>>> IN MEDICAL NEWS TONIGHT, WE TAKE A LOOK AT THE CONNECTION
BETWEEN CERTAIN BREAST CANCER TREATMENTS CAUSING AN INCREASED
RISK OF HEART DISEASE FOR SOME PATIENTS.
THE AMERICAN HEART ASSOCIATION RECENTLY RELEASED A STATEMENT ON
THE CONNECTION, AND CAROLEE MCGRATH SAT DOWN WITH
NON-INVASIVE CARDIOLOGIST DR.
HEBBA WASIF FROM BAY STATE MEDICAL CENTER TO LEARN MORE.
>> THE EMERGING PARADIGM, FOR THREE REASONS, THERE ARE COMMON
RISK FACTORS BETWEEN BREAST CANCER AND CARDIOVASCULAR
DISEASE, LIKE A SEDENTARY LIFESTYLE, CERTAIN DIETS,
EXCESSIVE MEATS, FOR EXAMPLE, SMOKING THAT HAS SOME
ASSOCIATION ALSO WITH BREAST CANCER.
SO THE DISEASE, BOTH DISEASES CAN EXIST IN THE SAME PERSON, SO
A PERSON CAN BE SUFFERING FROM BABIES AS WELL AS CARDIOVASCULAR
DISEASE.
THE SECOND REASON IS THERE ARE MANY TREATMENT OPTIONS NOW FOR
BREAST CANCER THAT HAVE SOME CARDIOVASCULAR TOXICITY THAT I
BELIEVE WE'LL BE DISCUSSING LATER ON.
SO IT'S IMPORTANT TO KNOW WHAT AN INDIVIDUAL'S UNDERLYING
CARDIOVASCULAR RISK IS.
THE THIRD OBVIOUSLY THAT IF YOU HAVE UNDERLYING CARDIOVASCULAR
DISEASE, THAT MAY DETERMINE OR DIRECT SOME OF YOUR TREATMENT
OPTIONS FOR BREAST CANCER.
>> SO WHAT TYPES OF TREATMENTS ARE WE TALKING ABOUT THIS WOULD
BE THE MOST ADEGREESIVE AND CAUSE PROBLEMS WITH THE HEART?
>> ONE OF THE MOST AGGRESSIVE TREATMENTS IS A GROUP OF DRUGS,
THERE ARE SEVERAL OF THEM IN THE GROUP, SOME CAUSE MORE
CARDIOTOXICITY THAN OTHERS.
>> EXPLAIN THAT.
>> FOR THE LAY PERSON, CARDIOTOXICITY, BECAUSE AS THESE
DRUGS ARE TOXIC AND KILL THE BREAST CANCER CELLS, THEY ALSO
KILL THE MYO CARDIAL CELLS, THE CELLS OF THE HEARTS.
THEY HAVE THE SAME IMPACT, SO THEY INTERACT WITH THE D.N.A.
IN A SIMILAR FASHION THAT THEY
WOULD DO WITH THE TUMOR CELLS.
BUT HERE NOW WE'RE TALKING ABOUT A LIVING HEART CELL.
AND THEREFORE IT CAN POTENTIALLY CAUSE WEAKNESS OF THE HEART
MUSCLE.
THESE DRUGS WERE USED FROM THE EARLY 70'S.
IT WASN'T UNTIL ALMOST 10 YEARS LATER THAT WE DISCOVERED SUCH
THESE TOXICITIES, SO TO SAY.
AND WE'VE ALSO DISCOVERED THAT IT'S SOMEWHAT DOSE DEPENDENT.
AND I WILL QUALIFY THAT STATEMENT, THAT THE I'MER THE
DOSE THE MORE RISK FOR THE HEART MUSCLE.
HOWEVER, THERE'S SOME INDIVIDUALS THAT ARE MORE
SUSCEPTIBLE EVEN AT VERY LOW DOSES, THEY CAN POTENTIALLY HAVE
PROBLEMS WITH THE HEART MUSCLE.
>> WHAT KINDS OF CONDITIONS ARE THOSE INDIVIDUALS IN?
THEY ALREADY HAVE UNDERLYING FACTORS FOR HEART DISEASE?
>> EXACTLY, SO IF THEY HAVE UNDERLYING CARDIOVASCULAR
DISEASE OR IF THEIR HEART MUSCLE IS BORDER LINE WEAK, SO WE
DEFINE A STRONG HEART MUSCLE IN THE WORLD OF MEDICINE IS A HEART
MUSCLE THAT PUMPS ABOUT 60% OF THE BLOOD.
