Breast cancer survivors understandably may be more concerned about the risk of breast cancer coming back (recurrence) than other health issues. Still, the study reviewed here found that the risk of a serious heart problem, such as a stroke or heart attack, often was the same or greater than the risk of breast cancer recurrence. The results were presented at the 2009 ASCO Breast Cancer Symposium.
The researchers looked at the health histories of 242 post-menopausal women treated for hormone-receptor-positive early-stage stage breast cancer and calculated the risk of breast cancer recurrence and a serious heart problem over 10 years using two tools.
Adjuvant! Online is an Internet tool that allows doctors and patients to calculate the risk of early-stage breast cancer recurrence over time, based on specific health and personal factors. Determining recurrence risk can help you and your doctor decide if treatments to lower recurrence risk, such as chemotherapy, make sense for your unique situation.
The Framingham Heart Study was a large, long-term study. Doctors use the results of the Framingham Study to calculate the risk of heart attack and stroke for a person, based on specific health and personal factors.
The results:
High risk meant that the women's risk of recurrence or having a heart problem in 10 years was higher than 25%.
Moderate risk meant that the women's risk of recurrence or having a heart problem in 10 years was 10%-25%.
Low risk meant that the women's risk of recurrence or having a heart problem in 10 years was less than 10%.
While it's likely that all of the women in the study were very aware of their risk of recurrence, it's also likely that many of them were less aware of their risk of heart problems. Still, this study shows that most of the women were as likely or even more likely to have a serious heart problem as recurrence. Only 22% of the women had a risk of recurrence that was higher than their risk of heart problems.
The researchers didn't identify any links between breast cancer and the risk of heart problems. But it is possible that there may be a relationship between certain breast cancer treatments and the risk of heart problems. Radiation therapy and some chemotherapy and targeted therapy medicines can injure the heart. Still, most of the cardiac risk was likely related to other health factors -- high blood pressure or high cholesterol, for example -- that increase the risk of heart problems in ALL people, whether or not they were treated for breast cancer.
If you've been diagnosed with breast cancer, work with your doctor to keep all health risks, including the risk of recurrence and heart problems, as low as they can be. Adopting a heart healthy lifestyle is important for everyone, but it's especially important for people diagnosed with breast cancer. You can't change the fact that you need treatment. But you can reduce your risk of both recurrence and cardiac disease by changing factors you can control:
It's also very important that you regularly see a doctor who's familiar with your breast cancer treatment history and understands any special risks you have. Together, you can come up with a counseling, monitoring, and screening plan that is best for your unique situation.
SAN FRANCISCO (MedPage Today) -- Although breast cancer survivors may focus on their long-term risk of recurrence, most should be just as concerned about their hearts, researchers found.
The 10-year risk of a serious cardiovascular event was at least as high as the risk of breast cancer for 78% of women, Aditya Bardia, MD, MPH, of Johns Hopkins, and colleagues reported here at the ASCO Breast Cancer Symposium.
These findings don't negate the importance of long-term management of breast cancer risk, Bardia said, but suggest more attention to the bigger picture. "Other things are also important," she said.
Rowan Chlebowski, MD, PhD, of Harbor-UCLA Medical Center in Los Angeles and chair of the session where the results were presented, said this is a consistent message emerging in breast oncology.
"Breast cancer patients need more attention to cardiovascular health regardless of their risk level," he said. "We need more interaction with cardiologists."
That may mean referrals of high-risk patients for appropriate managment, Bardia said. But counseling about risk reduction strategies common to cardiology and oncology, such as physical activity, may help avoid both hazards, he suggested.
His group analyzed data from 242 postmenopausal women (mean age 61) with hormone-responsive, up-to-stage-III breast cancer who had baseline cardiovascular risk factor data available in the Exemestane Letrozole Pharmacogenetic (ELPh) trial.
The researchers calculated 10-year modified Framingham risk scores as well as 10-year breast cancer recurrence risk computed from age, tumor size and grade, and lymph node status using the Adjuvant! Online tool.
They found that 3% and 12% of the women were at high risk (greater than 25% ) for breast cancer and cardiovascular disease, respectively.
Another 55% and 52%, respectively, were at moderate risk (10% to 25%), while 42% and 36% were at low risk (less than 10% over 10 years), respectively.
The analysis indicated that breast cancer characteristics do not interact with cardiovascular risk.
But comparing the two, just 22% of women had a breast cancer recurrence risk over 10 years that was greater than the risk of heart disease, stroke, or peripheral vascular disease.
The two risks were equal for 43% of the breast cancer survivors, and cardiovascular risk dominated for the remaining 35%.
Cardiovascular disease risk was more likely to be the predominant concern for women who had small breast tumors (PR 5.7 for smaller versus larger than 2 cm), low grade tumors (OR 3.0 for grades 1 and 2 versus grade 3), node negative disease (OR 2.9), and early stage cancer (OR 5.1 for stage I versus stages II or III).
Bardia cautioned that these results were estimates, based on prognostic tools, rather than actual outcome data, and he noted that the study did not factor in potentially important variables, including obesity, diabetes, and the effect of breast cancer treatment on risk.
While it's easy to point the finger at chemotherapy in regard to cardiovascular risk in this population, hypertension may be just as important, said Jean-Bernard Durand, MD, a cardiologist at the M.D. Anderson Cancer Center in Houston, who was not involved in the study.
He recommended that oncologists develop relationships or partnerships with cardiologists to help manage these risks and to weigh competing health morbidities. This is particularly important for women with very early stage breast cancer, to minimize use of cardiotoxic agents, and to offer early cardiac prevention strategies.
The study was based on a trial funded by the National Institutes of Health, Pfizer, and Novartis. The researchers reported receiving research funding from AstraZeneca, Eli Lilly, Pfizer, and Novartis.
Chlebowski reported conflicts of interest with AstraZeneca, Pfizer, Novartis, Lilly, sanofi-aventis, and Genetech. Duran reported no conflicts of interest.
Primary source: ASCO Breast Cancer Symposium Source reference: Bardia A, et al "Comparison of breast cancer recurrence risk and cardiovascular disease risk among postmenopausal breast cancer survivors" ASCO Breast 2009; Abstract 133.
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