TIME Cancer

How Aspirin Can Prevent Breast Cancer

Among overweight and obese women, the painkiller could help to prevent tumors from recurring

Doctors are beginning to learn that body weight could have a role in determining a woman’s risk for breast cancer as well as her ability to survive it — and according to new research, a surprisingly simple over-the-counter drug could help with prevention.

“Obesity by itself is the worst prognostic factor,” says Linda deGraffenried, an associate professor of nutritional sciences at the University of Texas at Austin. “Obese women do worse on hormone therapy, chemotherapy and radiation therapy. We used to think that the mechanism involved the fact that they had [other] conditions such as diabetes or heart disease, but now we are starting to appreciate that the obese patient has a different biological disease.”

And that understanding led deGraffenried and her colleagues to the surprising finding that among women with a higher body mass index (BMI), nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin can actually lower their risk of breast cancer.

In a report published Friday in the journal Cancer Research, deGraffenried found that obese and overweight breast cancer patients who used NSAIDs regularly lowered their risk of getting additional tumors by 52% compared with women who didn’t take the pills. “I’ve been doing cancer research for 20 years, and there has been nothing that was able to give that kind of benefit,” says deGraffenried. “So yes, I was extremely surprised that by just reducing inflammation you could get that significant a benefit.”

What’s happening in obese patients, she says, is that their larger volume of fat tissue promotes production of aromatase, an enzyme involved in producing a form of estrogen called estradiol. Because estrogen is part of the fuel that drives breast-cancer growth, having elevated levels of aromatase is associated with higher rates of breast cancer. The mechanism also explains why drugs that inhibit the enzyme aren’t as effective in obese or overweight women. The fat tissue also promotes release of other factors that are important for tumor survival, creating a feedback loop that keeps the cancer growing in heavier women.

But NSAIDs, which block another enzyme that stimulates aromatase production, could counter this effect. And that’s what deGraffenried and her colleagues found. Among a group of 440 women diagnosed with breast-cancer tumors containing estrogen receptors, those with a BMI greater than 30 and who used NSAIDs regularly had a much lower rate of breast cancer.

Whether women with other types of breast cancer, including tumors without estrogen receptors, can benefit from NSAIDs isn’t clear, but the team is studying those populations as well.

As for whether an aspirin a day should become part of women’s breast-cancer prevention efforts, deGraffenried notes that many already take low-dose aspirin — the same does that most of the women in the study took — to protect against heart disease and colon cancer. “If you are not already on an NSAID or if there is no contraindication for an NSAID, there is reason to consider asking your doctor about it,” she says.

MORE: Osteoporosis Drugs Do Not Prevent Breast Cancer After All

MORE: Breast-Cancer Drug Has a Surprising New Application, Study Finds

TIME Breast Cancer

Osteoporosis Drugs Do Not Prevent Breast Cancer After All

Some studies had hinted that the bone-building treatments may also have an added benefit in fighting tumors, but the latest study doesn’t support that connection

In recent years, several large studies involving tens of thousands of women found a potentially useful connection between bisphosphonates, the popular bone drugs, and a lower risk of breast cancer. But new research published Monday in JAMA Internal Medicine challenges that long-held belief.

In previous observational studies, women who reported taking medications like alendronate (Fosamax) or zoledronic acid (Reclast) to treat osteoporosis also seemed to have lower rates of breast cancer compared to women who didn’t take the medications. There was biological evidence to support the association as well – bisphosphonates were also correlated with lower rates of cell death and hampered cancer cell activity.

But Trisha Hue, an epidemiologist at the University of California, San Francisco, and her colleagues, wondered if the connection could truly be attributed to the osteoporosis medications, or whether there was something else about the women taking these drugs that could explain the cancer trend.

MORE: Combining Bone-Building Drugs Key to Making Bones Stronger

Indeed, when they focused their attention on two studies that randomly assigned women to either a bisphosphonate or placebo, and followed them for up to four years, they found no difference between the women taking the drug and those who did not when it came to their breast cancer rates.