IF YOUR HEART MUSCLE IS BORDER LINE, 50 TO 55%, THEN WE'RE
STARTING AT A WEAKER HEART MUSCLE, THAT CAN POTENTIALLY BE
AT RISK.
AND SOME OF IT IS ALL -- IT'S A WORLD OF UNCERTAINTIES.
BUT WE CAN ONLY TRY TO FIND WHAT ARE THE POSSIBLE ASSOCIATIONS
THAT WOULD INCREASE THE RISK, IDENTIFY THEM, AND THEN MODIFY
WHAT WE DO TO MINIMIZE THAT RISK.
SO IF AN INDIVIDUAL IS OVER 60 YEARS OLD, THEY HAVE TWO OR MORE
CARDIOVASCULAR RISK FACTORS, THEY HAVE A WEAK HEART MUSCLE,
AS I MENTIONED, LIKE A BORDER LINE HEART MUSCLE, THEN WE HAVE
TO MAYBE USE LESS AGGRESSIVE THERAPIES.
OR DO CONTINUOUS MONITORING AT THE BEGINNING OF THE TREATMENT,
AS THE TREATMENT PROGRESSES, AND EVEN AFTER THE TREATMENT IS
TERMINATED BECAUSE SOME OF THESE EFFECTS COULD BE VERY LATE AFTER
THE TREATMENT HAS ENDED.
>> WHEN WOMEN HEAR BREAST CANCER, YOU KNOW, IT'S AN
AUTOMATIC, AS IT SHOULD BE, YOU KNOW, YOU'RE FRIGHTENED, YOU'RE
SO WORRIED ABOUT YOUR FUTURE, YOUR CHILDREN, YOUR HUSBAND.
AND WHAT THE MEDICAL OUTCOME WILL BE.
SO I'M SURE PEOPLE ARE SAYING, YOU KNOW, GIVE METHE STRONGEST
TREATMENT POSSIBLE BECAUSE I WANT TO GET RID OF THIS.
BECAUSE YOU HAVE TO TREAT IT AGGRESSIVELY.
>> ABSOLUTELY.
AND THAT'S NOT HAVING SAID THAT BECAUSE OF THE CONCERN OF
CARDIOVASCULAR RISK OR CARDIOTOKS ISITY, THAT DOESN'T
MEAN THAT WE SHOULD HOLD TREATMENT FOR BREAST CANCER.
YOU HAVE TO TREAT THE CANCER IF IT'S AGGRESSIVE, YOU'RE MORE
LIKELY TO DIE FROM BREAST CANCER THAN DIEING FROM CARDIOVASCULAR
DISEASE.
SOME OF THESE POSSIBILITIES MAY BE LONG TERM.
AND BECAUSE WE HAVE LONG-TERM SURVIVORS, WE ARE SEEING MORE
WOMEN THAT ARE SURVIVING BREAST CANCER, WHICH IS AN AMAZING
ENDEAVOR THAT HAS BEEN ACHIEVED OVER THE LAST 25 YEARS MARKS THE
MORTALITY FROM BREAST CANCER HAS BEEN REDUCED SIGNIFICANTLY.
WE'RE SEEING WOMEN THAT ARE NOW DYING AS OLDER WOMEN FROM
CARDIOVASCULAR DISEASE, WHO HAD BREAST CANCER.
NOT FROM THE RECURRENCE OF THE BREAST CANCER, BUT RATHER FROM
CARDIOVASCULAR DISEASE.
SO IT'S IMPORTANT TO IDENTIFY WHO IS AT RISK FIRST, AND IT IS
AN EVOLVING FIELD WHERE THERE'S A LOT OF WORK THAT'S CURRENTLY
BEEN DONE.
AND IT'S ALSO BEEN IDENTIFIED AS A UNIQUE SUB SPECIALTY OF
CARDIOLOGY WHICH IS ALMOST NEW IN EXISTENCE OVER THE LAST FEW
YEARS.
>> GIVE US THE NUMBERS AS FAR AS THE MORTALLY RATES FOR HEART
DISEASE VERSUS BREAST CANCER.
>> TO PUT THINGS INTO PERSPECTIVE, THERE ARE MORE
WOMEN LIVING WITH CARDIOVASCULAR DISEASE IN THE U.S. THAN THERE
ARE WOMEN WITH BREAST CANCER.
