Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

Abstract

Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer.Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001-2008 in the Stockholm-Gotland region and followed-up until 2017. Time-dependent risks of arrhythmia, heart failure and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model.Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR=1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following loco-regional radiotherapy.Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices.Funding: This work was supported by the Swedish Research Council [grant no: 2018-02547]; Swedish Cancer Society [grant no: CAN-19-0266] and FORTE [grant no: 2016-00081].

COVID-19 e as implicações do afastamento compulsório das gestantes na Lei 14.151/2021

“…Among the patients who presented cardiotoxicity, it was observed that most of the patients used the classic treatment in monotherapy, as shown by the classic treatment protocols in Table 1. The result can be explained by the fact that the majority of the patients of the treatment containing anthracycline (Yang et al, 2022). Doxorubicin toxicity has a cumulative characteristic.…”

Circulating Leukocyte Subsets Before and After a Breast Cancer Diagnosis and Therapy

“…Approximately 4 million women with a history of breast cancer (hereinafter referred to as breast cancer survivors) live in the US . Breast cancer survivors have higher age-specific rates of hypertension and other chronic diseases than women without a history of breast cancer . Our group and others have shown that alterations to the immune system are associated with risk of these chronic conditions in the general population, leading to the hypothesis that the higher chronic disease risk in breast cancer survivors may be driven, in part, by changes in immune function.…”

“…1 Breast cancer survivors have higher age-specific rates of hypertension and other chronic diseases than women without a history of breast cancer. [2][3][4][5][6][7] Our group 8 and others [9][10][11] have shown that alterations to the immune system are associated with risk of these chronic conditions in the general population, leading to the hypothesis that the higher chronic disease risk in breast cancer survivors may be driven, in part, by changes in immune function. Herein, we examine this hypothesis by investigating whether breast cancer diagnosis and treatment are associated with lasting changes to the peripheral immune system.…”

Associations of age at diagnosis of breast cancer with incident myocardial infarction and heart failure: a prospective cohort study

“…(Du et al, 2009;Lin and Lengacher, 2019) Previous studies focused on the subsequent CVD risk after breast cancer diagnosis revealed that patients had an excess risk of myocardial infarction (MI) and heart failure (HF). (Khan et al, 2011;Reding et al, 2022;Yang et al, 2022) Improvements in breast cancer screening also resulted in an increase in patients diagnosed at younger age. The association of breast cancer with HF was found to be affected by age, as an increased risk of HF was observed only in younger patients.…”