Higher Heart Failure Risk Lasts Long After Chemotherapy for Breast Cancer Ends
People who received anthracycline chemotherapy to treat breast cancer had a higher risk of heart failure that lasted for decades after the treatment ended, according to a study.
The research was published online on Feb. 3, 2023, by the journal JAMA Network Open. Read “Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010.”
About anthracycline chemotherapy medicines
There are five anthracycline chemotherapy medicines used to treat breast cancer:
Adriamycin (chemical name: doxorubicin)
Ellence (chemical name: epirubicin)
Doxil (chemical name: liposomal doxorubicin)
daunorubicin (brand names: Cerubidine, DaunoXome)
mitoxantrone (brand name: Novantrone)
Anthracyclines work by damaging a cancer cell’s genes and interfering with its reproduction. Like all chemotherapy medicines, anthracyclines may cause side effects, including heart damage, which can lead to heart failure.
About the study
Although we know that anthracyclines can cause heart damage, we still don’t know how long the risk of heart problems lasts after treatment ends. In this study, the researchers wanted to try to answer that question, as well as estimate the size of the risk.
The study included 2,196 people who lived in Olmsted County, Minnesota:
812 people had been diagnosed with breast cancer, Hodgkin lymphoma, or non-Hodgkin lymphoma and received chemotherapy, with or without radiation
1,384 people had no history of cancer and were similar in terms of age, race, and biological sex
Both Hodgkin and non-Hodgkin lymphomas are cancers that begin in the lymphatic system.
Among all the people in the study:
half were older than 53 years, and half were younger
78% were women
about 92% were white
Follow-up time was longer for people with no history of cancer:
People who had been diagnosed with cancer were followed for 5.2 to 13.4 years.
People with no history of cancer were followed for 8.7 to 17.5 years.
People who had been diagnosed with cancer were more likely to be current or former smokers and have coronary artery disease:
43% of people who had been diagnosed with cancer had a history of smoking versus 21% of people with no history of cancer
5% of people who had been diagnosed with cancer had coronary artery disease versus 2% of people with no history of cancer
Coronary artery disease is one of the most common heart diseases in the United States. It’s caused by plaque building up on the walls of the arteries that supply blood to the heart. When the arteries are narrowed or blocked by plaque, it can cause chest pain — called angina by doctors — shortness of breath, and heart attacks.
The researchers’ analysis showed that people who had been diagnosed with cancer had a higher risk of congestive heart failure than people with no history of cancer, even after the researchers took into account a number of variables, including history of coronary artery disease, smoking, and high blood pressure.
This increase in risk started in the first year after diagnosis and increased over time.
Congestive heart failure happens when your heart doesn’t pump blood as well as it should.
People who had been diagnosed with cancer and received an anthracycline had a higher risk of congestive heart failure than people with no history of cancer:
One year after diagnosis, 1.81% of people diagnosed with cancer had congestive heart failure versus 0.09% of people with no history of cancer.
Five years after diagnosis, 2.91% of people diagnosed with cancer had congestive heart failure versus 0.79% of people with no history of cancer.
Ten years after diagnosis, 5.36% of people diagnosed with cancer had congestive heart failure versus 1.74% of people with no history of cancer.
Fifteen years after diagnosis, 7.42% of people diagnosed with cancer had congestive heart failure versus 3.18% of people with no history of cancer.
Twenty years after diagnosis, 10.75% of people diagnosed with cancer had congestive heart failure versus 4.98% of people with no history of cancer.
Twenty-five years after diagnosis, 14.69% of people diagnosed with cancer had congestive heart failure versus 9.02% of people with no history of cancer.
All these differences were statistically significant, which means they were likely due to the cancer treatment and not just because of chance.
There was no difference in congestive heart failure risk between people who received a non-anthracycline chemotherapy for cancer and people with no history of cancer.
The increase in congestive heart failure risk in people who received an anthracycline happened regardless of the anthracycline dose. In other words, people who received a lower dose of anthracycline chemotherapy had the same increase in congestive heart failure risk as people who received a higher dose.
The researchers also wanted to see if there were other risk factors linked to a higher risk of congestive heart failure. They found that age — people who were older when diagnosed with cancer — had a higher risk.
“In this … study, anthracyclines were associated with an increased risk of [congestive heart failure] early during follow-up, and the increased risk persisted over time,” the researchers concluded. “The cumulative incidence of [congestive heart failure] in patients with breast cancer or lymphoma treated with anthracyclines at 15 years was more than two-fold that of the control group.”
What this means for you
If you’re scheduled to receive or have received anthracycline chemotherapy to treat breast cancer, the results of this study are concerning, especially if you were older when you were diagnosed.
It makes sense to discuss the study’s results with your doctor so you can work together to develop a long-term plan to monitor your heart for any problems.
Many oncology guidelines recommend heart function testing before, immediately after, and one year after anthracycline chemotherapy. Still, many recommendations say that people who are considered to have a low or medium risk of heart problems don’t need to be rechecked until five years later. This study suggests that it may be important to check heart function more often.
Learn more about heart problems that are a side effect of breast cancer treatment.
Updated on February 24, 2023