Baystate Medical’s Dr. Heba Wassif on Breast Cancer Treatment and Heart Disease | Connecting Point

Baystate Medical’s Dr. Heba Wassif on Breast Cancer Treatment and Heart Disease | Connecting Point


>>>IN MEDICAL NEWS TONIGHT, WE
TAKE A LOOK AT THE CONNECTION BETWEEN CERTAIN BREAST CANCER
TREATMENTS CAUSING AN INCREASED RISK OF HEART DISEASE FOR SOME
PATIENTS. THE AMERICAN HEART ASSOCIATION
RECENTLY RELEASED A STATEMENT ON THE CONNECTION, AND CAROLEE
MCGRATH SAT DOWN WITH NON-INVASIVE CARDIOLOGIST
DR. HEBBA WASIF FROM BAY STATE
MEDICAL CENTER TO LEARN MORE.>>THE EMERGING PARADIGM, FOR
THREE REASONS, THERE ARE COMMON RISK FACTORS BETWEEN BREAST
CANCER AND CARDIOVASCULAR DISEASE, LIKE A SEDENTARY
LIFESTYLE, CERTAIN DIETS, EXCESSIVE MEATS, FOR EXAMPLE,
SMOKING THAT HAS SOME ASSOCIATION ALSO WITH BREAST
CANCER. SO THE DISEASE, BOTH DISEASES
CAN EXIST IN THE SAME PERSON, SO A PERSON CAN BE SUFFERING FROM
BABIES AS WELL AS CARDIOVASCULAR DISEASE. THE SECOND REASON IS THERE ARE
MANY TREATMENT OPTIONS NOW FOR BREAST CANCER THAT HAVE SOME
CARDIOVASCULAR TOXICITY THAT I BELIEVE WE’LL BE DISCUSSING
LATER ON. SO IT’S IMPORTANT TO KNOW WHAT
AN INDIVIDUAL’S UNDERLYING CARDIOVASCULAR RISK IS. THE THIRD OBVIOUSLY THAT IF YOU
HAVE UNDERLYING CARDIOVASCULAR DISEASE, THAT MAY DETERMINE OR
DIRECT SOME OF YOUR TREATMENT OPTIONS FOR BREAST CANCER.>>SO WHAT TYPES OF TREATMENTS
ARE WE TALKING ABOUT THIS WOULD BE THE MOST ADEGREESIVE AND
CAUSE PROBLEMS WITH THE HEART?>>ONE OF THE MOST AGGRESSIVE
TREATMENTS IS A GROUP OF DRUGS, THERE ARE SEVERAL OF THEM IN THE
GROUP, SOME CAUSE MORE CARDIOTOXICITY THAN OTHERS.>>EXPLAIN THAT.>>FOR THE LAY PERSON,
CARDIOTOXICITY, BECAUSE AS THESE DRUGS ARE TOXIC AND KILL THE
BREAST CANCER CELLS, THEY ALSO KILL THE MYO CARDIAL CELLS, THE
CELLS OF THE HEARTS. THEY HAVE THE SAME IMPACT, SO
THEY INTERACT WITH THE D.N.A. IN
A SIMILAR FASHION THAT THEY WOULD DO WITH THE TUMOR CELLS. BUT HERE NOW WE’RE TALKING ABOUT
A LIVING HEART CELL. AND THEREFORE IT CAN POTENTIALLY
CAUSE WEAKNESS OF THE HEART MUSCLE. THESE DRUGS WERE USED FROM THE
EARLY 70’S. IT WASN’T UNTIL ALMOST 10 YEARS
LATER THAT WE DISCOVERED SUCH THESE TOXICITIES, SO TO SAY.
