Breast cancer and CVD CARDIO-ONCOLOGY

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Breast cancer is the most common non-skin cancer in women. It is estimated that over 1.38 million cases, according to GLOBOCAN of WHO. It is a major health risk for women all over the world.

It was considered to the no.1 killer in women, but now cardiovascular {CVD] causes more deaths than Breast cancer. Now these two deadly diseases have become interlinked. For breast cancer survivors CVD represents the  greatest single non cancer cause of death, accounting approximately 35 % of non-breast cancer mortality for women of 50 years of age and older.

In Asia Pakistan has the highest rate of breast cancer. 1 in 9 women are diagnosed with this cancer.

Every year 90 thousand new cases are diagnosed and 40 thousand die annually. Socio-economic conditions are responsible for poor health of women. Illiteracy   is also a major cause of the problem.

Most women here do not have proper access to the medical facilities due to gender based discrimination

Different treatment modalities include Surgery, radiation, medical and complementary like yoga, acupuncture and psychotherapy.

Cancer by itself is catastrophic and heart is an easy victim to its collateral damage .Cardio-oncology specific CVS disorders in cancer survivors are

1-High blood pressure

2-diseases of heart valves

3-diseases of heart muscle [cardiomyopathy]

And finally heart failure.

Treatment especially chemotherapy may be lifesaving but it does not come without a hearty price.

It also causes unfavourable changes in lipid levels and increases the risk of cardiovascular events.

Radiation therapy, especially on left sided breast cancers may increase the risk of heart disease through injury to Heart muscle or surrounding blood vessels

The severity or form of radiation induced CVD is less fatal than chemotherapy induced heart disease

And now the most important question of preventing women from primary breast cancer and treatment related heart disease

Primary prevention includes screening with MAMMOGRAPHY; it is very helpful and effective in the detection of the disease. But it is expensive and many women may not have access to tertiary care centers with radiological facilities, simplest is self-examination.

We need to educate women about this very effective diagnostic method.

How can we prevent cardiac disease after treatment for breast cancer. CVD becomes a disproportionate cause of death in cancer survivors, especially those treated with chemotherapy.

It is recommended that Breast cancer survivors should be closely monitored for development of heart disease, beginning in the years immediately following diagnosis and treatment.

In order to arrive at a timely diagnosis, it is important to have pretreatment ECG, Cardiac markers and blood test to estimate serum cholesterol and blood sugar levels

Evaluation of liver and kidney function is important by ordering relevant tests

Echocardiography is very important to assess the pumping function of heart. Must have a baseline echocardiographic examination; repeat it at three, six and nine months   .

The main treatment goals of managing chemotherapy induced cardio. Myopathy is focused on management of Heart failure.

Future opportunities    include work to standardize a specialized and multi-disciplinary approach to screening and effective management approaches

Registries to better understanding the true incidence of CVD and the utility of current treatment would be invaluable for this growing population of breast cancer survivors.

Risk factors modification is beneficial in CVD prevention   and should be addressed at baseline and at follow up visit-in patients with a history of breast cancer

Role of women cardiologists is very important in our country, as the ladies are more comfortable discussing this problem with a lady cardiologist.

Women constitute 52 % of society and have very important role in nation building. So prevention is very important and this can be achieved by educating masses, encouraging early detection and treatment