How to protect your heart during breast cancer treatment

By Miles J. Varn, M.D., Chief Executive Officer at PinnacleCare

Like all types of medical care, treatment for breast cancer comes with both benefits and risks. A scientific statement published in the American Heart Association journal Circulation spurred media coverage of the link between some types of breast cancer treatment and an increased risk of developing heart failure and other types of heart disease. And while many media reports focused on the potential cardiotoxic effects of some chemotherapy drugs, targeted therapies, and radiation, that was not in fact the central message of the statement.

The goal of the statement was to encourage women undergoing treatment for breast cancer to talk with their oncologist and their primary care physician about steps they should take to mitigate the risk, what symptoms could mean they were experiencing heart problems, and what lifestyle changes they can make to lower the risk of heart disease during and after treatment. That message is supported by a very large study in the European Heart Journal that found that found that the risk of death from heart disease in women who’ve been treated for breast cancer isn’t actually higher than it is in the general population, even though some treatments can cause damage to the heart. The European study cited the importance of good risk management by physicians and hospitals as one of the reasons that the women in study did not have an increased risk of death due to heart disease.

What breast cancer treatments are associated with an increased heart disease risk?

Certain chemotherapy drugs, radiation therapy, especially to the left breast, and targeted therapies can have a negative effect on the heart. Some drugs in the anthracycline and taxane classes of chemotherapies can damage heart muscle cells, increasing the risk of heart failure. Herceptin (trastuzumab) and Perjeta (pertuzumab), which are used to treat HER-2 positive breast cancers, also increase this risk in some women and may cause arrythmias, blood clots, and enlargement of the heart. Radiation therapy can scar heart tissue, which many increase the risk of heart valve disorders and coronary artery disease.

But there are steps you can take to protect your heart during and after breast cancer treatment:

· Get your heart health assessed: If possible, before starting treatment, see a cardiologist or cardio-oncologist to find out if you have undiagnosed heart disease or factors such as high blood pressure, cholesterol, or blood sugar that increase your risk for heart disease and to develop a plan to lower your risk.

· Talk to your oncologist: Ask what potential risks your treatment presents, if there are ways to lower those risks, such as taking beta blockers, statins, or ACE inhibitors, which have been found to decrease the risk of heart damage from some types of breast cancer treatment, and how your heart health will be monitored during and after treatment.

· Learn the symptoms to watch for: Ask your doctor to outline the symptoms of treatment-related heart disease. For example, people with heart failure may have shortness or breath, swelling in the legs, feet, and ankles, fatigue and weakness, rapid or irregular heartbeat, and rapid weight gain from fluid retention.

· Make sure your medical record includes the specifics of your breast cancer treatment: If you have to seek emergency treatment for symptoms that could be caused by cardiovascular disease or damage, it’s important for all the physicians treating you to know what types of breast cancer treatment you’re undergoing or have undergone.

· Make heart healthy lifestyle changes: Studies have found that regular physical activity both improves survival and reduces the risk of heart injury from breast cancer treatment, so strive to get at least 30 minutes of aerobic exercise 5 or more days a week. Eating a healthy diet can also lower your risk of heart disease, as can reaching and maintaining a healthy weight. Don’t smoke and work with your doctor to keep your blood pressure, cholesterol, and blood sugar levels under control.