AND WE’VE ALSO DISCOVERED THAT IT’S SOMEWHAT DOSE DEPENDENT. AND I WILL QUALIFY THAT
STATEMENT, THAT THE I’MER THE DOSE THE MORE RISK FOR THE HEART
MUSCLE. HOWEVER, THERE’S SOME
INDIVIDUALS THAT ARE MORE SUSCEPTIBLE EVEN AT VERY LOW
DOSES, THEY CAN POTENTIALLY HAVE PROBLEMS WITH THE HEART MUSCLE.>>WHAT KINDS OF CONDITIONS ARE
THOSE INDIVIDUALS IN? THEY ALREADY HAVE UNDERLYING
FACTORS FOR HEART DISEASE?>>EXACTLY, SO IF THEY HAVE
UNDERLYING CARDIOVASCULAR DISEASE OR IF THEIR HEART MUSCLE
IS BORDER LINE WEAK, SO WE DEFINE A STRONG HEART MUSCLE IN
THE WORLD OF MEDICINE IS A HEART MUSCLE THAT PUMPS ABOUT 60% OF
THE BLOOD. IF YOUR HEART MUSCLE IS BORDER
LINE, 50 TO 55%, THEN WE’RE STARTING AT A WEAKER HEART
MUSCLE, THAT CAN POTENTIALLY BE AT RISK. AND SOME OF IT IS ALL —
IT’S A WORLD OF UNCERTAINTIES. BUT WE CAN ONLY TRY TO FIND WHAT
ARE THE POSSIBLE ASSOCIATIONS THAT WOULD INCREASE THE RISK,
IDENTIFY THEM, AND THEN MODIFY WHAT WE DO TO MINIMIZE THAT
RISK. SO IF AN INDIVIDUAL IS OVER 60
YEARS OLD, THEY HAVE TWO OR MORE CARDIOVASCULAR RISK FACTORS,
THEY HAVE A WEAK HEART MUSCLE, AS I MENTIONED, LIKE A BORDER
LINE HEART MUSCLE, THEN WE HAVE TO MAYBE USE LESS AGGRESSIVE
THERAPIES. OR DO CONTINUOUS MONITORING AT
THE BEGINNING OF THE TREATMENT, AS THE TREATMENT PROGRESSES, AND
EVEN AFTER THE TREATMENT IS TERMINATED BECAUSE SOME OF THESE
EFFECTS COULD BE VERY LATE AFTER THE TREATMENT HAS ENDED.>>WHEN WOMEN HEAR BREAST
CANCER, YOU KNOW, IT’S AN AUTOMATIC, AS IT SHOULD BE, YOU
KNOW, YOU’RE FRIGHTENED, YOU’RE SO WORRIED ABOUT YOUR FUTURE,
YOUR CHILDREN, YOUR HUSBAND. AND WHAT THE MEDICAL OUTCOME
WILL BE. SO I’M SURE PEOPLE ARE SAYING,
YOU KNOW, GIVE METHE STRONGEST TREATMENT POSSIBLE BECAUSE I
WANT TO GET RID OF THIS. BECAUSE YOU HAVE TO TREAT IT
AGGRESSIVELY.>>ABSOLUTELY. AND THAT’S NOT HAVING SAID THAT
BECAUSE OF THE CONCERN OF CARDIOVASCULAR RISK OR
CARDIOTOKS ISITY, THAT DOESN’T MEAN THAT WE SHOULD HOLD
TREATMENT FOR BREAST CANCER. YOU HAVE TO TREAT THE CANCER IF
IT’S AGGRESSIVE, YOU’RE MORE LIKELY TO DIE FROM BREAST CANCER
THAN DIEING FROM CARDIOVASCULAR DISEASE. SOME OF THESE POSSIBILITIES MAY
BE LONG TERM. AND BECAUSE WE HAVE LONG-TERM
SURVIVORS, WE ARE SEEING MORE WOMEN THAT ARE SURVIVING BREAST
CANCER, WHICH IS AN AMAZING ENDEAVOR THAT HAS BEEN ACHIEVED
OVER THE LAST 25 YEARS MARKS THE MORTALITY FROM BREAST CANCER HAS
BEEN REDUCED SIGNIFICANTLY. WE’RE SEEING WOMEN THAT ARE NOW
DYING AS OLDER WOMEN FROM CARDIOVASCULAR DISEASE, WHO HAD
BREAST CANCER. NOT FROM THE RECURRENCE OF THE
BREAST CANCER, BUT RATHER FROM CARDIOVASCULAR DISEASE. SO IT’S IMPORTANT TO IDENTIFY
WHO IS AT RISK FIRST, AND IT IS AN EVOLVING FIELD WHERE THERE’S
A LOT OF WORK THAT’S CURRENTLY BEEN DONE. AND IT’S ALSO BEEN IDENTIFIED AS
