Q & A: How can breast cancer affect heart health?

Heart disease and breast cancer are two of the most common diseases for women, with heart disease being the leading cause of death in the U.S. Heart disease and cancer can overlap in many ways, from shared risk factors to the potential for cancer treatment to affect heart health. It’s important for people undergoing treatment for breast cancer, and breast cancer survivors, to have ongoing heart health monitoring and to be aware of the risk factors and symptoms of heart disease.

As a cardio-oncologist, Suma Konety, MD, MS, is specially trained to work with people at risk of heart disease before, during, and after treatment for cancer. She also serves as director of the cardio-oncology program at M Health Fairview University of Minnesota Medical Center, and is a professor of medicine at the University of Minnesota Medical School.

We asked Konety about the connection between breast cancer and heart health, and what people with breast cancer can expect when it comes to heart care.

What is the connection between breast cancer treatment and heart disease?

We have to recognize that heart disease and breast cancer have several overlapping risk factors, such as obesity and smoking. Fortunately, breast cancer patients are living longer these days due to early recognition and significant advances in cancer therapies. But we also need to be aware that some widely used and very effective chemotherapy drugs such as doxorubicin (anthracyclines), trastuzumab (Herceptin), and cyclophosphamide could also have unintended effects on the heart. Oral chemotherapy agents like tyrosine kinase inhibitors also come with potentially serious heart-related effects. These could include cardiomyopathy (weakening of the heart muscle), heart failure, rhythm disturbances, and hypertension (high blood pressure). Breast cancer patients who have received left-sided radiation therapy are also at higher risk of developing heart disease several years after treatment.

How does our cardio-oncology program care for patients with cancer?

Our cardio-oncology program is one of the first of its kind in the Midwest. We’re home to a specialized team of both cardiologists and oncologists who partner to care for cancer patients and survivors in an effort to prevent cancer-related heart conditions and treat them when they occur.

Prior to starting treatment for breast cancer, we review important risk factors for heart disease. Blood pressure assessment is important because chemotherapy can cause hypertension. We also advise and work with patients on blood pressure, cholesterol, and blood sugar management, and importantly on lifestyle modifications including exercise, nutrition, and quitting smoking.

We provide ongoing heart surveillance for patients during and after cancer treatment, and work to identify any early heart damage using cardiac imaging and lab tests. We then provide tailored therapy to limit heart-related side effects of treatment and reduce unnecessary interruptions in cancer treatment.

Our cardio-oncology team helps patients with cancer reduce their risk of heart disease. Learn more.

Who should meet with a cardio-oncologist?

People with pre-existing heart and vascular disease, or with risk factors for heart disease, who are being considered for cancer treatment (including chemotherapy and radiation), cancer surgery, or a stem-cell transplant should meet with an experienced cardio-oncologist who can help assess and manage their heart health throughout treatment.

I also recommend that people who have previously received radiation therapy to their chest, patients on hormone therapy for prostate and breast cancer, as well as patients who have previously developed heart-related side effects from cancer treatment, meet with the cardio-oncology team for evaluation and treatment.

What else should people with breast cancer know about heart health?

All breast cancer patients will benefit from optimally managing their cardiac risk factors, and by adhering to a healthy lifestyle with daily exercise and a diet low in saturated fat and carbohydrates. 

Cancer patients can be at increased risk for heart problems many years after treatment. Long-term monitoring is key in promoting heart health because cancer survivors represent a rapidly growing group of people at risk for heart disease.