Cancer Questions: How breast cancer and heart disease connect

  • a —Dr. SETH KAUFMAN a —

For the Gazette
Monday, March 05, 2018

The American Heart Association recently issued what it has called its first “scientific” statement on cardiovascular disease and breast cancer.

The statement, “Cardiovascular Disease and Breast Cancer: Where These Entities Intersect,” is actually a 23-page, fairly detailed document on how some breast cancer treatments can increase a women’s risk for cardiovascular disease, how that disease as a pre-existing condition might impact breast cancer treatment and how the two diseases share some risk factors.

It is directed at those who provide a breast cancer survivor’s medical treatment as well as at survivors themselves. Its point for survivors is not to avoid treatment, but to be aware of the cardiovascular disease risks involved.

One of its strongest messages is that better survival rates for breast cancer mean that older survivors with certain risk factors may be at a greater risk to die from cardiovascular disease.

The warning about cardiovascular disease is actually a valid one for the general population as well.

Released in February during American Heart Month, the document makes clear that cardiovascular disease is the No. 1 cause of mortality in women. Heart disease is actually the leading cause of deaths in the United States, followed by cancer. In Massachusetts, cancer is slightly ahead of heart disease as the No. 1 cause, with 12,750 cancer deaths in 2015, followed by 12,130 deaths from heart disease.

Avoiding some of cardiovascular disease’s preventable risk factors — living a sedentary lifestyle, smoking, consumping red-processed meat — also may help to lower one’s risk for breast cancer. At the same time, the people who practice these behaviors, could be putting themselves at risk for diseases that include breast cancer and cardiovascular disease.

As the document notes, “Much of the intersection between CVD (cardiovascular disease) and breast cancer pertains to similarities in (such) predisposing risk factors.”

The document says that the development of cardiovascular disease risk factors is higher in older breast cancer survivors than the risk of tumor recurrence.

It quotes statistics that more than 90 percent of breast cancer survivors are alive at least five years after their initial diagnosis, and that there are currently 3 million breast cancer survivors in the U.S. It says that older, post-menopausal breast cancer survivors face a higher risk of death attributable to cardiovascular disease than women without a history of breast cancer. This greater risk is said to manifest itself seven years after diagnosis.

The document mentions the emergence of the field of cardio-oncology — which brings together cardiology and cancer treatment — to, as the document notes, “provide the best cancer care without compromising cardiovascular health.”

It is a field concerned with heart disease in all cancers, and many medical centers have departments of cardio-oncology. The American College of Cardiology recently held a meeting on the topic of “Advancing Cardiovascular Care of the Oncology Patient.” There is also an online journal, Cardio-Oncology, devoted to publishing research in this field. This includes a recent article about developing a risk assessment questionnaire to screen breast cancer patients prior to treatment for risk of cardiovascular disease or cardiotoxity, that is, damage to the heart.

It has been known that some breast cancer treatments, including radiation, can put a patient at risk for cardiovascular disease. However, the statement does acknowledge the use of modern radiation delivery techniques that can minimize heart exposure, as well as precautions health care providers can take to assess heart health before treatment. This gives the medical team the ability to tailor cancer care (whether it be drug therapy, radiation therapy or both) appropriately for patients based on their heart health.

Whether intended or not, the document serves as a reminder that there are some 15 million cancer survivors alive today in the U.S. Aging is a risk factor for cancer, and having cancer puts one at greater risk for a second cancer. Survivors should be as informed as possible about health risks related to their cancer treatment as should their specialists, subspecialists and primary providers.

Dr. Seth Kaufman is the radiation oncologist/director of the Department of Radiotherapy and Radiosurgery, Baystate Regional Cancer Program based in Springfield. He is one of the Baystate health professionals who contribute a column to this space on a monthly basis.