News | Cardio-oncology | August 07, 2018

Cardiac Monitoring a Higher Priority for High-Risk Breast Cancer Patients

Study asserts that certain chemotherapy treatments increase a patient's risk of heart failure

Cardiac Monitoring a Higher Priority for High-Risk Breast Cancer Patients

August 7, 2018 — While heart failure is an uncommon complication of breast cancer treatment, the risk is higher in patients treated with certain types of chemotherapy and lower in younger patients, according to a study in a special "Imaging in Cardio-oncology" issue of JACC: Cardiovascular Imaging. Researchers concluded that cardiac monitoring should be a higher priority for high-risk patients.

Cardiovascular disease is the second leading cause of death of breast cancer survivors, behind secondary malignancies, due in part to the cardiac toxicities of some cancer therapies. However, little is known about the rate of chemotherapy-related cardiotoxicity and the rate of cardiac monitoring adherence among breast cancer patients treated with chemotherapy.

In this study, cardiotoxicity was defined as an incident case of heart failure following a breast cancer diagnosis. The study included 16,456 patients with a median age of 56 years who were treated with chemotherapy within six months of their diagnosis. Of those, 4,325 patients received trastuzumab-based chemotherapy.

Trastuzumab-based chemotherapy is a common treatment for patients with HER2-positive breast cancer, a very aggressive type of cancer. It has consistently been shown to benefit patients, but it is also associated with cardiotoxicity.

The study found that 8.3 percent of the trastuzumab-treated patients developed heart failure versus 2.7 percent of patients who did not receive trastuzumab. Among patients who were treated with trastuzumab, 46.2 percent received guideline-adherent cardiac monitoring, which according to the National Comprehensive Cancer Network, is before initiating treatment and every three months while on the treatment. Researched also saw that as age increased, there was a consistent increase in the risk of heart failure.

This was the first study of its kind to estimate cardiotoxicity rates and cardiac monitoring using data on both younger and older women from the MarketScan database. Previous studies focused on older women who have higher rates of heart failure than reported in clinical trials; this study focused more on younger women, who usually have fewer comorbidities and are similar to patients in previous trastuzumab trials. Younger women may receive more aggressive chemotherapy because they have a longer life expectancy, making them an important group to study for cardiac toxicity and cardiac monitoring.

Researchers said there could be many explanations for the low rates of cardiac monitoring seen in the patients treated with trastuzumab, including a low perceived need on the part of the physicians, rather than an unawareness of the guidelines.

"We must remember that while cardiac monitoring is recommended in different guidelines, such recommendations are not based on category 1 data, and the timing recommended, and the intervals of testing are rather arbitrary," said Mariana L. Henry, lead author of the study and a graduate student at Yale School of Public Health. "In examining the rate of both cardiac monitoring and cardiotoxicity we could begin to address the controversial issue of whether cardiac monitoring is warranted in young breast cancer patients."

This study is one of several papers featured in a special issue dedicated to imaging in cardio-oncology. Other studies/papers include:

  • Radiation Associated Cardiac Disease: a practical approach to diagnosis and management;
  • Anthracycline Therapy Is Associated With Cardiomyocyte Atrophy and Preclinical Manifestations of Heart Disease; and
  • Contemporary Role of Echocardiography for Clinical Decision Making in Patients During and After Cancer Therapy.

For more information: www.imaging.onlinejacc.org

Reference

Henry M.L., Niu J., Zhang N., et al. "Cardiotoxicity and Cardiac Monitoring Among Chemotherapy-Treated Breast Cancer Patients." JACC: Cardiovascular Imaging, August 2018. DOI: 10.1016/j.jcmg.2018.06.005

 

Related Content

Hologic, Inc. launched the Back to Screening campaign encouraging women to schedule their annual mammograms now that healthcare facilities across the nation are re-opening their doors following closures due to the COVID-19 pandemic.

Nine-time GRAMMY Award winner and breast cancer survivor Sheryl Crow has served as the spokesperson for Hologic’s Genius 3D Mammography exam for nearly five years.

