Caught off Guard

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Study shows that heart health is not monitored according to risk in women with breast cancer.
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Some risk factors for breast cancer and heart disease are shared; these include advanced age, poor diet, family history, physical inactivity and tobacco use. Improving diet, physical activity and quitting smoking can help decrease the risk for these diseases.

A large Ontario study shows that the early monitoring of heart health in women on certain anticancer treatments—specifically those that are known to increase the risk of heart failure—is not being carried out according to heart disease risk levels.

“This means that some of the women who are in greatest need of preventative therapies for heart failure may not be getting the care they need,” says the lead author of the study, Dr. Paaladinesh Thavendiranathan—Scientist at the Toronto General Hospital Research Institute (TGHRI) and cardiologist at the Peter Munk Cardiac Centre.

The study, which was published in the Journal of Clinical Oncology, used Ontario-wide data for 18,444 women that were diagnosed with early-stage breast cancer between 2007 and 2012. The data was used by the research team to identify the factors that determine whether women receive cardiac imaging—an essential procedure for assessing heart health—after diagnosis with breast cancer.

“Early monitoring of heart health is particularly important for women who go on to receive the chemotherapeutics anthracycline and/or trastuzumab, which can increase the risk of heart failure. For these individuals, knowing heart health before cancer treatment is essential for identifying who may benefit from preventative therapies,” says Dr. Thavendiranathan.

The findings revealed that those women that were at greatest risk for heart complications—i.e., those who received the chemotherapeutic anthracycline and displayed risk factors for heart disease (e.g., diabetes, hypertension)—were around a quarter less likely to receive early monitoring for heart health than women who received trastuzumab and had no risk factors for heart disease.  

Dr. Thavendiranathan comments, “We found that the type of chemotherapeutic prescribed was a key factor in determining whether patients received heart health monitoring. These findings show that, in Ontario, a mismatch exists between monitoring and risk levels. Changing current policies to address this mismatch could help to reduce unnecessary monitoring, while also ensuring that those at high risk for cardiac complications receive the care that they need.”

This work was supported by the Heart and Stroke Foundation, the University of Toronto, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences, the Ontario Ministry of Health and Long-Term Care, the Ted Rogers Centre for Heart Research and the Toronto General & Western Hospital Foundation.

Thavendiranathan P, Abdel-Qadir H, Fischer HD, Liu Y, Camacho X, Amir E, Austin PC, Lee DS. Risk-Imaging Mismatch in Cardiac Imaging Practices for Women Receiving Systemic Therapy for Early-Stage Breast Cancer: A Population-Based Cohort Study. J Clin Oncol. 2018 May 23:JCO2018779736. doi:10.1200/JCO.2018.77.9736.

Dr. Thavendiranathan (pictured) is the lead author of the study.