Marrison Sarah Tucker, Shungu Nicholas, Diaz Vanessa
Medical University of South Carolina, 135 Cannon Street, Suite 405, Charleston, SC, United States, 1 8438761210.
JMIR Cancer. 2025 Jul 3;11:e71062. doi: 10.2196/71062.
Breast cancer survivors have increased cardiovascular risk compared to those without cancer history. Cardiovascular disease is the most common cause of death in breast cancer survivors. Cardiovascular risk in breast cancer survivors is impacted by both cancer treatment-associated effects and in risk factors for breast cancer and cardiovascular disease overlap. Strategies to improve screening for and management of cardiovascular disease in breast cancer survivors are needed to improve the delivery of survivorship care.
This study aims to assess current cardiovascular risk counseling practices and perceived cardiovascular risk in breast cancer survivors.
Semistructured interviews were conducted from May to December 2021 with breast cancer survivors identified as having a primary care clinician within an academic family medicine center in Charleston, South Carolina. The interview guide and content were developed using the Health Belief Model with a focus on cardiovascular risk behaviors, risk perception, and barriers to risk reduction. Analysis of categorical data was conducted by frequency and quantitative variables by mean and SD. Template analysis was performed for qualitative analysis. Outcome measures included self-reported history of cardiovascular disease, risk perception, and risk behaviors.
The average age of participants (n=19) was 54 (SD 7) years; 68% (13/19) were White and 32% (6/19) were Black or African American. Of the interviewed women, 90% (17/19) reported a personal history and 90% (17/19) reported a family history of cardiovascular disease. Only 53% (10/19) had previously reported receipt of cardiovascular counseling. Primary care most commonly provided counseling, followed by oncology. Among breast cancer survivors, 32% (6/19) reported being at increased cardiovascular risk, and 47% (9/19) were unsure of their relative cardiovascular risk. Factors affecting perceived cardiovascular risk included family history, cancer treatments, cardiovascular diagnoses, and lifestyle factors. Video (15/19, 79%) and SMS text messaging (13/19, 68%) were the most highly reported mechanisms through which breast cancer survivors requested to receive additional information and counseling on cardiovascular risk and risk reduction. Commonly reported barriers to risk reduction such as physical activity included time for meal planning and exercise, resources to support dietary and exercise changes, physical limitations, and competing responsibilities. Barriers specific to survivorship status included concerns for immune status during the COVID-19 pandemic, physical limitations associated with cancer treatment, and psychosocial aspects of cancer survivorship.
Breast cancer survivors identified that factors associated with their cancer diagnosis and treatment both impacted their cardiovascular risk and introduced additional barriers to risk reduction. Potential strategies to improve counseling and awareness around cardiovascular risk include video and messaging platforms. Further risk reduction strategies should consider the unique challenges of cancer survivorship in delivery and implementation.
与无癌症病史者相比，乳腺癌幸存者患心血管疾病的风险增加。心血管疾病是乳腺癌幸存者最常见的死亡原因。乳腺癌幸存者的心血管疾病风险受到癌症治疗相关影响以及乳腺癌和心血管疾病共同危险因素的双重影响。需要采取策略来改善乳腺癌幸存者心血管疾病的筛查和管理，以提高生存护理的质量。
本研究旨在评估乳腺癌幸存者当前的心血管疾病风险咨询实践情况以及他们对心血管疾病风险的认知。
2021年5月至12月，对南卡罗来纳州查尔斯顿一家学术性家庭医学中心内被确定有初级保健医生的乳腺癌幸存者进行了半结构化访谈。访谈指南和内容是根据健康信念模型制定的，重点关注心血管疾病风险行为、风险认知以及降低风险的障碍。分类数据的分析采用频率法，定量变量的分析采用均值和标准差法。定性分析采用模板分析法。结果指标包括自我报告的心血管疾病病史、风险认知和风险行为。
参与者（n = 19）的平均年龄为54岁（标准差7）；68%（13/19）为白人，32%（6/19）为黑人或非裔美国人。在接受访谈的女性中，90%（17/19）报告有个人心血管疾病病史，90%（17/19）报告有家族心血管疾病病史。此前只有53%（10/19）报告接受过心血管疾病咨询。初级保健机构提供咨询最为常见，其次是肿瘤学机构。在乳腺癌幸存者中，32%（6/19）报告心血管疾病风险增加，47%（9/19）不确定自己相对的心血管疾病风险。影响心血管疾病风险认知的因素包括家族病史、癌症治疗、心血管疾病诊断和生活方式因素。视频（15/19，79%）和短信（13/19，68%）是乳腺癌幸存者最常提及的获取心血管疾病风险及降低风险的更多信息和咨询的方式。常见的降低风险障碍，如体育活动方面，包括饮食计划和锻炼的时间、支持饮食和锻炼改变的资源、身体限制以及其他事务的干扰。与生存状态相关的障碍包括对新冠疫情期间免疫状态的担忧、与癌症治疗相关的身体限制以及癌症生存的心理社会方面。
乳腺癌幸存者发现，与癌症诊断和治疗相关的因素既影响了他们的心血管疾病风险，也给降低风险带来了额外障碍。改善心血管疾病风险咨询和认知的潜在策略包括视频和信息平台。进一步的降低风险策略在实施过程中应考虑癌症生存者面临的独特挑战。