So why the strong connection in previous studies? Hue points out that those analyses, which were not randomized controlled trials, but rather observational studies, could not account for the fact that the drug-taking group may have been biased in some way. And in fact that’s likely what occurred – women who are prescribed bisphosphonates have low bone mineral density, and they also have low levels of the hormone estrogen, which is known to fuel tumor growth. So the earlier studies were not finding a correlation between bisphosphonate use and a lower risk of breast cancer, but instead were picking up the fact that bisphosphonate users were likely to have lower rates of breast cancer to begin with.

MORE: How Often Do Women Really Need Bone Density Tests?

It’s not the first time the benefits of the bone drugs have been called into question. In 2011, some studies found that the therapies could increase the risk of rare bone fractures in the strong bones such as the thigh.

While some doctors and patients may have turned to the bone-building drugs to potentially avoid getting cancer, Hue says “our take-home message is that if you are already on bisphosphonates for prevention of fractures, it’s very effective for preventing fractures. But they shouldn’t be taken specifically for the primary prevention of breast cancer.”

TIME Breast Cancer

Promising Cancer Drug Fails to Slow Breast Cancer

NEXAVAR
Nexavar Bayer Pharmaceuticals Corporation

Researchers had hoped to add breast cancer to the list of cancers for which the drug is already approved

A Phase 3 trial of cancer drug Nexavar in patients with advanced breast cancer failed to delay progression of the disease, according to the drug’s makers, Bayer and Onyx Pharmaceuticals, Inc., an Amgen subsidiary.

The study, called Reslience, evaluated Nexavar in combination with capecitabine, an oral chemotherapeutic agent, in patients with HER2-negative breast cancer.

The drug is approved to treat certain types of liver, kidney and thyroid cancer and works by targeting signalling pathways that tumor cells use to survive. Researchers hoped that Nexavar would have the same tumor-stalling effect on breast growths.

“We are disappointed that the trial did not show an improvement in progression-free survival in patients with advanced breast cancer,” Dr. Joerg Moeller, Member of the Bayer HealthCare Executive Committee and Head of Global Development, said in a statement. “While the primary endpoint of this trial was not met, the trial results do not affect the currently approved indications for Nexavar. We would like to thank the patients and the study investigators for their contributions and participation in this study.”

Data from the study will be presented at an upcoming scientific conference.

TIME Breast Cancer

Removing Both Breasts May Not Improve Survival From Breast Cancer

The latest study adds support to the data suggesting that in some cases, less may be more in treating breast cancer

Researchers at the University of Minnesota confirm that when it comes to treating some forms of breast cancer, drastic surgery to remove breast tissue may not help in improving survival from the disease.

Reporting in the Journal of the National Cancer Institute, the scientists describe a model for calculating life expectancy based on recent rates of recurrent cancers among women with stage 1 or stage 2 disease. Although previous studies found that among women diagnosed with breast cancer in one breast, removing the other breast can lower risk of breast cancer in that breast by up to 90%, few studies have documented whether that also translated into greater survival of breast cancer, which can recur in other organs.

According to the researchers’ model, the overall difference in survival at 20 years after diagnosis for both women who had their opposing, unaffected breast removed and those who did not, was less than 1%.

The data confirm recent findings from a study of women with metastatic disease, which also showed that women who received additional surgery to remove lymph nodes and their breasts did not survive any longer than those who were treated with chemotherapy only. As TIME wrote about that study,

Researchers from Tata Memorial Hospital in Mumbai, India, recruited 305 women between 2005 and 2013, all of whom had metastatic breast cancer and had responded to six cycles of chemotherapy. The women were split into two groups. One group of 173 women received additional surgery and radiation treatment, and 177 did not. The women who received surgery had partial or total removal of their breasts and lymph nodes followed by radiotherapy.

After just over two and a half years, the scientists found no overall difference in survival between the two groups; in fact, there was a slight, but not significantly significant, increase in risk of death for the women undergoing surgery and radiation. The lack of difference remained strong even after the scientific team adjusted for the types of breast cancer the women had, and the extent to which their cancer had spread to other organs. The findings should provide more confidence to both doctors and patients who choose not to go under the knife or receive radiation in an effort to prolong their lives, since the evidence suggests that the added measures don’t provide significant benefit, and may only expose the women to more complications.

