Purpose: To review the risk factors shared between cardiovascular disease and breast cancer and screening protocols for cardiac complications as a result of breast cancer treatment.
Methods: An extensive literature search was conducted to analyze current recommendations for prevention and screening for cardiotoxicity in breast cancer patients. Then, a retrospective analysis was performed on the medical records of 307 patients who received a survivorship care plan at Levine Cancer Institute, following the completion of their breast cancer treatment. This population was grouped into subcategories, those who received cardiotoxic regimens (n=194) vs. non-cardiotoxic regimens (n=113). Cardiotoxic regimens involved Anthracyclines, left-sided radiation (LXRT) and/or Trastuzumab. Each patient’s history was evaluated for CV risk factors, including: age > 65 years, obesity, DM, HTN, HLD, CVD, and tobacco use. Of patients who received cardiotoxic regimens, a comparison was made between cardiac risk factors to the development of adverse cardiac events, if any. Lastly, patients who were appropriately screened for cardiotoxicity after treatment completion with an echocardiogram (echo) were identified.
Results: While a strong body of evidence exists demonstrating the known cardiotoxic effects of various breast cancer treatment regimens, there are no consensus guidelines available for the screening of potential cardiotoxicities in breast cancer patients and survivors.
Conclusion: Cardiotoxicity as a result of breast cancer treatment can manifest in several different ways, including heart failure, an asymptomatic drop in left ventricular ejection fraction (LVEF), hypertension, arrhythmias, QTC prolongation, pericarditis and myocardial ischemia.3 Due to the varying presentation of cardiotoxicity, it is essential providers understand the effects of selected cancer treatments, tailor treatments to minimize exacerbation of pre-existing cardiac risk factors when possible, and appropriately screen patients following the completion of cancer treatment.
Keywords: Cardiotoxicity, Breast Cancer, Anthracyclines, Trastuzumab, Cardio-Oncology, Radiation Therapy
Hines M. Cardiotoxicity Screening in Breast Cancers Survivors. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(1).
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