Breast Neoplasms – ABC CARDIOL

IJCS

Editorial

Breast Cancer, Cardiotoxicity and Cardiovascular Disease Prevention: Where Are We in this Knowledge?

Maria Alayde Mendonça Rivera et al. Ivan Romero Rivera Glaucia Maria Moraes de Oliveira

In recent decades, significant advances have been made in the early detection and treatment of different types of cancer, which have led to a significant worldwide increase in the number of survivors of this group of diseases, with estimates that two-thirds of all survivors would be 65 years old or older in 2020.

There are currently more than 32 million cancer survivors worldwide and this number is expected to continue growing, due to efficient screening for the disease and increased patient life expectancy after definitive treatment, as well as increased life expectancy of populations, which increases the incidence of numerous neoplasms and is currently around 73.4 years worldwide for both sexes (70.8 years for men and 76 years for women).

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IJCS

Review Article

Cardiovascular Disease in Women With Breast Cancer: A Contemporary Review

Adriana Puente Barragán et al. Patricia Nuriulú Escobar Alejandra Madrid Miller Luis Antonio Moreno Ruiz

Abstract

Breast cancer (BC) is the most common malignant neoplasia in women and is responsible for one in six deaths from cancer in the female population. Five years after diagnosis, BC survival rates currently exceed 80%. Cardiovascular disease (CVD) is a frequent cause of morbidity and mortality in BC, mainly in patients receiving cardiotoxic drugs (anthracyclines, immunotherapy) and radiotherapy (RT).

CVD and BC have common risk factors (RF), which are related to aging, traditional and cardiometabolic RFs (obesity, dyslipidemia, consumption of alcoholic beverages), and others associated with sex and reproductive women’s age, such as early menarche, late menopause, nulliparity, use of oral contraceptives, as well as hormone replacement therapy in postmenopause.

Risk stratification and the promotion of an ideal state of cardiovascular (CV) health are fundamental in preventing CVD in survivors. Therapeutic management and follow-up of patients with BC require a multidisciplinary team to reduce complications and mortality of CV origin.

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Original Article

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Geanne Maria Holanda de Menezes Barroso et al. Júlio César Oliveira Costa Teles Paulo Victor de Jesus Silva Karin Yasmin Santos Fonseca … Vinícius Antônio Santos Aragão Marília Marques Aquino Enaldo Vieira de Melo Karina Oliveira Ferreira Ronnei José Feitosa de Assis Michel Fabiano Silva Alves Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

Abstract

Background

Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers.

Objectives

To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer.

Methods

This was an observational prospective study of 78 adult women who underwent serial echocardiograms (baseline and 1, 3, and 6 months after the beginning of chemotherapy), to evaluate biplane and 3D EF and global longitudinal strain. Cardiotoxicity and subclinical dysfunction were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Statistical significance was set at p < 0.05.

Results

The mean age of the patients was 50.1 ± 11.48 years. The frequency of subclinical cardiotoxicity (defined by global longitudinal strain) was 14.9% after 30 days of chemotherapy, 16.7% after 3 months, and 19.7% after 6 months, compared to 4.5%, 3%, and 6.6%, respectively, when clinical cardiotoxicity was determined according to EF. The group that developed subclinical cardiotoxicity by 30 days (group A) had a higher frequency of clinical cardiotoxicity at 3 months (p=0.028) and a lower mean biplane EF after 30 days (p= 0.036) than the group that showed no evidence of subclinical cardiotoxicity (group B).

Conclusion

Subclinical cardiotoxicity was frequent and began early, being associated with a drop in EF during the clinical course.

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Original Article

Metabolic Syndrome and Risk of Cardiovascular Diseases in Female Breast Cancer Survivors

Leandro Marque da Silva et al. José Albuquerque de Figueiredo Neto

Abstract

Background

The implementation of intensive therapy protocols increases the probability of adverse events in patients with breast cancer (BC). Components of metabolic syndrome (MS) are among these events.

Objective

To verify the prevalence of MS and cardiovascular disease (CVD) risk in female BC survivors.

Materials and Methods

This is a descriptive, observational, cross-sectional study. Our sample comprised 60 women without BC (G1) and 60 women who had survived BC (G2). We collected sociodemographic, anthropometric, tumor, and clinical data. After variable analysis, the participants received positive or negative MS diagnoses and a 10-year CVD risk stratification. The significance level adopted for the analyses was 5% ( p < 0.05) and the confidence interval (CI) was 95%. For comparing categorical data, we used the chi-squared, Fisher’s exact, or G tests; for comparing continuous data, we used the parametric Student’s t-test and the non-parametric Mann-Whitney test.

Results

Both groups presented overweight and an increased waist-to-hip ratio. Weight, body mass index, abdominal circumference, hip circumference, and low-density cholesterol were variables that presented statistically significant differences between groups. MS was diagnosed in 32% of women in G1 and 45% of those in G2. Regarding the 10-year risk for CVD, most women were in the low-risk stratum: the mean total risk of CVD occurrences was 7.48% in G1 and 7.70% in G2.

Conclusion

We observed a higher prevalence of MS among women who survived BC, possibly due to overweight, as well as a low 10-year risk for CVD after cancer treatment. Although we did not observe a statistically significant difference, we suggest the adoption of a healthy lifestyle and rigorous control of cardiometabolic risk factors.

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Breast Cancer, Cardiotoxicity and Cardiovascular Disease Prevention: Where Are We in this Knowledge?

Cardiovascular Disease in Women With Breast Cancer: A Contemporary Review

Abstract

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Abstract

Background

Objectives

Methods

Results

Conclusion

Metabolic Syndrome and Risk of Cardiovascular Diseases in Female Breast Cancer Survivors

Abstract

Background

Objective

Materials and Methods

Results

Conclusion

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