Professor Aoife Lowery
Consultant Breast Surgeon & Director of Clinical Research Facility, University of Galway
As survival from breast cancer improves, a multidisciplinary approach is required to manage the many effects of cancer treatment.
In Ireland, over 3,000 patients are diagnosed with breast cancer annually. Advances in diagnosis and treatment have improved outcomes considerably, making breast cancer highly curable if diagnosed and treated at an early stage.
Breast cancer and survivorship needs
As outcomes from breast cancer have improved, the issues facing patients living through and after cancer treatment are increasingly evident, particularly other causes of mortality and damaging side effects of cancer treatment. This is an area that has been under-researched and under-resourced in the past. However, there is a growing appreciation of the importance of living well after cancer treatment; The HSE National Cancer Survivorship Needs Assessment (2019) identified understanding and managing the physical effects of cancer and its treatment as an unmet need for cancer survivors.
There is a growing appreciation
of the importance of living
well after cancer treatment.
Increased cardiovascular risk in breast cancer patients
Female breast cancer survivors are reportedly more likely to die of cardiovascular disease than their age-matched counterparts. This relates not only to a higher prevalence of cardiovascular risk factors such as high cholesterol, overweight, high blood pressure and diabetes in the breast cancer population but is increased exponentially by potential toxic side effects of multimodal cancer treatment on the heart.
To date, the rates and patterns of cancer-related heart disease have not been well defined in the Irish population. Identifying high-risk patients could enable personalised care pathways to reduce risk and manage treatment side effects more effectively.
Addressing risk through multidisciplinary study to improve care pathway
The UCARE (Understanding CARdiac Events in breast cancer) study, funded by the Irish Cancer Society and National Breast Cancer Research Institute, is pilot testing a multidisciplinary assessment and monitoring care pathway at University Hospital Galway for patients at risk of developing cardiac toxicity from cancer treatment.
Management of these patients requires a careful balance of adequate and appropriate cancer treatment while minimising cardiac risk, as there is evidence that early diagnosis and treatment can increase the potential for minimising or reversing cardiotoxic effects. The ultimate aim is to prevent heart disease in cancer patients by creating care pathways and improving communication about cardiac risks during treatment.
