Do You Need to See a Cardiologist After Breast Cancer Treatment? It Depends
Breast cancer treatments are known to increase the risk of heart issues. Researchers now have a tool that they say can help predict breast cancer survivors who are most likely to develop heart failure within 10 years of treatment.
The new tool can help these people figure out if they should see a cardiologist to help them monitor their heart health.
Most people who have had breast cancer will not develop heart failure. But measuring risk factors for heart failure is an important part of preventative care for survivors, says Ana Barac, MD, a cardio-oncologist at Inova, a healthcare system in Northern Virginia. Barac was a co-author of the study in JAMA Oncology that describes the new tool.
Calculating heart failure risk
To predict the risk of heart problems following breast cancer treatment, researchers studied more than 26,000 women with early-stage breast cancer from California. They followed 60% of these women for 10 years to see if they developed heart failure or cardiomyopathy (a disease that can lead to heart failure). Then, the researchers used statistics to figure out how different risk factors affected the women’s chances of developing these heart problems.
The researchers came up with a scoring system to predict the risk of heart problems as either low, medium, or high. They then tested the model using the other 40% of women in the study. They found that in almost 80% of cases, the tool correctly classified the women as having low, medium, or high risk of heart failure or cardiomyopathy.
“Anyone who has a high risk and people with a medium risk who are in the younger category [diagnosed before age 54] should consider seeing a cardiovascular specialist,” Barac says.
Factors that raise the risk of heart failure
The researchers found a handful of risk factors that raise the chances a woman develops heart failure after breast cancer treatment:
diagnosis with breast cancer at age 65 or older
high blood pressure
other heart conditions
diabetes, obesity, or history of smoking
treatment with chemotherapy, especially anthracyclines
treatment with anti-HER2 therapies
Having chemotherapy or anti-HER2 therapies doesn’t put you into a higher risk category on its own or mean you’ll have heart failure. You have to look at the whole picture to know your risk.
Using the tool to guide treatment decisions
The new model doesn’t just help doctors figure out a woman’s risk after breast cancer treatment. It can also guide conversations about treatment plans.
For example, if a woman younger than age 54 doesn’t have other risk factors like high blood pressure or diabetes, her doctor may not be too concerned about using anthracycline chemotherapy. In this case, the benefits of using this chemotherapy drug, which is one of the most effective against breast cancer, will outweigh the risks to the heart.
Even if a treatment would bring a woman into the high-risk category for heart failure, it may be what’s best for her overall health. It all depends on the specifics of the cancer. “The point of this score is to facilitate that decision-making,” Barac says.
Managing heart health
One of the most important findings of the study is which risk factors people should focus on to protect themselves from heart failure. If you have high blood pressure, for instance, there are steps you can take to manage it with medicine, weight loss, and changes to your diet.
The new risk prediction tool is meant to be used by healthcare professionals. Barac suggests sharing the study with your oncologist, cardiologist, or primary care provider and asking them which risk category you’re in and if you should be doing anything differently to manage your heart health.
If you’re at high risk, “there’s no reason to panic,” Barac says. Take this as a sign that you should see a cardiologist. They can use blood tests or imaging to monitor you. They can also help you take steps to reduce your risk of heart failure.