Cancer Linked to Heart Disease
The Link Between Cancer and Heart Disease
48, New Haven, CT
Three years ago, Holly Wasilewski was six months into chemotherapy and radiation treatment for stage II breast cancer when she started having chest palpitations, shortness of breath and swelling in her legs. She ignored her symptoms, even though her leg pain grew so severe that she began wearing compression stockings. When she finally told her doctors a few weeks later, they ran some tests and found out that she was in heart failure.
46, St. Paul, MN
Stephanie Hansen was also blindsided by heart disease. She was diagnosed with stage III breast cancer shortly after completing a marathon in Minnesota in 2011. She had a double mastectomy and was treated with chemotherapy and radiation. After about 10 doses of Herceptin, an injectable cancer drug, Stephanie began to feel sluggish and was having trouble walking up the stairs. "I thought it was because of the chemotherapy and I should just deal with it," she says. Finally, after almost two months, Stephanie told her physician: "I don't feel right. Something is wrong." Tests revealed that she, too, was in heart failure.
60, Santa Barbara, CA
Dianne Travis-Teague was nine years out from being treated for breast cancer with radiation and chemotherapy when she began to experience fatigue and persistent chest pain. She brushed off her symptoms for nearly a week because she had recently seen her doctor and everything seemed fine.
"Eventually, the pain got so bad that I became really irritable," says Dianne. When she mentioned her discomfort at a routine doctor's appointment, they told her she needed to go to the hospital immediately. At the ER, they stabilized her, then took Dianne into emergency surgery the next day. A stent was inserted to open up a blocked artery, which doctors told her may have been a result of her aggressive cancer treatment years earlier. Dianne, who has no family history of heart disease, was stunned that the two health conditions could be connected.
Holly, Stephanie and Dianne's cases may sound extreme, but a diagnosis of heart disease during or after breast cancer treatment is not uncommon. These three women are part of a growing group of cancer survivors surprised by treatment-related heart disease.
Up to 20% of women can develop heart problems—including atherosclerosis, weakening of the heart muscle and heart attacks—due to breast cancer treatment, according to some studies. (Certain populations, like African-Americans and women 60 and older, have even higher odds.)
Research suggests that radiation may cause damage to the heart soon after treatment, or even years later. And some older chemotherapy medications called anthracyclines, coupled with newer targeted therapies such as Herceptin, may also affect your heart. (One study found that during treatment, women using both anthracyclines and trastuzumab—the active ingredient in Herceptin—were more likely to develop heart problems than women treated with anthracyclines alone.)
What This Means
Everyone should talk about heart disease—the number-one killer of women—with their doctors, but it's especially crucial before you undergo cancer treatment. Choosing a treatment is hard enough, so it's important to work with a physician to weigh the risks and benefits of each option while keeping in mind, says Carrie Thompson, MD, a hematologist oncologist at the Mayo Clinic in Rochester, MN. Cancer patients can also consider visiting a cardio-oncology center, where cardiologists and oncologists work together as a team to handle treatment. (See slide 9.)
And as with heart problems in all women, timing is critical, says Juan Carlos Plana, MD, director of the cardio-oncology clinic at the Cleveland Clinic. Never ignore telling symptoms like chest pain, shortness of breath and crushing fatigue. "If we recognize heart issues early, we can start therapy and reverse the progression," says Dr. Plana. "The window of opportunity is about six months from when trouble begins."
Bottom line: Talk to your doctor about your heart-disease risk factors and work together to settle on the right treatment. Pay attention to any new symptoms—and if you do notice anything unusual, don't wait to speak up.
Adopting a healthy lifestyle will not only work to reduce your risk of heart disease, it may also help you prevent cancer.
The nutritional guidelines issued by the American Cancer Society for cancer survivors are the same as the diet that is recommended for heart-disease prevention, says Marion Nestle, PhD, professor of nutrition, food studies and public health at New York University. "Keep it simple: Up your intake of fruits, vegetables and , and don't eat too much junk food," she says.
When it comes to fitness, staying active is key. Since treatment can weaken your heart and you're usually less able to exercise during that time, cancer survivors are typically in worse physical and cardiovascular shape than their healthy counterparts, says Arash Asher, MD, director of cancer survivorship and rehabilitation at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute in Los Angeles. The good news? A safe exercise program can reverse some of the damage.
Pick an enjoyable aerobic activity, such as walking, hiking, swimming or cycling. Start with as little as 5 to 10 minutes and work up to a goal of 150 minutes of moderate (being able to talk while working out) aerobic exercise per week.
If you are scheduled for radiation treatment, ask what's being done to shield your heart. For instance, a technique called active breathing control can help you hold your breath during treatment, which can move the heart away from the beam of radiation. Treatment in the prone position (lying on your belly instead of your back) may allow more separation of the breast tissue from the heart in certain cases.
Although the double whammy of health problems was tough to handle, Holly, Stephanie and Dianne all agree that their sudden heart issues were a wakeup call.
Forgoing sweets helped Holly shape up. She used to buy fresh cookies from the deli every day but cut them out cold turkey. She also started a few times a week and, so far, has lost 32 pounds. "I feel like this situation was my second chance to strengthen my body and my heart so I can live healthier for years to come," she says.
Stephanie exercises two days a week with a cancer recovery specialist who helps her work on balance, strength training and cardio intervals to keep her heart strong. She bought a FitBit to track her activity and, earlier this year, she and a few friends started a "100 days of movement" challenge, vowing to move each day for 30 minutes or more.
"Before my heart episode, when I wasn't working, I was mostly sitting and relaxing," says Dianne. Now she swims regularly and takes tai chi classes. She overhauled her diet, too, replacing sugary lattes with plain green tea and cutting back on greasy food. "I have more energy than before," says Dianne, who has lost 25 pounds.
1. Smilow Cancer Hospital at Yale-New Haven
2. Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute
3. The Cleveland Clinic
4. MD Anderson Cancer Center
5. Dana Farber Cancer Institute
6. University of Michigan
7. University of Rochester Medical Center
8. Medstar Washington Hospital Center
9. Medstar Georgetown University Hospital
10. Brigham and Women’s Hospital
11. Duke university Hospital
12. University of Rochester Medical Center
13. Mayo Clinic
14. University of Kansas
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