Cardiac Disease After Breast Cancer Treatment: Make Sure to Check Our Blind Spot!
Menée au Canada à partir de données portant sur 78 318 patientes atteintes d'un cancer du sein de stade précoce et sur 234 954 témoins, cette étude analyse les différents facteurs (âge, hypertension, traitements anticancéreux, etc.) associés au risque d'arrêt cardiaque et à d'autres maladies cardiovasculaires nécessitant une hospitalisation
In this issue of the Journal of the National Cancer Institute, Dr Abdel-Qahi et al. report on a population-based retrospective study of a long-term analysis of the cardiovascular (CV) outcomes of patients with early breast cancer (EBC) who have undergone treatment in Ontario, Canada (1). These data are very carefully reviewed and synthesized. The treated patients are compared to a control group of age-matched patients on a 1:3 ratio allowing a robust comparison for CV risk factors and outcomes in these patients with breast cancer to an appropriate control population. These authors report on some very interesting findings, especially when compared to previous work in similar breast cancer groups. In short, the authors report that even among patients treated with potentially cardiotoxic therapy, such as anthracyclines or trastuzumab, the rate of admission for heart failure (HF) is surprisingly low, even after 10 years, especially when one considers that the most common cardiac issue encountered in these patients being treated for cancer is actually coronary artery disease or the development of ischemic heart disease (IHD). This report also deals with other common CV events such as stroke and arrhythmia, which thankfully occur at a low rate over 10 years but still occur more frequently than control patients during that time. It is expected that patients with EBC, especially those treated with anthracyclines and/or trastuzumab, would have a higher incidence of HF hospitalization compared to age-matched patients. Fortunately, the overall risk of HF related to chemotherapy or targeted therapy is much lower than that seen with other large database studies reported previously and portends an overall excellent CV prognosis despite cancer treatment (2,3).(...)
Journal of the National Cancer Institute , éditorial en libre accès, 2018