A UNIQUE SUB SPECIALTY OF CARDIOLOGY WHICH IS ALMOST NEW
IN EXISTENCE OVER THE LAST FEW YEARS.>>GIVE US THE NUMBERS AS FAR AS
THE MORTALLY RATES FOR HEART DISEASE VERSUS BREAST CANCER.>>TO PUT THINGS INTO
PERSPECTIVE, THERE ARE MORE WOMEN LIVING WITH CARDIOVASCULAR
DISEASE IN THE U.S. THAN THERE ARE WOMEN WITH BREAST CANCER. ALMOST 48 MILLION WOMEN WITH
CARDIOVASCULAR DISEASE, AND ONE OUT OF THREE WOMEN WILL DIE FROM
CARDIOVASCULAR DISEASE. AND THAT’S INCLUDING STROKE AS
WELL. ONE OUT OF 31 WOMEN WILL DIE
FROM BREAST CANCER. SO WOMEN ARE MORE LIKELY TO DIE
FROM HEART DISEASE THAN BREAST CANCER. BUT THIS IS AGAIN WHERE WE’RE
IDENTIFYING AWE BREAST CANCERS IN ALL ITS STAGES AND ALL ITS
FORMS AS WELL AS CARDIOVASCULAR DISEASE. IT DOESN’T SPEAK FOR THE
PARTICULAR INDIVIDUAL.>>HOW DO YOU WORK WITH THE
ONCOLOGIST, WHEN YOU HAVE A PATIENT WHO HAS HEART DISEASE
WHO IS ALSO BEING TREATED FOR BREAST CANCER, TELL ME HOW THAT
RELATIONSHIP HAS TO WORK TO BEST BENEFIT THE PATIENT.>>AS I SAID, THIS IS AN
EMERGING PARADIGM, AND IT’S AN EVOLVING COLLABORATION NOW
BETWEEN CARDIOLOGISTS AND ONCOLOGISTS. THE ONCOLOGIST IS THE PRIMARY
TREATING PHYSICIAN, THEY IDENTIFY WHAT IS THE MOST
APPROPRIATE THERAPY FOR THE PATIENT. BUT THEY WORK HAND IN HAND WITH
THE CARDIOLOGIST TO FIRST MONITOR THE PATIENTS FROM A
CARDIOVASCULAR STANDPOINT, FOR EXAMPLE, IF THE HEART MUSCLE IS
RELATIVELY WEAK TO START WITH, THEN MAYBE INITIATING CERTAIN
THERAPIES MAY BE ADVICABLE. IF HEART WEAKNESS OCCURS DURING
THE THERAPY, AJUSTMENT OF THE TREATMENT OPTIONS IS WARRANTED. AND THIS CONTINUOUS MONITORING
BY CARDIAC ECHO CARD YOG REAF, WHICH IS THE ULTRASOUND FOR THE
MART MUSCLE, I VERY — IS VERY IMPORTANT. IT’S A COLLABORATION OF THE
BEGINNING, MIDDLE OF THERAPY AND EVEN AFTER THE THERAPY IS
TERMINATED.>>I KNOW YOU’RE A MEDICAL
DOCTOR, BUT I HAVE TO IMAGINE THAW SEE THE EMOTIONAL SIDE OF
YOUR PATIENTS.>>SLEUMENT.>>HERE YOU HAVE BREAST CANCER
AND NOW YOU’RE AT HIGH RISK FOR A HEART, SOME SORT OF HEART
FAILURE OR HIGH RISK OF HEART DISEASE. THAT’S LIKE TWO MAJOR THINGS
THAT PEOPLE WOULD HAVE TO DEAL WITH. HOW DO YOU HELP PATIENTS
UNDERSTAND THE PROCESS?>>IT’S OBVIOUSLY, YOU CAN’T
TAKE AT THE MOTION OUT OF EITHER CONDITION. THERE’S A LOT OF EMOTIONS
ASSOCIATED WITH THEM AND PEOPLE ARE PEOPLE, WE’RE HUMAN BEINGS. AT THE END OF THE DAY THIS IS
LIFE THREATENING ON BOTH ENDS. IT’S ALL ABOUT ASSESSING RISK,
WHAT IS THE MOST RISK NOW, AND IF THE BREAST CANCER IS THE MOST
RISK, WHICH IT USUALLY IS IMMEDIATELY, THEN YOU MANAGE THE
BREAST CANCER, AND YOU MONITOR. AND YOU MAY, AS I SAID, MAYBE
USE LESS AGGRESSIVE THERAPIES. AND THERE ARE LESS AGGRESSIVE
THERAPIES, BUT IT HAS TO BE WITH THE AGREEMENT OF THE ONCOLOGIST
THAT THAT IS AN APPROPRIATE THERAPY FOR THAT PARTICULAR
PATIENT.