By: Jennifer Fiorini, MD
At The Breast Place, our focus extends beyond breast health. This month we launched The Breast Place Fitness Challenge to promote the prevention of both breast cancer and cardiovascular disease. More women die of cardiovascular disease than breast cancer. Even in women with breast cancer, dying from heart disease is a leading cause of death. This is partly because cardiovascular disease is ten times more common than breast cancer and because breast cancer has become more treatable.
Last month the American Heart Association published a statement on the relationship between breast cancer and heart disease. There are two main messages in their statement. First, that heart disease and breast cancer have many of the same risk factors and will often be found in the same patients. And second, that most women who are diagnosed with breast cancer will survive their cancer diagnosis. Because of this, health care professionals must keep in mind that long term survival depends on taking cardiac health into consideration in the quest to cure cancer.
Several factors associated with increased risk for cardiovascular disease are also known to increase risk for breast cancer. The strongest associations demonstrated have been age, unhealthy diet, alcohol intake, obesity, hormone replacement, tobacco use, and lack of exercise. Most of these are modifiable - meaning that those at risk could be making better choices in how they treat their bodies. Researchers believe that up to 80% of cardiovascular disease could be prevented by following healthy diets, getting exercise, avoiding tobacco, and other such measures. When we encourage healthy living for cancer patients, we are actively fighting heart disease as well.
To "do no harm" is the mantra of the physician, but for every therapy we offer there are risks as well as potential benefits. It is the role of the careful physician to counsel a patient as to those risks and offer guidance as to the whether the intended benefit is worth those risks. The AHA statement does not change that decision making process, but reminds us that the cardiovascular risks are not to be underestimated. Many of the cancer treatments available have the possibility of creating cardiovascular problems. Chemotherapy, antibody therapy, radiation, anti-estrogen medication, and surgery are to be considered with respect to the affected individual's overall wellness, with the goal of benefiting long-term survival rates and quality of life. Many of the best advances in breast cancer care in the recent years have been improvements in identifying patients who we can treat lessaggressively without compromising survival and treatments that target the disease more precisely, sparing the healthy tissues from incidental damage.
Sometimes the decisions to be made in cancer care are difficult ones, but in all cases the focus needs to be on the entire patient. Of course a cancer cure is the goal, but so are maintaining a patient's emotional wellbeing, quality of life, and heart health. Better than a cure would be disease prevention. Using the knowledge regarding which activities impact the risks for cancer and heart disease it is my hope that by encouraging a healthy lifestyle we will see both fewer breast cancers and improved cardiovascular health.
Laxmi S. Mehta, Karol E. Watson, Ana Barac, Theresa M. Beckie, Vera Bittner, Salvador Cruz-Flores, Susan Dent, Lavanya Kondapalli, Bonnie Ky, Tochukwu Okwuosa, Ileana L. Pina, Annabelle Santos Volgman. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation, 2018