Breast cancer and heart health may seem like two unrelated medical concerns. And, for many women struggling through chemo and radiation, concerns about the health of their heart may not be high on their list of concerns. However, expert insights by Breast Cancer Trials (AUNZ’s largest oncology research group), reveal a deeper connection between them. Professor Aaron Sverdlov – a cardiologist with a special interest in heart failure and cardio-oncology- has explores why understanding this critical intersection is crucial for breast cancer patients and survivors, as well as their healthcare providers.
The connection between breast cancer and heart health
According to Professor Sverdlov, both breast cancer and heart disease share several common risk factors such as age, smoking, obesity, and excessive alcohol consumption. These shared risk factors mean that individuals predisposed to one are often at a higher risk for the other. However, the link goes beyond these commonalities. Treatments for breast cancer, including chemotherapy, radiation, and targeted therapies, can have significant impacts on heart health.
Impact of breast cancer treatments on the heart
Professor Sverdlov explains that chemotherapy drugs, especially anthracyclines, and HER2-targeted therapies like trastuzumab, are known to damage the heart, potentially leading to heart failure or weakened heart muscles. “Anthracyclines, used for some forms of breast cancer, kill cancer cells by damaging their DNA and mitochondria, but these effects can also occur in heart cells,” he says. Since heart cells cannot regenerate, the damage can accumulate and become permanent, resulting in weakened heart muscle and heart failure.
Radiation therapy, particularly to the chest area, poses another risk. It can harm the heart and blood vessels, increasing the likelihood of coronary artery disease due to the direct effects of ionising radiation and the formation of free radicals. While modern radiation techniques have reduced the extent of heart damage, the risk remains, especially when combined with certain chemotherapies.
Long-term cardiovascular risks for breast cancer survivors
Breast cancer survivors face increased risks of heart problems such as heart failure, coronary artery disease, and arrhythmias. These risks vary depending on the type of treatment received. “Survivors need regular heart check-ups to manage these risks effectively,” notes Professor Sverdlov. The long-term effects of treatments like anthracyclines and HER2-targeted therapies are particularly concerning, as they are linked to a higher chance of heart failure. Radiation therapy can also lead to long-term issues like coronary artery disease and heart valve problems, although these are becoming less common with better techniques.
Preventative measures and monitoring
Preventive measures are vital for protecting heart health during and after breast cancer treatment. A thorough heart health assessment before starting cancer treatment and regular monitoring during and after treatment are crucial. “Managing risk factors such as high blood pressure, high cholesterol, and diabetes, along with maintaining a healthy lifestyle, can significantly reduce both short and long-term toxicities of cancer therapies,” advises Professor Sverdlov. Tests like echocardiograms and blood biomarkers help detect early signs of heart damage. In high-risk patients, heart-protective medications like beta-blockers and ACE inhibitors can be beneficial.
Looking into lifestyle choices
Adopting a healthy lifestyle is key to mitigating heart risks. Eating a balanced diet rich in fruits and vegetables, staying physically active, avoiding smoking, and maintaining a healthy weight can significantly improve heart health and cancer outcomes. “Exercise, even moderate activities like walking, can boost cardiovascular fitness and lower the risk of heart disease,” says Professor Sverdlov. There is strong evidence that moderate exercise reduces the risk of cardiotoxicity and improves cancer treatment response rates.
The importance of collaborative care
Furthemore, research is continuously advancing in this field, aiming to better understand the mechanisms of cardiotoxicity and develop protective strategies. Current research focuses on developing and validating risk assessment tools, new biomarkers for early detection of heart damage, and creating cancer treatments that are less harmful to the heart. Studies are also exploring the effectiveness of various heart-protective strategies and personalised medicine approaches to better predict and manage heart risks in cancer patients.
Collaboration between oncologists, cardiologists, and other specialists is essential for providing comprehensive care. This team approach ensures that both cancer treatment and heart health are managed effectively, reducing the risk of heart problems and unnecessary interruptions of cancer therapy. Clear communication and coordinated care among healthcare providers are critical for timely detection and management of heart-related issues.
Breast Cancer Trials Q&A Event
To further explore the connection between breast cancer and heart health, guests can join the Breast Cancer Trials’ free online Q&A event on Wednesday, 7th August from 5 – 6:30 pm (AEST). The expert panel will discuss the prevalence and management of cardiotoxicity and cardiovascular disease after breast cancer, strategies for prevention, and a multidisciplinary approach to risk management.
Alongside, Professor Aaron Sverdlov, the panel includes Professor Bogda Koczwara, a senior medical oncologist and leader in cancer survivorship research; Dr Elysia Thornton-Benko, a GP specialising in cancer survivorship; Associate Professor Eng-Siew Koh, a senior specialist in radiation oncology focused on survivorship and late effects research; Ms Lee Hunt, a cancer consumer and advocate who has experienced cardiac toxicity from treatment; and Ms Melissa Bell, a passionate clinical trial advocate with post-treatment cardiovascular issues.
Further support
Breast Cancer Trials is launching their 2025 Women’s Health Diary which will be available to purchase from September 2nd either through the Breast Cancer Trials website or at all good newsagents.
All proceeds from the diary go to funding critical research into the prevention and treatment of breast cancer – the most diagnosed cancer for women. With diagnoses on the rise for breast cancer, ongoing research is vital to save more lives.
