Significant Cardiovascular Mortality Following Early-Stage Breast Cancer Interview with:

Husam Abdel-Qadir

Dr. Husam Abdel-Qadir

Husam Abdel-Qadir, MD, FRCPC, DABIM
(Cardiology and Internal Medicine)
Graduate student, Clinical Epidemiology and Health Care Research
Elliot Philipson Clinician Scientist Training Program
University of Toronto What is the background for this study?

Response: Breast cancer is the most common malignancy among North American women. The successes of screening and treatment have led to a marked increase in the number of breast cancer survivors, whose cardiovascular health is becoming of prime concern. Many recent publications have raised alarm about the incidence of cardiovascular abnormalities after breast cancer treatment. However, there is a paucity of data about the frequency of death from cardiovascular disease rather than breast cancer. Contemporary estimates of the incidence of competing risks like cardiovascular disease are important to guide discussions about prognosis, subsequent follow-up, and survivorship plans. It is important that such incidence estimates are generated using methodology that appropriately accounts for competing risks to avoid providing results that are biased upwards. What are the main findings?

Response: In this manuscript, we report on the frequency of causes of death in a cohort of women diagnosed with early stage breast cancer in Ontario, Canada over median follow-up of 6.6 years. Our data indicate that breast cancer continues to be the most common cause of death in the present era, accounting for 50% of deaths. However, cardiovascular death is an important cause of death, being responsible for almost 1 in 6 deaths after breast cancer. The risk of dying from cardiovascular disease is most relevant in older women and those with prior cardiovascular disease. In fact, women with cardiovascular disease, and older women who survived at least five years after breast cancer diagnosis were more likely to die of cardiovascular disease than any other single cause (including breast cancer). What should readers take away from your report?

Response: Cardiovascular death is an important competing risk in the ten years after breast cancer diagnosis, particularly among older women and those with prior cardiovascular disease. This mandates adequate attention to cardiovascular preventative therapy after breast cancer diagnosis. What recommendations do you have for future research as a result of this study?

1. It is important to study how the risks of death from breast cancer, cardiovascular disease, and other causes play out over longer term follow-up.
2. There should be further study into what types of cardiovascular disease affect women with breast cancer because this will guide what type of preventative therapy they should receive.
3. Attempts should be made to predict more accurately which women are at higher risk of dying from cardiovascular disease than
their breast cancer, as this may impact decisions about cancer therapies that have adverse cardiovascular effects. Thank you for your contribution to the community.


A Population-Based Study of Cardiovascular Mortality Following Early-Stage Breast Cancer
Husam Abdel-Qadir, MD; Peter C. Austin, PhD; Douglas S. Lee, MD, PhD; et al.
JAMA Cardiol. Published online October 12, 2016. doi:10.1001/jamacardio.2016.3841

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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