In the current study, the researchers note that survival is only one factor that women may take into account when debating whether to remove an unaffected breast. In an accompanying editorial, other researchers echoed the distinction, saying that quality of life and peace of mind factors may be important reasons for supporting the continued use of prophylactic mastectomy surgery.

TIME Cancer

Breast-Cancer Drug Has a Surprising New Application, Study Finds

An early study shows that gel-based tamoxifen may be as effective as the oral drug, and have fewer side effects

Tamoxifen is a mainstay of breast cancer treatments: it blocks the effects of the female hormone estrogen on the breast, inhibiting estrogen’s tendency to encourage breast tissue to grow uncontrollably. Now, Dr. Seema Khan, professor of surgery at Northwestern University Feinberg School of Medicine, reports in Clinical Cancer Research that putting the drug in a gel, and applying it directly to the breast tissue, where it needs to work, may have merit.

Doctors generally prescribe tamoxifen for women diagnosed with early breast cancer, including very early-stage ductal carcinoma in situ (DCIS), to prevent recurrent growths. But the drug has also been linked to an increased risk of stroke, blood clots and cancers in other tissues, including the uterus. That’s why more women, including those who have not yet had cancer but are at high risk for the disease could benefit from the drug but are reluctant to take it.

MORE: Why Mammograms Are Less Effective Among Breast Cancer Survivors

Dr. Khan’s study was small—only 26 women—but it provides proof that the principle of applying tamoxifen directly on the breast may be worth investigating. All of the women were diagnosed with DCIS, which generally does not spread. But 30% of DCIS can recur even after surgery and proper treatment, so most women are prescribed tamoxifen. In the current study, about half of the women in the study were randomly assigned to take the oral form of the drug, while the other half were given doses of a tamoxifen gel to apply directly to the breast tissue for six to 10 weeks before their surgery. Khan analyzed the breast tissue after surgery to study markers for tumor growth, and conducted blood tests for levels of tamoxifen metabolites as well.

At the end of the study, the women in both groups showed similar decreases in tumor-related proteins, but blood levels of tamoxifen were five times lower among the women using the gel than those taking the oral pill. That, says Dr. Khan, suggests that the major side effects of the drug, which occur in the blood and other reproductive organs, may be largely avoided if women use the gel.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“Our study showed that applying the drug through the breast skin leads to high concentrations in the breast and low concentrations in the rest of the body,” she says. “The biological effect on the breast is consistent with the benefit of oral tamoxifen, so for that reason, we hope that this kind of approach would make preventive medication more acceptable to women with non-invasive breast cancer and how may be at high risk of developing breast cancer.”

Dr. Khan says that the breast may be uniquely designed for such transdermal therapy, since it is essentially an appendage of the skin, with its own internal lymphatic circulation. That may keep things applied to the breast skin within the breast tissue, and could explain the higher concentrations of tamoxifen metabolites she and her team found after the gel applications.

Still, she says that the small number of participants in the study means more research is needed to confirm the results. Right now, the gel version is not available. The company that provided the experimental doses for the study stopped making that formulation, so Dr. Khan is studying a related, similar metabolite called endoxifen that may have similar cancer-fighting effects on breast tissue.

If the strategy proves effective, it’s possible that cancer treatments, or at least breast cancer treatments, may become useful in preventing cancer as well, as more women at high risk who have yet to be diagnosed with the disease take advantage of them. Applying a gel with relatively few side effects may help more women to eliminate small tumors before they have a chance to grow. And if other types of drugs can be used on the skin as well, that could significantly broaden the therapies available to women looking for ways to prevent the disease.

“For high-risk women who need better prevention strategies, delivering the drug to the breast is a very desirable solution,” says Dr. Khan.

TIME Breast Cancer

Why Statins Could Be the Next Treatment for Breast Cancer

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Photodisc—Getty Images

Research connects high cholesterol levels with increased risk of breast cancer.

