Laxmi Mehta, M.D., FACC, FAHA, Section Director of Preventative Cardiology and Women’s Cardiovascular Health, Sarah Ross Soter Endowed Chair in Women’s Cardiovascular Health and Associate Professor of Medicine, The Ohio State University; Chair, Writing Group, AHA Scientific Statement on Cardiovascular Disease and Breast Cancer: Where these Entities Intersect
Breast cancer patients may benefit from a treatment approach that compares the benefits of specific therapies with potential harm to the heart, given that they may face an increased risk of cardiovascular diseases (CVD). CVD is the leading cause of death among women in the United States, and 47.8 million women live with CVD compared to 3.32 million women breast cancer survivors.
To kick off Heart Month last week, the American Heart Association released its first scientific statement about the connections between CVD and breast cancer. The statement provides an overview of the prevalence of these conditions and their shared risk factors, as well as the potential heart damage of breast cancer therapy and the prevention and treatment of CVD in breast cancer patients.
Breast cancer survivors, especially those 65 years and older, are more likely to die from CVD than breast cancer. Among U.S. women, data show:
- CVD causes 1 in 3.3 deaths.
- Coronary heart disease causes 1 in 8.3 deaths.
- Breast cancer causes 1 in 31.5 deaths.
The chart below from the AHA’s 2018 Heart Disease and Stroke Statistics Update illustrates the higher age-adjusted death rates for CHD and stroke compared to breast cancer for non-Hispanic white, non-Hispanic black and Hispanic females.
Direct medical costs reflect the differences in death rates – totaling an annual $272.5 billion for CVD, $124.57 billion for all cancers and $16.5 billion for breast cancer.
National efforts such as the American Heart Association’s Red Dress campaign and Go Red For Women movement have helped raise awareness of heart disease in women. But we have a long way to go. Though mortality rates for CVD (in both genders) and for female breast cancer have decreased, we must increase public awareness of the relative scope of these conditions and the common risk factors they share.
Low-quality diets, family history of disease, use of hormone replacement therapy, presence of obesity, lack of physical activity, and tobacco use increase the risk of both diseases. Some of these risk factors can’t be changed, but some can.
Fortunately, many in the healthcare community know that the steps to reduce heart disease risk may also help reduce the risk of breast cancer. An impressive 80 percent of CVD can be prevented through the AHA’s Life’s Simple 7: eating a healthy diet; being physically active; maintaining a healthy weight; not using tobacco; and controlling blood pressure, cholesterol and blood sugar levels.
We also need to continue raising awareness among the healthcare community of treatment options for preventing co-occurrence of these conditions and managing negative consequences when both are present. For example, breast cancer treatments such as chemotherapy and radiation may damage the heart. Heart failure is the most common type of heart problem associated with breast cancer treatment, and coronary artery disease and blockages, abnormal heart rhythms and heart attacks may also occur.
No treatments have been proven to absolutely prevent heart failure or other CVD in breast cancer patients, but some small studies have yielded several promising treatment approaches.
All of this doesn’t mean that breast cancer patients should avoid treatment. Instead, healthcare
providers should weigh the potential benefits and risks of specific therapies for each case, and monitor each patient’s heart before, during and after breast cancer treatment.
I’m encouraged that a relatively new field of cardio-oncology has emerged in response to the intersection between these two entities. Comprehensive, coordinated care by primary care physicians, oncologists, cardiologists and other allied healthcare providers will help maximize the gains from cancer treatment and minimize risks to heart health. As we begin Heart Month 2018, that’s worth celebrating.