Introduction: Breast cancer (BC) treatment toxicity contributes to elevated rates of cardiovascular morbidities, such as reduced exercise capacity, a risk factor for long-term cardiovascular disease (CVD) and mortality. Past studies have shown that Black women experience greater cardiotoxicity after BC treatment than white women. No studies have investigated racial differences in exercise capacity. The lack of longitudinal data leaves uncertainty as to whether greater declines in exercise capacity are experienced by Black BC survivors. Methods: This cohort was comprised of 236 women with stage I-III BC (80% white; 20% Black) and 130 cancer-free controls in the UPBEAT (NCT02791581) and DETECT (NCT01719562) studies. Submaximal exercise capacity was obtained via 6-Minute Walk Distance (6MWD, meters [m]) at baseline (pre-treatment) and 3 months. Linear regression was used to examine associations of race with baseline 6MWD and changes in 6MWD. Results: Mean age [SD] of BC survivors was 55.7 [10.9] years. Mean [SD] total meters walked pre-treatment was lower in Black women with BC (423 m [81.0]) than white women with BC (475 m [87.7]; p=0.01), and lower than Black women without BC (471 m [76.9]; p=0.07). Black BC survivors experienced a greater mean decline from baseline to 3-months in 6MWD (30 m [68.5]) than white BC survivors (21.7 m [86.6]; Table 1; p=0.02) or Black women without BC (9.2 m [67.3]; p=0.001), translating to a mean difference of 60 m between Black and white BC survivors during BC treatment. Conclusions: This is the first study to suggest racial differences in submaximal exercise capacity during BC treatment. Black BC survivors experienced a greater reduction in exercise capacity than white BC survivors after cancer treatment as early as 3-months post-diagnosis. This clinically-meaningful difference in exercise capacity warrants further investigation, particularly to determine interventions to reverse the loss of exercise capacity.
Advances in breast cancer (BC) treatment have contributed to improved survival, but BC survivors experience significant short-term and long-term cardiovascular mortality and morbidity, including an elevated risk of heart failure with preserved ejection fraction (HFpEF). Most research has focused on HF with reduced ejection fraction (HFrEF) after BC; however, recent studies suggest HFpEF is the more prevalent subtype after BC and is associated with substantial health burden. The increased HFpEF risk observed in BC survivors may be explained by treatment-related toxicity and by shared risk factors that heighten risk for both BC and HFpEF. Beyond risk factors with physiological impacts that drive HFpEF risk, such as hypertension and obesity, social determinants of health (SDOH) likely contribute to HFpEF risk after BC, impacting diagnosis, management and prognosis.Increasing clinical awareness of HFpEF after BC and screening for cardiovascular (CV) risk factors, in particular hypertension, may be beneficial in this high-risk population. When BC survivors develop HFpEF, treatment focuses on initiating guideline-directed medical therapy and addressing underlying comorbidities with pharmacotherapy or behavioural intervention. HFpEF in BC survivors is understudied. Future directions should focus on improving HFpEF prevention and treatment by building a deeper understanding of HFpEF aetiology and elucidating contributing risk factors and their pathogenesis in HFpEF in BC survivors, in particular the association with different BC treatment modalities, including radiation therapy, chemotherapy, biological therapy and endocrine therapy, for example, aromatase inhibitors. In addition, characterising how SDOH intersect with these therapies is of paramount importance to develop future prevention and management strategies.
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