Cholesterol and cancer may not seem to have much in common, but scientists are increasingly seeing some intriguing connections between the two. In the latest study on the topic, presented at the Frontiers in Cardiovascular Biology in Barcelona, Spain, researchers report on preliminary but strong evidence that women with high cholesterol levels had a 1.6 times greater risk of developing breast cancer over 14 years than women with lower levels.

While the association doesn’t prove that cholesterol can cause breast cancer, the strength of the study comes from its numbers – the data emerged from 664,000 women enrolled in an ongoing study in the UK.

MORE: The Serious Heart Risks That Come With Chemo

Earlier studies have suggested that obesity may be tied to an increased risk of breast cancer, but more recent trials raised the possibility that cholesterol was the driving factor in this correlation – animal studies found, for example, that lowering cholesterol can inhibit tumor cell growth.

So Dr. Rahul Potluri, from Aston University in the UK, decided to investigate the relationship with the database he had established known as the Algorithm for Comorbidities, Associations Length of Stay and Mortality (ACALM) study, focusing on a subset of data from among 1.2 million women in the UK between 2000 and 2013. And indeed, those whose records showed cholesterol levels of 200mg/dL or more were more likely to develop breast cancer. (In the U.S., recent changes to cholesterol guidelines by the American Heart Association and the American College of Cardiology mean that doctors no longer focus on target cholesterol levels but include cholesterol as part of a heart disease risk calculation that includes age, smoking history, blood pressure and diabetes. In previous guidelines, levels between 200mg/dL and 239 mg/dL were considered borderline high.)

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“It’s a starting point for looking at the relationship in human populations,” says Potluri, who is cautious about overstating what the correlation means. He says that the database did not include information on medications, for example, so he and his colleagues could not adjust for other factors that could explain the association, such as whether the women smoked, or their exposure to other things that could increase their risk for breast cancer.

MORE: Treating Cancer With A Malaria Drug

Still, says Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan Kettering Cancer Center who was not involved in the study, “I think this is an important observation. It’s interesting when a big study like this supports some evolving basic science.”

Hudis suspects that the explanation for how cholesterol is involved in breast cancer – or potentially in other types of cancers – may be quite complex, and certainly requires deeper investigation. His own work, for example, explores how obesity and its related metabolic syndrome, which involves resistance to the effects of insulin and low levels of inflammation, could be activating some tumor triggers in breast tissue. Cholesterol is also part of the body’s steroid hormone pathways, which can play a role in certain cancers.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“The problem of obesity is going to have profound public health repercussions,” says Hudis; these results are just another reminder of how insidious the health effects of obesity can be.

 

 

 

 

 

 

 

 

TIME Breast Cancer

High-Tech 3D Mammograms Probably Saved This Woman’s Life

A large study shows the latest screening tool can detect more cancers with fewer false positives

Lori Safer is a convert. The 55 year old occupational therapist had been told by many mammogram technicians that her breasts were hard to image. Her fibrocystic tissue meant that every mammography report was somewhat less than reassuring. “They would say, ‘It doesn’t’ look like anything is there, but just come back in a year, and we’ll keep an eye on it,’” the New Jersey resident says.

Worried that the mammograms were not picking up on possible cancers, Safer went to University of Pennsylvania, where the breast imaging center was testing a 3D mammogram, which is the subject of a new study published in JAMA. Building on the 2D technology, the 3D version simply slices the images of the breast and reconstructs them on a computer in 3D form, allowing doctors to get a better view of the entire breast and any potential tumors growing within.

Sure enough, the 3D test picked up a suspicious lump. She got a biopsy, and even that was negative, but because the 3D mammogram had detected a potential tumor, doctors recommended she have a lumpectomy to remove the growth. It turned out to be malignant. But because the cancer was picked up in its earliest stages, before any cancer cells could spread to the lymph nodes, Safer is now cancer-free. “If I had waited a year, like I would have if I had been getting the regular mammogram, it could be a totally different story,” she says.

