Association of cancer treatment with excess heart age among five-year young breast cancer survivors

Jacqueline B Vo; Shoshana Rosenberg; Bessie X Zhang; Craig Snow; Greg Kirkner; Philip D Poorvu; Rachel Gaither; Kathryn J Ruddy; Rulla M Tamimi; Jeffrey M Peppercorn; Lidia Schapira; Virginia F Borges; Steven E Come; Anju Nohria; Ann H Partridge

doi:10.1007/s11764-024-01645-9

Association of cancer treatment with excess heart age among five-year young breast cancer survivors

J Cancer Surviv. 2024 Jul 15. doi: 10.1007/s11764-024-01645-9. Online ahead of print.

Authors

Jacqueline B Vo¹, Shoshana Rosenberg^{2

3}, Bessie X Zhang⁴, Craig Snow², Greg Kirkner², Philip D Poorvu², Rachel Gaither^{2

5}, Kathryn J Ruddy⁶, Rulla M Tamimi³, Jeffrey M Peppercorn⁷, Lidia Schapira⁸, Virginia F Borges⁹, Steven E Come¹⁰, Anju Nohria^{2

11}, Ann H Partridge²

Affiliations

¹ Cancer Prevention Fellowship Program, Division of Cancer Epidemiology & Genetics, National Cancer Institute, 9609 Medical Center Drive, 7E532, Bethesda, Rockville, MD, 20906, USA. jacqueline.vo@nih.gov.
² Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
⁶ Department of Oncology, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁸ Department of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA.
⁹ Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA.
¹⁰ Department of Medicine, Breast Oncology Program, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹¹ Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 39008138
DOI: 10.1007/s11764-024-01645-9

Abstract

Purpose: Data evaluating cardiovascular disease (CVD) risk by cancer treatment among young women (≤ 40 years) with breast cancer are limited.

Methods: Among 372 five-year breast cancer survivors aged 30-40 years from the Young Women's Breast Cancer Study, we assessed the association of cancer treatments (anthracyclines, trastuzumab, radiation/laterality, endocrine therapy) and excess heart age (difference between predicted 10-year CVD risk as assessed by adapted Framingham Risk Score and chronological age), prevalent elevated excess heart age (≥ 2 years), and worsening excess heart age (change of ≥ 2 excess heart age years) at breast cancer diagnosis and two- and five-year follow-up using multivariable linear and logistic regressions.

Results: Most women had stage I or II (79%), ER + (71%), or PR + (65%) breast cancer. At diagnosis, women had little excess heart age by treatment receipt (range of means = -0.52,0.91 years). Left-sided radiation (β = 2.49,SE = 0.96,p = 0.01) was associated with higher excess heart age at five-year follow-up. For prevalent elevated excess heart age (two-year = 26%;five-year = 27%), women treated with right-sided radiation had increased risk at two-years (OR = 2.17,95%CI = 1.12-4.19), yet at five-years, associations were observed after any radiation (OR = 1.92,95%CI = 1.09-3.41), especially after left-sided (OR = 2.13,95%CI = 1.09-3.41) radiation. No associations were observed between systemic treatments and prevalent elevated excess heart age or any treatments with worsening excess heart age.

Conclusions: Among young breast cancer survivors, radiation, but not other cancer treatments, was associated with elevated excess heart age.

Implications for cancer survivors: CVD risk tools that incorporate cancer treatment, such as radiation, are needed to identify high risk young breast cancer survivors given the long survivorship and long latency of cardiovascular disease.

Keywords: Breast cancer survivorship; Cardiovascular disease risk; Excess heart age; Young breast cancer.