Division of Cancer Prevention, Cancer Prevention Fellowship Program, National Cancer Institute, 9609 Medical Center Drive, 7E556, Rockville, MD, 20850, USA.
Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
Cancer Causes Control. 2021 Jun;32(6):617-626. doi: 10.1007/s10552-021-01415-3. Epub 2021 Mar 24.
Breast cancer survivors are at risk for developing cardiovascular disease due to cardiotoxic cancer treatment. Research on young breast cancer survivors (diagnosed < 45 years old) are limited.
Young breast cancer survivors diagnosed between age 30 and 44, stage I-III, and treated at the University of Alabama at Birmingham Hospital between 2012 and 2015 were included. Cardiovascular disease risk was estimated using excess heart age (calculated using age, systolic blood pressure, blood pressure medication, diabetes, smoking, body mass index) and examined at two time points: diagnosis and 2-year follow-up. Statistical analyses included within-group mean comparison tests and linear regression to examine predictors of excess heart age.
A total of 152 young breast cancer survivors were included; 95 received anthracyclines and/or trastuzumab, and 57 did not. Overall excess heart age was 4.2 at diagnosis and 5.4 years at 2-year follow-up (p = 0.08). Change in excess heart age from diagnosis to 2-year follow-up among those receiving or not receiving anthracyclines and/or trastuzumab was 4.3-4.4 years, p = 0.93; and 4.0-7.1 years, p < 0.01; respectively. Factors that predicted excess heart age included endocrine therapy (p = 0.049) and change from premenopausal to postmenopausal status (p = 0.048).
Anthracyclines and trastuzumab were not predictors of excess heart age. Subclinical changes undetected by heart age may still occur. Future research is needed to evaluate heart age over longer follow-up and to develop a modified heart age tool, that incorporates treatment risk, that facilitates identification of high-risk cancer patients for early intervention in cardiac risk prevention.
由于癌症治疗的心脏毒性，乳腺癌幸存者患心血管疾病的风险增加。针对年轻乳腺癌幸存者（<45 岁确诊）的研究有限。
纳入 2012 年至 2015 年期间在阿拉巴马大学伯明翰分校医院确诊、年龄在 30 至 44 岁之间、分期为 I-III 期的年轻乳腺癌幸存者。使用超龄心脏（通过年龄、收缩压、降压药物、糖尿病、吸烟、体重指数计算）来评估心血管疾病风险，并在两个时间点进行检查：诊断时和 2 年随访时。采用组内均值比较检验和线性回归分析来评估超龄心脏的预测因素。
共纳入 152 名年轻乳腺癌幸存者，其中 95 名接受了蒽环类药物和/或曲妥珠单抗治疗，57 名未接受。诊断时的总体超龄心脏为 4.2 岁，2 年随访时为 5.4 岁（p=0.08）。接受或未接受蒽环类药物和/或曲妥珠单抗治疗的患者，从诊断到 2 年随访时，超龄心脏的变化分别为 4.3-4.4 岁（p=0.93）和 4.0-7.1 岁（p<0.01）。预测超龄心脏的因素包括内分泌治疗（p=0.049）和从绝经前状态变为绝经后状态（p=0.048）。
蒽环类药物和曲妥珠单抗不是超龄心脏的预测因素。亚临床变化可能仍未被超龄心脏检测到。未来需要进行更长时间随访的超龄心脏研究，并开发一种包含治疗风险的改良超龄心脏工具，以识别高危癌症患者，从而进行早期心脏风险预防干预。
