Vo Jacqueline B, Rosenberg Shoshana, Zhang Bessie X, Snow Craig, Kirkner Greg, Poorvu Philip D, Gaither Rachel, Ruddy Kathryn J, Tamimi Rulla M, Peppercorn Jeffrey M, Schapira Lidia, Borges Virginia F, Come Steven E, Nohria Anju, Partridge Ann H
Cancer Prevention Fellowship Program, Division of Cancer Epidemiology & Genetics, National Cancer Institute, 9609 Medical Center Drive, 7E532, Bethesda, Rockville, MD, 20906, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
J Cancer Surviv. 2024 Jul 15. doi: 10.1007/s11764-024-01645-9.
Data evaluating cardiovascular disease (CVD) risk by cancer treatment among young women (≤ 40 years) with breast cancer are limited.
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.
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.
Among young breast cancer survivors, radiation, but not other cancer treatments, was associated with elevated excess heart age.
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.
评估年轻（≤40岁）乳腺癌女性患者因癌症治疗导致心血管疾病（CVD）风险的数据有限。
在“年轻女性乳腺癌研究”中选取372名年龄在30 - 40岁的五年期乳腺癌幸存者，我们使用多变量线性和逻辑回归分析，评估癌症治疗（蒽环类药物、曲妥珠单抗、放疗/照射部位、内分泌治疗）与心脏年龄超标（根据改良的弗雷明汉风险评分评估的预测10年CVD风险与实际年龄之差）、普遍心脏年龄超标升高（≥2岁）以及乳腺癌诊断时、两年和五年随访时心脏年龄超标恶化（心脏年龄超标变化≥2岁）之间的关联。
大多数女性患有I期或II期（79%）、雌激素受体阳性（ER +，71%）或孕激素受体阳性（PR +，65%）乳腺癌。在诊断时，接受治疗的女性心脏年龄超标情况较少（平均范围 = -0.52,0.91岁）。左侧放疗（β = 2.49，标准误 = 0.96，p = 0.01）与五年随访时较高的心脏年龄超标相关。对于普遍心脏年龄超标升高（两年时 = 26%；五年时 = 27%），接受右侧放疗的女性在两年时风险增加（比值比 = 2.17，95%置信区间 = 1.12 - 4.19），但在五年时，任何放疗后均观察到关联（比值比 = 1.92，95%置信区间 = 1.09 - 3.41），尤其是左侧放疗后（比值比 = 2.13，95%置信区间 = 1.09 - 3.41）。未观察到全身治疗与普遍心脏年龄超标升高或任何治疗与心脏年龄超标恶化之间的关联。
在年轻乳腺癌幸存者中，放疗而非其他癌症治疗与心脏年龄超标升高相关。
鉴于心血管疾病的长期生存期和长潜伏期，需要纳入放疗等癌症治疗因素的CVD风险评估工具来识别高风险年轻乳腺癌幸存者。
