Abstract
There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer. A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy. Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices. This work was supported by the Swedish Research Council (grant no: 2018-02547); Swedish Cancer Society (grant no: CAN-19-0266); and FORTE (grant no: 2016-00081).
Highlights
The use of adjuvant systemic therapies at least halves the risk of dying from breast cancer (Early Breast Cancer Trialists' Collaborative, 2005, 2012; Early Breast Cancer Trialists'Collaborative et al, 2015; Goldvaser et al, 2019; Gray et al, 2019)
The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices
As well as administration of anthracycline +/- taxane-based regimens were independently associated with an increased risk of heart failure, while receipt of aromatase inhibitor therapy was associated with an increased risk of ischemic heart disease
Summary
The use of adjuvant systemic therapies at least halves the risk of dying from breast cancer (Early Breast Cancer Trialists' Collaborative, 2005, 2012; Early Breast Cancer Trialists'Collaborative et al, 2015; Goldvaser et al, 2019; Gray et al, 2019). The use of adjuvant systemic therapies at least halves the risk of dying from breast cancer Adjuvant therapies for breast cancer have been associated with an increased risk of heart diseases including heart failure, arrhythmias and ischemic heart disease This evidence mostly comes from studies focusing on specific subgroups of patients based on age, cancer stage or treatment regimen. There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer
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