News | Breast Imaging | August 03, 2020
August 3, 2020 — Hologic, Inc. launched the Back to Screening campaign encouraging women to schedule their ann
It covers every major modality, including breast imaging/mammography, fixed and portable C-arms (cath, IR/angio, hybrid, OR), CT, MRI, nuclear medicine, radiographic fluoroscopy, ultrasound and X-ray
News | Radiology Imaging | July 29, 2020
July 29, 2020 — IMV Medical Information, part of Scien...
Prostate biopsy with cancer probability (blue is low, red is high). This case was originally diagnosed as benign but changed to cancer upon further review. The AI accurately detected cancer in this tricky case. Image courtesy of Ibex Medical Analytics

Prostate biopsy with cancer probability (blue is low, red is high). This case was originally diagnosed as benign but changed to cancer upon further review. The AI accurately detected cancer in this tricky case. Image courtesy of Ibex Medical Analytics

News | Prostate Cancer | July 28, 2020
July 28, 2020 — A study published in 
Zebra Medical Vision announced its sixth FDA 510(k) clearance for its mammography solution, HealthMammo, which has already received a CE mark. Zebra Medical’s algorithm empowers breast radiologists by prioritizing and identifying suspicious mammograms, providing a safety net for radiologists. The suspicious mammograms are identified faster and read earlier than the current “first-in first-out” standard of care. 
News | Breast Imaging | July 27, 2020
July 26, 2020 —  Zebra Medical Vision announced its sixth FDA 510
(a) A schematic of cycloidal computed tomography (not to scale, seen from top); by adding an array of beam stops in front of the detector, the setup is transformed into an edge-illumination x-ray phase-contrast imaging device. (b) A sinogram sampling grid for a rotation-only scheme. (c) A sinogram sampling grid for a cycloidal scheme. The grids are shown for one mask period and a subset of rotation angles; the combination of empty and filled circles shows the grids that would be achieved through fine latera

(a) A schematic of cycloidal computed tomography (not to scale, seen from top); by adding an array of beam stops in front of the detector, the setup is transformed into an edge-illumination x-ray phase-contrast imaging device. (b) A sinogram sampling grid for a rotation-only scheme. (c) A sinogram sampling grid for a cycloidal scheme. The grids are shown for one mask period and a subset of rotation angles; the combination of empty and filled circles shows the grids that would be achieved through fine lateral sampling (requiring dithering); the filled circles show the data that are sampled without dithering.

News | Computed Tomography (CT) | July 24, 2020
July 24, 2020 — A computed tomography (CT) sca
Medical professionals around the world have been feeding lung X-rays into a database since the beginning of the pandemic

Pre-processing results. Image courtesy of Applied Sciences.

News | Coronavirus (COVID-19) | July 22, 2020
July 22, 2020 — Researchers from the Departme
Pioneering study, which included humans, led by Tel Aviv University researchers contradicts widespread conjectures
News | Magnetic Resonance Imaging (MRI) | July 21, 2020
July 21, 2020 — Researchers at Tel Aviv University, led by Prof.

Fig. 1 The basis of high-sensitivity SPION imaging at ultra-low magnetic fields.

(A) Magnetization of 25-nm SPIONs (green), gadolinium CA (Gd-DTPA/Magnevist, blue), and water (red) as a function of magnetic field strength (B0). (B) Magnetization as a function of magnetic field strength (B0) in the ULF (<10 mT) regime for the materials shown in (A). Superparamagnetic materials, such as SPIONs, are highly magnetized even at ULF. Paramagnetic materials, such as CAs based on gadolinium, and body tissues (which typically have diamagnetic susceptibilities close to water) have absolute magnetizations that increase linearly with field strength. Curves in (A) and (B) were reproduced from data in (3253) and reflect the magnetic moment per kilogram of compound. (C) Highly magnetized SPIONs (brown) interact with nearby 1H spins in water, shortening 1H relaxation times, and causing susceptibility-based shifts in Larmor frequency. Image courtesy of Science Advances

News | Magnetic Resonance Imaging (MRI) | July 20, 2020
July 20, 2020 — Lowering the cost of magne...
Representative maximum-intensity projection PET images of a healthy human volunteer injected with 64Cu-NOTA-EB-RGD at 1, 8, and 24 hours after injection. Axial MRI and PET slices of glioblastoma patient injected with 64Cu-NOTA-EB-RGD at different time points after injection. Image courtesy of Jingjing Zhang et al., Peking Union Medical College Hospital, Beijing, China/ Xiaoyuan Chen et al., Laboratory of Molecular Imaging and Nanomedicine, NIBIB/NIH, Bethesda, USA

Representative maximum-intensity projection PET images of a healthy human volunteer injected with 64Cu-NOTA-EB-RGD at 1, 8, and 24 hours after injection. Axial MRI and PET slices of glioblastoma patient injected with 64Cu-NOTA-EB-RGD at different time points after injection. Image courtesy of Jingjing Zhang et al., Peking Union Medical College Hospital, Beijing, China/ Xiaoyuan Chen et al., Laboratory of Molecular Imaging and Nanomedicine, NIBIB/NIH, Bethesda, USA

News | PET Imaging | July 15, 2020
July 15, 2020 — A first-in-human study presented at the Society of...