Abstract P3-10-16: Competing mortality risks: Cardiovascular risk versus risk of metastatic disease in breast cancer patients receiving adjuvant therapy
Authors: Prior L , Featherstone H , Nugent K , Lim M , Kelly C 
Published: February 2018

Background

Breast cancer is the most commonly diagnosed cancer in women in Ireland. The 5 year net survival is over 80%. Most women diagnosed with breast cancer do not die from the disease and instead cardiovascular disease (CVD) remains the most frequent cause of death. Many breast cancer patients are older and have established CVD risk factors. They are at further risk of a cardiovasular (CV) event due to exposure to anthracyclines, HER2 targeted agents, endocrine therapy and radiotherapy. In this study, we aimed to compare the 10 year risk of breast cancer mortality versus that of a CV event or death in an oncology day ward population at our centre through the use of online prognostic risk calculators. Furthermore, we sought to investigate the predicted outcome of lifestyle changes on their overall CV risk and level of interest in addressing these risk factors.

Methods

This was a cross cohort study of all breast cancer patients attending for adjuvant chemotherapy at our institution from September 2015 to September 2016. To calculate patients' 10 year CVD risk, we used the JBS3 online calculator. Using this calculator we could also predict patient's lifetime CV risk. To calculate patients' 10 year mortality risk from breast cancer we used NHS predict! These calculators incorporate several variables which we identified from chart review, the use of questionnaires and the performance of a serum lipid test.

Results

101 subjects were identified. All patients (pts) completed questionnaires. Eighteen pts were excluded from CV risk analysis due to lack of lipid profile. Of 83 pts, 83% (n=69) were &gt;50 years of age and 17% (n=14) pts were &lt;50 years of age. The median age in the &gt;50 age group (grp) was 59 and 42 in the &lt;50 age grp. The median BMI in the &gt;50 and &lt;50 grp was 29.2 and 26.4 respectively. Forty-two percent (n=29) of pts in the &gt;50 grp were smokers/ex smokers and 49% (n=7) were in the &lt;50 grp. Twenty-nine percent (n=20) in the &gt;50 grp were on statins and 25% (n=17) were on antihypertensives. Fifty-two percent (n=36) of pts in the &gt;50 grp and 66% (n=10) received anthracyclines. Fifty percent in both grps received left sided radiotherapy. Ninety five percent (n=63) were on endocrine therapy in the &gt;50 grp and 93% (n=13) in the &lt;50 grp. Forty-one percent in the &gt;50 grp (n=28) and 29% (n=4) of patients in the &lt;50 grp received Trastuzumab. In the &gt;50 grp, 13% (n=9) were found to have a high 10 year cardiovascular risk (&gt;20% risk of CV event) and 28% were found to be at moderate risk (n=19). Ten percent of patients were found to have a CV risk that exceeded their breast cancer mortality risk (n=7). Even though the 10 year CV risk was low in patients &lt;50, their median lifetime risk was calculated at 52%. Eighty seven percent of pts were interested in receiving advice on reducing their cardiovascular risk. The predicted median 10 year cardiovascular risk of age&gt;50 patients in the high risk group post CV risk modification was 8.8% (+/-5.6) versus 28% (+/-8) at baseline.

Conclusion

This patient population has significant CV risk factors at baseline. Benefits predicted with CV risk intervention model and significant patient interest indicates that formalised CV risk prevention strategy is needed.

Citation Format: Prior L, Featherstone H, Nugent K, Lim M, Kelly C. Competing mortality risks: Cardiovascular risk versus risk of metastatic disease in breast cancer patients receiving adjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-16.