Breast Cancer and Cardiac Problems

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

FEBRUARY 16, 2018

  Sometimes it really seems a bit much! We all know that cancer and heart disease are the biggest killers of women, actually of all Americans, and it seems that we who have had breast cancer may have hit the jackpot. There is increasing evidence that sometimes breast cancer treatments cause cardiac problems, either fairly quickly or sometimes a long time later. Wow, we got to hit the big two in a single diagnosis! (Which is definitely not to say that every woman who is treated for breast cancer will experience cardiac issues that are related!)

  How can this be? The answer is quite straight forward: some drugs used to treat breast cancer may be damaging to hearts. The most common culprits are Adriamycin and hereptin. Do both of these drugs do way more good for us than harm? Absolutely yes, but there are possible downsides. If you have had either of these drugs, you likely had a cardiac function test before the treatment began; it is important to identify an already vulnerable heart and to have a baseline. Some women receive herceptin for a long time, and they will periodically have this test again to see if problems are evolving.

  The other culprit can be left-sided radiation. This certainly can be true for other cancers that are sometimes treated with chest radiation (e.g. Hodgkins Disease), but since approximately half of all breast cancers are in the left breast, this comes up pretty often. As radiation oncology has become increasingly sophisticated, there have been better and better technical ways to plan the radiation field and avoid the heart. Sometimes it seems to be unavoidable and some of us, like me, who had left-sided radiation a long time ago, were not the beneficiaries of this improved technology. 

  I have seen a few articles that suggest that all women who fall into one or more of these groups should meet at some point with a cardiologist. Most doctors whom I know do not agree with this recommendation, but do concur that it is important to recognize the realities and be ready to call in the heart experts if there seems to be a problem. For whatever it is worth, probably not much, this is not something on my personal worry list.

  From EurekAlert Science comes this article:

New focus on where heart disease and breast cancer treatment meet
Statement by American Heart Association calls for advancement of cardio-oncology

A new scientific statement issued today by the American Heart Association underscores the commonalities
between cardiovascular disease and breast cancer among women, and it calls for more focus on research and
specialized treatment where the diseases overlap.
The statement, chaired by Dr. Laxmi Mehta, a cardiologist at The Ohio State University Ross Heart Hospital, is
the first to compile the newest information on prevalence, shared risk factors and cardiotoxic effects of cancer
therapy, as well as prevention and treatment of heart disease in breast cancer patients. It appears in the
journal Circulation.
Cardiovascular disease is the leading cause of death for women in the U.S. and globally. However, more
women think breast cancer is the bigger threat. In many ways, the two diseases can intertwine.
"Heart disease and breast cancer share common risk factors such as age, sedentary lifestyle and smoking,"
said Mehta, who is also director of preventative cardiology and women's cardiovascular health at Ohio State.
"More importantly, we see that many of the same things that improve heart health (healthy diet, healthy
weight, exercise, not smoking) can also reduce a woman's risk for breast cancer."

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