A growing number of breast cancer survivors are living longer, but this also means a greater focus on their heart health. But is it necessary for every survivor to see a cardiologist?
With over 4.3 million women in the U.S. currently living with a history of breast cancer – and that number expected to increase by another million in the next decade – the long-term health of these survivors is more critical than ever. Certain cancer treatments, while life-saving, can potentially impact the heart. This raises a crucial question: who truly needs extra heart monitoring?
This is the question addressed in a new editorial published in JAMA Oncology by UCLA Health experts, including Dr. Patricia Ganz and Dr. Eric Yang. They argue that the answer isn't as simple as it seems.
"Current cardio-oncology guidelines recommend cardiac imaging during and immediately following systemic cancer therapies in breast cancer and other malignant neoplasms, but long-term surveillance with these approaches has not been evaluated and evidence-based guidelines are lacking," the UCLA authors write. Biomarker tests, like those measuring B-type natriuretic peptide, show promise, but their usefulness in cancer survivors remains uncertain.
Understanding the Link Between Cancer Treatment and the Heart
Certain breast cancer treatments, such as anthracycline chemotherapy and HER2-targeted drugs like Herceptin (trastuzumab), can put stress on the heart in some patients. For years, doctors have monitored patients during treatment to catch early signs of heart problems. But, the big question is: how long should survivors continue to be monitored once treatment ends, and does everyone need to see a cardiologist?
To address this, Dr. Ganz and Dr. Yang evaluated a study that introduced a new tool to help pinpoint which breast cancer survivors face the highest chances of developing heart failure or cardiomyopathy in the decade following treatment. The team created a risk calculator using real-world clinical data from over 26,000 breast cancer patients within an integrated healthcare system in Southern California.
The findings were surprising. While specific breast cancer treatments did increase risk, most women did not develop serious cardiac disease. The strongest predictors of heart problems were less about cancer treatment and more about overall health.
And this is the part most people miss...
Most women aged 65 and older included in the study were already at high risk of heart disease, regardless of their cancer therapy. High blood pressure, diabetes, obesity, smoking, and a history of heart disease were bigger factors in a woman's long-term heart health than the chemotherapy regimen itself. The authors also found that cancer treatment alone rarely pushed younger women into a high-risk category. Few women under 40 at the time of diagnosis were at increased risk, suggesting that routine long-term cardiac imaging for all survivors may not be warranted.
So, who should see a cardiologist?
"It depends!" said Dr. Ganz and Dr. Yang.
Women who may benefit from seeing a cardiologist include those who:
- Received higher-risk chemotherapy.
- Developed heart issues during treatment.
- Are older or have multiple cardiovascular risk factors.
- Report symptoms like shortness of breath, fatigue, or swelling.
Instead of blanket heart screening for every survivor, the editorial emphasizes the importance of:
- Controlling blood pressure.
- Managing cholesterol.
- Maintaining a healthy weight.
- Knowing the early warning signs of heart disease.
For most survivors, regular visits with a primary care clinician, combined with an oncologist's input, may be sufficient.
"What all breast cancer survivors need is access to primary care that focuses on prevention or management of established cardiac risk factors, as well as regular clinical assessment of their functioning," wrote Dr. Ganz and Dr. Yang. "With attention to cardiac prevention and control, heart failure/cardiomyopathy is less likely to occur."
What do you think? Should all breast cancer survivors undergo routine heart screenings, or should it be more individualized? Share your thoughts in the comments below!
