There is higher rate of heart failure
among breast cancer survivors than has previously been reported. 12,000
women were studied, and a report found that the women had a 20 percent
risk of developing heart failure over just five years if they got a
common chemotherapy regimen. This is compared to just 3.5 percent of
breast cancer patients who did not get chemo.
Clinical trials of breast cancer
patients have shown that the drugs can damage the heart and cause higher
rates of heart failure. They generally demonstrate about a 4 percent
increase in heart failure over three to five years for women getting
chemo. Clinical trials usually involve a select group of patients who
are healthy in other ways.
Each drug raised the risk on its own, but the combination greatly raised heart failure rates.
It is important to note that these
rates do vary by age. The rates are much lower in the younger women.
More than 40 percent of the women over the age of 75 who got a
combination of an anthracycline and Herceptin also developed heart
failure within five years and 13.7 percent of the breast cancer
patients that age who did not get chemo developed heart failure.
The study highlights a growing
problem. The American Cancer Society estimates there are 12 million
cancer survivors alive in the United States now. As many cancer patients
survive their disease and lead ever-longer lives, they find they must fight second battles against
the long-term effects of the treatments that saved their lives. Even
so-called targeted therapies, which were designed to better target tumor
cells while leaving healthy tissue alone, have been shown to cause
long-lasting damage.
And as they leave the care of a
specialized oncologist and return to day-to-day care, they may not know
they’re at special risk of other conditions – and their primary care
doctors may not be aware, either. The American Society of Clinical
Oncology has been warning about the problem for years, and released
research at its annual meeting last June showing that 94 percent of primary care doctors didn’t know about the potential long-term effects of drugs commonly used to treat breast and prostate cancer.
Breast cancer is the leading cancer killer of U.S. women,
after lung cancer. It is diagnosed in more than 220,000 women a year,
according to the American Cancer Society, and will kill nearly 40,000
this year. About 20 percent of cases are a kind called HER-2 positive,
and Herceptin was formulated to especially target this kind. It’s very
effective and has saved thousands of lives, but it was known to also
damage the heart, although doctors don’t understand just how.
Heart failure is also very common. The National Heart, Lung and
Blood Institute estimates 4.8 million Americans have congestive heart
failure, which is a chronic condition in which the heart doesn’t pump
blood effectively. Half of patients with heart failure die within five
years, and 400,000 people get newly diagnosed every year.
So what can women do if they’ve had chemo for breast cancer and want to watch their hearts?
Cardiologist Dr. Larry Allen of the
University of Colorado in Denver, who also worked on the study, said
they first of all need to be educated about what drugs they have taken
and what the side-effects are.
“Second, patients should ask about what
heart tests may be indicated before, during, and after treatment,”
Allen said in a statement. These may include tests of how well the heart
is pumping blood – tests that most women won’t get during a routine
physical or well-woman visit.
“Third, in addition to allowing doctors
to monitor for heart problems, patients can monitor themselves for
worsening heart function by understanding how heart problems may present
— including shortness of breath especially when lying flat, leg
swelling, palpitations/heart fluttering, and exercise intolerance (these
symptoms can represent non-heart disease too, but generally warrant
additional evaluation),” Allen added.
“Unfortunately, it is unknown if
medications that are typically used to treat heart failure (such as
beta-blockers and ACE inhibitors) might protect against heart damage
from certain chemotherapy drugs.
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