Breast Cancer Therapy Can Cause Heart Disease

Did Cancer Care Give You Heart Disease?

This is disheartening. Whether or not we were especially worried about our health before cancer, now that we've had it, most of us do. Generally we worry the most about cancer, but we have learned that we are vulnerable, and that our bodies can unpleasantly surprise us in lots of ways.  We know that cancer and heart disease are the biggest health threats to Americans, but it feels unfair that one can be due to the other. 

A recent study from the Netherlands reports:
Encompassing a treatment period of almost 40 years beginning in 1970 ... anthracycline-containing chemotherapy plus irradiation of the internal mammary chain (IMC) was associated with a heart failure (CHF) risk nine times greater than that of women in the general population. Anthracycline therapy alone increased heart failure risk four times over that of the general population, according to Flora E. van Leeuwen, PhD, of the Netherlands Cancer Institute in Amsterdam, and colleagues.

What does this mean for women whose breast cancer treatment  has included both left-sided radiation (because the radiation field may have included part or all of our hearts) and Adriamycin, a form of anthracycline as part of our chemotherapy?

On another note, although it was not included in this study, the drug Herceptin sometimes damages cardiac function, and women who receive it for HER2 positive breast cancers are carefully monitored. It is helpful to remember that the study looked at women who were treated quite a while ago. Fortunately, radiation has greatly improved over the intervening decades. Targeted fields now are more specific, and our doctors have become increasingly skilled at avoiding healthy tissue and limiting the radiation rays to the tumor. For breast cancer radiation, this has generally meant being careful to avoid the heart and the lungs.

We can’t do much about what has already happened. The biggest risk we faced was the breast cancer diagnosis. If radiation and chemo were recommended, it was important to comply. It makes no sense to worry about possible trouble far down the road when faced with an immediate threat. In the best scenario, we might have had a conversation with our doctors about this and considered whether there was an alternative. Chances are that didn’t happen. At least for me, when I had radiation back in 1993, this was not considered. And, honestly, I can't imagine what an alternative might have been, other than a mastectomy. 

We can consider alternatives now. When you next have an appointment with your doctor, ask about possible cardiac risks from your cancer treatment. If the response is that, yes, this might apply to you, ask whether you should have a consultation with a cardiologist or whether there is something else you might do. This is definitely not a panic situation, but it does fall into the category of being well-informed and pro-active.

Some doctors are focusing on this issue, and there are now partnerships between oncologists and cardiologists. BIDMC's Cardio-Oncology Program provides consultations with expert cardiologists who help evaluate cardiovascular risk and work with oncologists to devise treatment strategies that avoid or minimize heart damage.

I have talked about it with several medical oncologists, and the general opinion is that there is no urgent reason for every women  to run to a cardiologist. If you have symptoms, or there are other risks in you family or health history, or  you are especially worried, it probably does make sense to have a baseline evaluation. Otherwise, know the facts and go on with your life. As more and more people survive cancer and live long lives, it seems obvious that there may be medical problems that develop because of the cancer treatment. Most of us are willing to live with the possibility of later problems to avoid having to live with recurrent cancer.