UCLA experts call for personalized heart monitoring in breast cancer survivors

As breast cancer survival rates continue to rise—4.3 million women in the U.S. are currently living with a history of the disease, and in the next 10 years that number is expected to increase by another million—heart health has become an increasingly important part of survivorship care.

Some breast cancer treatments, while life-saving, can also put stress on the heart, raising important questions about who might benefit from closer monitoring.

But does every breast cancer survivor need to see a cardiologist?

A new article published on JAMA Oncology and led by UCLA Health Jonsson Comprehensive Cancer Center researchers Patricia Ganz, MD, distinguished professor of medicine at the David Geffen School of Medicine at UCLA, and Eric Yang, MD, director and founder of the UCLA Cardio-Oncology Program, says the answer is more nuanced than many might expect.

“Current cardio-oncology guidelines recommend cardiac imaging during and immediately after systemic cancer treatments in breast cancer and other malignancies, but long-term follow-up with these approaches has not been evaluated and no evidence-based guidelines existg,” the UCLA authors write. Tests of biomarkers, such as B-type natriuretic peptide, show promise, but their utility in cancer survivors remains uncertain.

Understanding the relationship between cancer treatment and the heart

Some breast cancer treatments, including anthracycline chemotherapy and drugs that target HER2, such as Herceptin (trastuzumab), are known to stress the heart in some patients. For years, doctors have monitored patients during treatment to detect early signs of heart dysfunction.

However, it is unclear how long survivors should continue to be followed after treatment ends and whether all survivors would benefit from seeing a cardiologist.

In the editorial, Dr. Ganz and Dr. Yang evaluated a study that introduced a new tool to help identify which breast cancer survivors face the highest odds of developing heart failure or cardiomyopathy in the decade after treatment. The team created a risk calculator using real-world clinical data from more than 26,000 breast cancer patients in an integrated healthcare system in Southern California.

The findings revealed that while some breast cancer treatments, including anthracycline chemotherapy and drugs that target HER2, increased the risk, most women did not go on to develop serious heart disease. Instead, the strongest predictors had less to do with cancer and more to do with overall health.

Most women 65 and older included in the study were at high risk of heart disease, regardless of cancer treatment. High blood pressure, diabetes, obesity, smoking and a history of heart disease contributed more to a woman’s long-term heart outlook than the chemotherapy regimen.

The authors also found that cancer treatment alone rarely pushed younger women into a high-risk category, with few women younger than 40 at the time of diagnosis being at increased risk, suggesting that routine long-term cardiac imaging for all survivors may not be warranted.

So, who should see a cardiologist?

“Iit doesn’t depend!said Dr. Ganz and Dr. Yang.

Women who may benefit from seeing a cardiologist include those who received higher-risk chemotherapy, developed heart problems during treatment, are older or have multiple cardiovascular risk factors, or report symptoms such as shortness of breath, fatigue, or swelling.

Rather than blanket heart screening for every survivor, the article emphasizes the importance of the basics: blood pressure control, cholesterol management, maintaining a healthy weight, and knowing early warning signs of heart disease.

For most survivors, regular visits with a primary care clinician, combined with input from an oncologist, may be sufficient.

“What all breast cancer survivors need is access to primary care that focuses on the prevention or management of defined cardiac risk factors, as well as regular clinical assessment of their functionDr. Ganz and Dr. Yang wrote.With attention to cardiac prevention and control, heart failure/cardiomyopathy is less likely to occur.”