ALMOST 48 MILLION WOMEN WITH CARDIOVASCULAR DISEASE, AND ONE
OUT OF THREE WOMEN WILL DIE FROM CARDIOVASCULAR DISEASE.
AND THAT'S INCLUDING STROKE AS WELL.
ONE OUT OF 31 WOMEN WILL DIE FROM BREAST CANCER.
SO WOMEN ARE MORE LIKELY TO DIE FROM HEART DISEASE THAN BREAST
CANCER.
BUT THIS IS AGAIN WHERE WE'RE IDENTIFYING AWE BREAST CANCERS
IN ALL ITS STAGES AND ALL ITS FORMS AS WELL AS CARDIOVASCULAR
DISEASE.
IT DOESN'T SPEAK FOR THE PARTICULAR INDIVIDUAL.
>> HOW DO YOU WORK WITH THE ONCOLOGIST, WHEN YOU HAVE A
PATIENT WHO HAS HEART DISEASE WHO IS ALSO BEING TREATED FOR
BREAST CANCER, TELL ME HOW THAT RELATIONSHIP HAS TO WORK TO BEST
BENEFIT THE PATIENT.
>> AS I SAID, THIS IS AN EMERGING PARADIGM, AND IT'S AN
EVOLVING COLLABORATION NOW BETWEEN CARDIOLOGISTS AND
ONCOLOGISTS.
THE ONCOLOGIST IS THE PRIMARY TREATING PHYSICIAN, THEY
IDENTIFY WHAT IS THE MOST APPROPRIATE THERAPY FOR THE
PATIENT.
BUT THEY WORK HAND IN HAND WITH THE CARDIOLOGIST TO FIRST
MONITOR THE PATIENTS FROM A CARDIOVASCULAR STANDPOINT, FOR
EXAMPLE, IF THE HEART MUSCLE IS RELATIVELY WEAK TO START WITH,
THEN MAYBE INITIATING CERTAIN THERAPIES MAY BE ADVICABLE.
IF HEART WEAKNESS OCCURS DURING THE THERAPY, AJUSTMENT OF THE
TREATMENT OPTIONS IS WARRANTED.
AND THIS CONTINUOUS MONITORING BY CARDIAC ECHO CARD YOG REAF,
WHICH IS THE ULTRASOUND FOR THE MART MUSCLE, I VERY --
IS VERY IMPORTANT.
IT'S A COLLABORATION OF THE BEGINNING, MIDDLE OF THERAPY AND
EVEN AFTER THE THERAPY IS TERMINATED.
>> I KNOW YOU'RE A MEDICAL DOCTOR, BUT I HAVE TO IMAGINE
THAW SEE THE EMOTIONAL SIDE OF YOUR PATIENTS.
>> SLEUMENT.
>> HERE YOU HAVE BREAST CANCER AND NOW YOU'RE AT HIGH RISK FOR
A HEART, SOME SORT OF HEART FAILURE OR HIGH RISK OF HEART
DISEASE.
THAT'S LIKE TWO MAJOR THINGS THAT PEOPLE WOULD HAVE TO DEAL
WITH.
HOW DO YOU HELP PATIENTS UNDERSTAND THE PROCESS?
>> IT'S OBVIOUSLY, YOU CAN'T TAKE AT THE MOTION OUT OF EITHER
CONDITION.
THERE'S A LOT OF EMOTIONS ASSOCIATED WITH THEM AND PEOPLE
ARE PEOPLE, WE'RE HUMAN BEINGS.
AT THE END OF THE DAY THIS IS LIFE THREATENING ON BOTH ENDS.
IT'S ALL ABOUT ASSESSING RISK, WHAT IS THE MOST RISK NOW, AND
IF THE BREAST CANCER IS THE MOST RISK, WHICH IT USUALLY IS
IMMEDIATELY, THEN YOU MANAGE THE BREAST CANCER, AND YOU MONITOR.
AND YOU MAY, AS I SAID, MAYBE USE LESS AGGRESSIVE THERAPIES.
AND THERE ARE LESS AGGRESSIVE THERAPIES, BUT IT HAS TO BE WITH
THE AGREEMENT OF THE ONCOLOGIST THAT THAT IS AN APPROPRIATE
THERAPY FOR THAT PARTICULAR PATIENT.