects of chemotherapy and radiation in the treatment planning process. In planning your treatment, you need to engage your cardiologist from the get-go.”
According to Dr. Massey, breast cancer treatment can affect every part of the heart. Most of the chemotherapeutic agents – especially the breast cancer agents – have a direct myocardial toxicity, which can translate into pump dysfunction and heart failure. It can also cause injury to the lining of the coronary vessels, which may lead to hypertension or accelerated coronary artery disease. Both chemotherapy and radiation therapy can thicken and calcify the pericardium, the sac that surrounds and protects the heart. In addition, radiation therapy can affect the valves or electrical system.
These cardiac effects occur late – generally 5-10 years post treatment – and are difficult to diagnose early by clinical exam or traditional imaging techniques.
Dr. Massey said not everyone will go on to develop heart failure or coronary disease. In fact, the numbers are currently thought to be less than 25 percent. “But, we certainly don’t want anyone to face a heart failure event if we can prevent it,” she said.
Dr. Massey said survivor awareness of the potential for cardiovascular risks is key to prevention, as well as physician awareness of newly developing guidelines for surveillance.
One surefire way to reduce the potential of cardiac damage is to treat cardiac risk factors such as hypertension and diabetes before, during, and after cancer treatment. “Ninety percent of cancer patients have at least one cardiac risk factor at the time of diagnosis,” she said. “Pre-existing cardiac conditions may limit therapeutic options and increase the potential for developing cardiac side effects after cancer treatment.”
As a result of this newly expanding field of knowledge, the National Cancer Institute, National Institutes of Health and the American College of Cardiology are urging oncologists and cardiologists to work together to find ways to protect the heart from the long term cardiovascular side effects of effective cancer treatment. Care is shifting toward multidisciplinary team-driven care and the development of cardio-oncology programs.
“Multidisciplinary team-driven care offers the best chance of optimal long-term outcome,” Dr. Massey said. “This is a newly developing field of knowledge that is expected to result in dramatic changes in the care of patients with newly diagnosed breast cancer, as well as changes in the care of breast cancer survivors.”
Dr. Massey gave an overview of this topic at the April Med School Café lecture. To view the lecture in its entirety, click here.