He shares his experience, not to frighten, but rather to encourage those of us who have undergone a breast cancer treatment, known to cause heart damage, to have checkups that include seeing a heart doctor on a regular basis.
When Vincent Moltisanti was diagnosed with breast cancer in 2005, he did what most of us did when we were diagnosed with breast cancer; he followed the treatment plan given to him by his care team. Treatment for his 2cm tumor included a mastectomy followed by four rounds of Adriamycin, a chemo drug that can cause heart damage years after active treatment is completed. After completing active treatment, Vincent went on tamoxifen, a hormone therapy. When he had adverse reactions to tamoxifen, it was discontinued. On the advice of his doctor, he had a mastectomy to remove his remaining breast.
Genetic testing found he is a carrier of a BRCA gene mutation.
Before and after his breast cancer, in his mid 50′s, Vincent maintained a healthy weight, followed a low-fat/ low sugar diet. He is a nonsmoker. He was physically fit and had an active life style. Before his breast cancer he had no history of heart trouble.
In October of 2012, on the day he planned to participate in the American Cancer Society Making Strides Walk in Staten Island, NY, he began experiencing a tightness across the scar line on the left side of his chest. The tightness was accompanied by a shortness of breathe. He cancel out of the walk and called his brother-in-law’s cardiologist.
During the cardiologist’s examination, an echo-cardiogram spotted an aneurysm in his Aorta. An MRI, immediately following, resulted in his being hospitalized at a local medical center where he could be monitored until an opening for surgery came available at Columbia Presbyterian Hospital, a major medical center. He had his heart surgery the day before Thanksgiving. Surgery took 16 hours. He was in the hospital for two weeks. Additional surgery included having a pacemaker.
Today, Vincent’s heart pumps at 17% of capacity. His doctors informed him that the damage to his heart was a result of his chemo medication. Chemo also changed the shape of his heart. His energy level is low and needs to take heart medications.
Vincent is not alone in experiencing heart damage as a result of chemotherapy treatment for breast cancer. What follows is an excerpt of a report on a study that identifies a much higher rate of heart failure among breast cancer survivors than previously reported.
The 12,000 women studied for the report had a 20 percent risk of developing heart failure over just five years if they got a common chemotherapy regimen, compared to just 3.5 percent of breast cancer patients who did not get chemo.
“I think these drugs are critical to improving breast cancer survival,” said Erin Aiello Bowles of the Seattle-based Group Health Research Institute, who led the study published in the Journal of the National Cancer Institute. “But these drugs are toxic. They are meant to target disease but they can often damage other parts of the body.”
The study highlights a growing problem. The American Cancer Society estimates there are 12 million cancer survivors alive in the United States now. As many cancer patients survive their disease and lead ever-longer lives, they find they must fight against the long-term effects of the treatments that saved their lives. Even so-called targeted therapies, which were designed to better target tumor cells while leaving healthy tissue alone, have been shown to cause long-lasting damage.
As they leave the care of a specialized oncologist and return to day-to-day care, they may not know they’re at special risk of other conditions – and their primary care doctors may not be aware, either. The American Society of Clinical Oncology has been warning about the problem for years, and released research at its annual meeting last June showing that 94 % of primary care doctors didn’t know about the potential long-term effects of drugs commonly used to treat breast and prostate cancer.
So what can breast cancer survivors do if they’ve had chemo for breast cancer and want to watch their hearts?
Cardiologist Dr. Larry Allen of the University of Colorado in Denver, who also worked on the study, said they first of all need to be educated about what drugs they have taken and what the side-effects are.
“Second, patients should ask about what heart tests may be indicated before, during, and after treatment,” Allen said in a statement. “These may include tests of how well the heart is pumping blood – tests that most women won’t get during a routine physical or well-woman visit.”
“Third, in addition to allowing doctors to monitor for heart problems, patients can monitor themselves for worsening heart function by understanding how heart problems may present — including shortness of breath especially when lying flat, leg swelling, palpitations/heart fluttering, and exercise intolerance (these symptoms can represent non-heart disease too, but generally warrant additional evaluation),” Allen added.
“Unfortunately, it is unknown if medications that are typically used to treat heart failure (such as beta-blockers and ACE inhibitors) might protect against heart damage from certain chemotherapy.”