Open AccessCardiotoxicity screening of long‐term, breast cancer survivors—The CAROLE (Cardiac‐Related Oncologic Late Effects) Study
Author(s) -
Puckett Lindsay L.,
Saba Shahryar G.,
Henry Sonia,
Rosen Stacey,
Rooney Elise,
Filosa Samaria L.,
Gilbo Philip,
Pappas Karalyn,
Laxer Alison,
Eacobacci Katherine,
Kapyur Amitha N.,
Robeny Justin,
Musial Samantha,
Chaudhry Anisha,
Chaudhry Rahul,
Lesser Martin L.,
Riegel Adam,
Ramoutarpersaud Sariah,
Rahmani Navid,
Shah Amar,
Papas Vivian,
Dawodu Toluwani,
Charlton Jessica,
Knisely Jonathan P. S.,
Lee Lucille
Publication year - 2021
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.4037
Subject(s) - medicine , cardiotoxicity , breast cancer , anthracycline , cancer , coronary artery disease , chemotherapy , clinical endpoint , disease , clinical trial , cardiology , oncology
Background Long‐term breast cancer survivors are at risk for cardiotoxicity after treatment, but there is insufficient evidence to provide long‐term (~10 years) cardiovascular disease (CVD) screening recommendations. We sought to evaluate a tri‐modality CVD screening approach. Methods This single‐arm, feasibility study enrolled 201 breast cancer patients treated ≥6 years prior without CVD at diagnosis. Patients were sub‐grouped: cardiotoxic (left‐sided) radiation (RT), cardiotoxic (anthracycline‐based) chemotherapy, both cardiotoxic chemotherapy and RT, and neither cardiotoxic treatment. Patients underwent electrocardiogram (EKG), transthoracic echocardiogram with strain (TTE with GLS), and coronary artery calcium computed tomography (CAC CT). The primary endpoint was preclinical or clinical CVD. Results Median age was 50 (29–65) at diagnosis and 63 (37–77) at imaging; median interval was 11.5 years (6.7–14.5). Among sub‐groups, 44% had no cardiotoxic treatment, 31.5% had cardiotoxic RT, 16% had cardiotoxic chemotherapy, and 8.5% had both. Overall, 77.6% showed preclinical and/or clinical CVD and 51.5% showed clinical CVD. Per modality, rates of any CVD and clinical CVD were, respectively: 27.1%/10.0% on EKG, 50.0%/25.3% on TTE with GLS, and 50.8%/45.8% on CAC CT. No statistical difference was seen among the treatment subgroups (NS, χ 2 test, p = 0.58/ p = 0.15). Conclusion This study identified a high incidence of CVD in heterogenous long‐term breast cancer survivors, most >10 years post‐treatment. Over half had clinical CVD findings warranting follow‐up and/or intervention. Each imaging test independently contributed to the detection rate. This provides early evidence that long‐term cardiac screening may be of value to a wider group of breast cancer survivors than previously recognized.