Shortreed Hannah, Clark Megan, Abdel-Qadir Husam, Siddiqui Rabail, Aseyev Olexiy
Department of Undergraduate Medical Education, Northern Ontario School of Medicine University, Thunder Bay, ON P7B 7A5, Canada.
Division of Cardiology and Department of Medicine, Women's College Hospital and University Health Network, Toronto, ON M5S 1B2, Canada.
Cancers (Basel). 2025 Jun 8;17(12):1909. doi: 10.3390/cancers17121909.
Breast cancer affects over 25,000 women annually in Canada and has seen improved survival rates due to advances in screening and treatment. However, cardiotoxic therapies including anthracyclines and trastuzumab have made cardiovascular disease a leading cause of death among survivors. Baseline left ventricular ejection fraction is a reliable predictor of heart failure, and various guidelines recommend pretreatment cardiac imaging; however, its utility is largely based on expert opinion.
This retrospective cohort study analyzed 93 breast cancer patients treated at a single cancer centre in Northwestern Ontario between 2012 and 2017 to determine the yield (defined as imaging leading to clinically actionable changes in care) of imaging.
Patients were grouped by treatment regimen: trastuzumab-only (cohort A, = 3, mean age = 73.55 ± 9.90), anthracycline-only (cohort B, = 60, mean age = 58.83 ± 9.83), and combination therapy with both trastuzumab and anthracyclines (cohort C, = 30, mean age = 59.37 ± 10.91). Due to the very small sample size in cohort A, findings are presented for qualitative insight only. Cohort B had the highest imaging yield (13.33%), while cohorts A and C showed lower yields (7.14% and 4.17%) with more frequent imaging. Predictors of higher yield varied, with cohort B identifying the most, including diabetes and coronary artery disease.
These findings underscore the need for targeted cardiac imaging to optimize resource allocation and patient outcomes, particularly in resource-limited settings such as Northwestern Ontario. Subsequent investigations should seek to stratify proactive versus reactive interventions, evaluate outcomes, refine imaging guidelines, and gather more data on patients receiving trastuzumab.
在加拿大，每年有超过25000名女性受到乳腺癌影响，由于筛查和治疗方面的进展，生存率有所提高。然而，包括蒽环类药物和曲妥珠单抗在内的心脏毒性疗法使心血管疾病成为幸存者的主要死因。基线左心室射血分数是心力衰竭的可靠预测指标，各种指南推荐在治疗前进行心脏成像；然而，其效用很大程度上基于专家意见。
这项回顾性队列研究分析了2012年至2017年期间在安大略省西北部一个癌症中心接受治疗的93名乳腺癌患者，以确定成像的收益（定义为成像导致临床上可采取行动的护理变化）。
患者按治疗方案分组：仅使用曲妥珠单抗（A组，n = 3，平均年龄 = 73.55 ± 9.90），仅使用蒽环类药物（B组，n = 60，平均年龄 = 58.83 ± 9.83），以及曲妥珠单抗和蒽环类药物联合治疗（C组，n = 30，平均年龄 = 59.37 ± 10.91）。由于A组样本量非常小，仅给出定性见解的结果。B组成像收益最高（13.33%），而A组和C组成像收益较低（7.14%和4.17%），且成像更频繁。高收益的预测因素各不相同，B组识别出的最多，包括糖尿病和冠状动脉疾病。
这些发现强调了进行有针对性的心脏成像以优化资源分配和患者预后的必要性，特别是在安大略省西北部等资源有限的地区。后续研究应寻求区分主动干预与被动干预，评估结果，完善成像指南，并收集更多接受曲妥珠单抗治疗患者的数据。
