High rate of breast cancer (BC) survivors is registered. Increased longevity is associated with increased cardiovascular disease (CVD) risk. Screening for cardiac defects could then be an interesting approach since it can lower the risk of cardiovascular complications.
In this prospective study, all BC patients treated ≥ 5 years ago were screened for CVD. We identified BC patients with no history of CVD at diagnosis, treated between 1998 and 2017 and followed them through December 2022. We used for CVD screening, electrocardiogram (EKG) and transthoracic echocardiogram (TTE). CVD were categorized as asymptomatic or symptomatic. We considered to be CVD risk factors: age, obesity, hypertension, diabetes mellitus, dyslipidemia, anthracycline, trastuzumab, aromatase inhibitor, left-sided radiation. For analysis we used univariate and multiple logistic regression with a backward elimination method.
296 patients were identified, with an average age of 47.6 years (32-65) at diagnostic and 59.2 years (37-82) at screening. 46% were postmenopausal at diagnosis. 32.6% had Hypertension, 13.5% Diabetes mellitus, 29.3% Dyslipidemia, 34.9% Obesity. 93.6% received cardiotoxic treatment (92.6% Anthracyclines, 7.6% Trastuzumab, 38.8% Aromatase inhibitor, 53.0% Left sided radiation). Median interval from diagnosis to screening was 10.4 years (range 5.8–23.4). CVD occured in 21.6% patients. 3.7% was clinical CVD : heart failure (1.7%), atrial fibrillation (0.7%), stable angina (0.7%), myocardial infraction (0.3%), severe aortic stenosis (0.3%). The remaining 17.9% of CVD were detected on EKG and TTE in asymptomatic patients: 9.8% valvular regurgitation, 5.7% left ventricular hypertrophy, 1.0% diastolic dysfunction, 0.7% systolic dysfunction, 0.7% heart block. Multiple logistic regression analysis revealed that increasing age, hypertension, and the combination doxorubicin plus left-sided radiation plus aromatase inhibitor (OR = 1,44; 95% CI, 1.14–1.61; p < 0,01) were significant risk factors.
Our results suggest that Bi-modality CVD screening in BC survivors could be an interesting approach since most CVD were asymptomatic and occurred in high-risk patients. This should allow reduce severe forms of CVD and cardiovascular death.
The authors.
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All authors have declared no conflicts of interest.