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Breast Cancer and Heart Failure

Q & A with Javid Moslehi, M.D., Director of Vanderbilt’s Cardio-Oncology Program

January 28, 2016

What is Cardio-Oncology?

Cardio-Oncology is cardiovascular care of cancer patients and cancer survivors. This field has essentially emerged as a result of the success of novel cancer therapies which have revolutionized care for patients. On the other hand, some of these successful therapies can lead to effects on the heart and vasculature. For example, there are 3 million breast cancer survivors in the U.S. today. These patients are at risk of cardiac disease, which can result from chemotherapy and radiation used to treat breast cancer. Cardiotoxicity can occur in various forms and can include damage to the heart muscle itself, the heart arteries or the heart valves. If the heart muscle is damaged, the heart will pump less efficiently—a disease called cardiomyopathy, or heart failure.

Which breast cancer drugs have the potential to cause heart failure?

Anthracyclines are strong chemotherapy drugs that disrupt tumor growth. An example is doxorubicin (also known as Adriamycin). HER2 targeted therapies, for example trastuzumab (also called Herceptin), are often given in combination with other chemotherapies and decrease the risk of cancer recurrence in a subset of patients. Both doxorubicin and trastuzumab can lead to heart failure—either during the duration of therapy or several years after the cancer has been in remission.

What tests should the doctor order to determine heart function?

  1. Electrocardiogram, commonly referred to as an EKG or ECG, records the electric activity of the heart. It may show irregularity in the beats or damaged parts of the heart.
  2. Echocardiogram, or Echo, is an ultrasound of the heart.

As a general rule, we recommend that all patients being treated with either anthracyclines or HER2 targeted therapies undergo cardiac evaluation either during or after completion of breast cancer treatment. This should include an echocardiogram.

How should heart failure be managed and treated?

There are several medications that protect the heart and help alleviate the stress that it endures during heart failure. Beta-blockers or angiotensin-converting enzyme inhibitors are two classes of medications that help protect the heart. Both do this, in part, by decreasing blood pressure, thus decreasing the workload of the heart.

If heart failure as a result of breast cancer therapy is suspected, your oncologist should refer you to a cardio-oncologist, or a cardiologist who specializes in the care of the heart for cancer patients.

What are my risks of developing heart failure?

The chance of developing heart failure varies in each case and depends on a number of issues including baseline cardiac risk factors or cardiac disease in each patient as well as dose and types of chemotherapy received. Risk factors include gender, age, underlying cardiovascular disease or concurrent treatment with other chemotherapy or radiation.