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A study of cardiac dysfunction in breast cancer survivors suggests the problem is more prevalent and needs closer attention than previously thought.

Smita Bhatia, MD, MPH, of the University of Alabama at Birmingham (UAB), and colleagues analyzed echocardiographic data from a large group of survivors who received anthracyclines, trastuzumab, or radiation therapy.

"This cohort of 829 breast cancer survivors followed via 2,808 echocardiograms for a median of 8.6 years is one of the largest studies in a real-world setting to assess the risk of cardiac dysfunction in this population," the researchers noted in the .

The cumulative incidence of new-onset cardiac dysfunction increased steadily from 1.8% at 2 years to 15.3% at 15 years from cardiotoxic therapy initiation. Significant risk factors for cardiac dysfunction included Black race (HR 2.15, P=0.009), use of anthracyclines (HR 2.35, P=0.0079), use of anthracyclines with trastuzumab (HR 3.93, P=0.0010), and pre-cancer hypertension (HR 3.16, P=0.0006).

"The current study provides evidence for the importance of extended surveillance for cardiac dysfunction in breast cancer survivors," the investigators concluded.

Bhatia, Vice-chair of Outcomes in the Department of Pediatrics, the Gay and Bew White Endowed Chair in Pediatric Oncology, and Director of the Institute for Cancer Outcomes and Survivorship, discussed additional details of the study and implications in the following interview.

How does this study differ from previous studies on this issue?

Bhatia: This study describes the trajectory of echocardiographic parameters among breast cancer survivors who have been treated with cardiotoxic therapy. The study also examines the modifying influence of pre- and post-cancer conventional cardiovascular risk factors (hypertension, dyslipidemia, smoking, diabetes, and obesity) on the risk of cardiotoxic therapy–associated cardiac dysfunction.

What do current guidelines recommend for surveillance for cardiac dysfunction in breast cancer survivors?

Bhatia: Currently, surveillance is limited to history and physical examination, and echocardiograms are recommended only for those who present with symptoms.

What does the study suggest about surveillance for cardiac dysfunction and management of cardiovascular risk factors in breast cancer survivors?

Bhatia: Our results provide evidence that early echocardiographic changes are present in those exposed to anthracyclines. Findings from the study support close echocardiographic surveillance for several years after cardiotoxic therapy exposure and also suggest a need to examine the efficacy of such screening for early detection of cardiac dysfunction and management of cardiovascular risk factors to mitigate risk.

What did you find in terms of early-onset versus late-onset cardiac dysfunction in this cohort?

Bhatia: Exposure to trastuzumab/pertuzumab results in not only early-onset cardiac dysfunction, particularly when administered with radiation and in the setting of cardiovascular risk factors, but also late-onset cardiac dysfunction.

Do you plan additional research in this area?

Bhatia: We plan to develop interventions to mitigate the risk. Possible interventions include aggressive management of cardiovascular risk factors and use of pharmacologic agents to prevent cardiotoxicity.

Read the study here.