Scientists have known for many years that heart disease can be an unwelcome side effect of even the most successful breast cancer treatments.
Some chemotherapy drugs—including anthracyclines, considered a cornerstone of breast cancer treatment—and some targeted therapies put patients at risk for heart problems. Those who receive radiation to the left breast—closer to the heart—may have an increased risk for heart damage, as well.
But today at the Masonic Cancer Center, University of Minnesota, University of Minnesota Health doctors and researchers are exploring innovative ways to detect, treat and sometimes even predict and prevent heart problems before they develop.
“When we treat women for breast cancer, we’re not just treating that disease but looking at how we can keep the rest of you healthy as well,” said University of Minnesota Health Cancer Care Hematologist/Oncologist Anne Blaes, MD, who specializes in breast cancer and leads the University of Minnesota Health Cancer Survivor Program. “And now, with women often surviving for many years after breast cancer treatment, it’s so important to fully understand how heart disease can affect patients not just during treatment but years down the road.”
M Health doctors who employ today’s leading-edge treatments for breast cancer patients are also hard at work with their laboratory research colleagues developing tomorrow’s breakthrough therapies. As they learn more about how and why heart disease—now the leading cause of non-cancer death among breast cancer survivors—affects their patients, they are zeroing in on more effective tools to fight back.
One such project involves the use of cardiovascular magnetic resonance imaging (CMR), a relatively new imaging technique that can detect structural heart disease even in patients who show no symptoms and who have had more conventional screening tests come back clean.
“While CMR is used widely for evaluation of some cardiac diseases, it’s still not widely used for evaluation and monitoring of cancer patients,” said University of Minnesota Health Heart Care Cardiologist Chetan Shenoy, MBBS.
Shenoy is working to demonstrate that by using CMR to evaluate heart health before patients begin cancer treatment, doctors may be able to predict which patients are most at risk for developing heart problems.
“I see patients in remission who were treated with chemotherapy or radiation 10 to 15 years ago who have developed heart problems, many of whom were unaware that they were at additional risk for heart disease when they received cancer therapy,” said Cardiologist Suma Konety, MD, MS, head of the Cardio-Oncology Clinic for University of Minnesota Heart Care. “I also frequently see patients who develop cardiac problems during cancer treatment.”
The clinics—located on the University of Minnesota Medical Center campus in Minneapolis, as well as Fairview Southdale Hospital in Edina and Fairview Ridges Specialty Care Center in Burnsville—provide specialized care for both current cancer patients and long-term survivors.
In addition to her practice, Konety also conducts research aimed at improving cardiac outcomes for breast cancer patients.
Like Konety and Shenoy, Blaes focuses much of her research on cardiac complications of chemotherapy. She is currently looking at the impact of aromatase inhibitors—anti-estrogen therapy used to treat breast cancer—on overall vascular health.
“At our annual Cancer Survivorship Conference,” Blaes said, “we now include a special breakout session on heart health.”
Blaes and her colleagues prefer the “ounce of prevention” approach to cardiotoxicity.“While most research efforts at other institutions are directed at the early detection of cardiotoxicity, our research here is focused upstream on primary prevention,” adds Shenoy, “and that has the potential for huge impact in the field.”