MORE: What Now? 4 Takeaways From the Newest Mammogram Study

The latest research on the 3D mammograms, or tomosynthesis, backs her up. Led by Dr. Sarah Friedewald, chief of breast imaging at Advocate Lutheran General Hospital in Illinois, researchers report that 3D mammograms can pick up more breast cancers and lead to fewer callbacks for repeat testing than 2D mammography. It’s the data that many breast cancer physicians have been waiting for.

Since the Food and Drug Administration approved the first 3D mammogram machine in 2011, doctors have been documenting whether the technology can outperform existing mammography by improving detection of breast cancer while cutting back on false positives. In the JAMA study, the researchers collected data from more than 454,000 mammograms done at 13 sites; nearly a quarter included both the traditional 2D mammogram as well as an additional 3D image. Compared to the 2D mammograms alone, the tomosynthesis improved detection of invasive cancers by 41%, while not increasing rates of picking up DCIS cancers, which don’t spread from the milk ducts and have higher survival rates. That’s important because other technologies, including ultrasound and MRI, led to higher rates of detecting all types of growths, but it’s more important to identify early-stage invasive cancers because treating them can lead to higher remission rates and longer survival.

MORE: The Mammogram Melee: How Much Screening Is Best?

“In my long career, this is the biggest improvement in screening I have seen,” says Dr. Emily Conant, professor or radiology and chief of breast imaging at the University of Pennsylvania Perelman School of Medicine and one of the study’s co-authors. “This is much bigger than the improvement in going from analogue or film to digital; I don’t think there’s a doubt about that.”

The study is the largest to show that 3D mammograms can increase the detection of invasive cancers while lowering the rate of recall testing. “That’s a critical point of 3D,” says Friedewald. “Other screening modalities [such as ultrasound and MRI] have shown that they can pick up additional cancers but none have simultaneously reduced the number of recalls.” Fewer recalls can lead to fewer risks, and costs, for women. Safer, for example, says that she has been called back after a mammogram at least six or seven times for additional testing, which contributed to more time and costs for her, not to mention psychological stress about whether she had cancer.

MORE: Higher Risk for Women With False-Positive Mammogram Results

With these findings, the focus will now shift to figuring out how often women need to be screened using the 3D technology, and how to phase in the machines, which cost $500,000. Not all insurers cover the cost of the 3D screening, which is slightly more expensive than traditional mammography. That could also mean that women requesting it will pay more out-of-pocket as well.

The 3D machines used in the study required women to get double the dose of radiation of a regular mammogram, which was still below the safe levels established. But newer versions of the technology will bring that exposure down to levels similar to those of current mammography machines.

Should every hospital switch to imaging? “I think it’s premature to replace 2D mammography, since we are still trying to understand the utility and limitations of the technology,” says Dr. Therese Bevers, medical director of the cancer prevention center at the University of Texas MD Anderson Cancer Center. “But a test that weighs more favorably toward benefits—and fewer callbacks—is a win-win.”

MORE: Breast Cancer Screening Isn’t Going Away—At Least Not Yet

The researchers hope that that results will convince more insurers to cover 3D imaging on the premise that despite its higher upfront cost, the test’s sensitivity in detecting invasive cancers would lead to cost savings by avoiding costly follow ups and additional testing.

For Safer, there’s no question about what type of mammogram she will be getting from now on. “I called all my friends and relatives, and told them you can’t just go for a regular mammogram,” she says. “I told them they have to go online to find places that have 3D.”

If these results hold up, then those facilities won’t be so hard to find in the near future.

TIME Breast Cancer

Treating Cancer With A Malaria Drug

A drug that treats malaria may make breast cancer tumors more responsive to treatment

An inexpensive malaria could be the answer for some women who are not responding to their cancer treatment, according to a promising but preliminary animal study.

In a recent study published in Clinical Cancer Research, researchers discovered the anti-malaria drug hydroxychloroquine (HCQ) can actually reverse drug resistance to the common breast cancer drug, tamoxifen. The researchers inserted cancerous tumors into mice with serious postmenopausal estrogen receptor-positive (ER+) breast cancer. ER+ breast cancers are some of the most common, and are often treated with tamoxifen. However, about 50% of women who are treated with tamoxifen won’t respond to the drug or become resistant to it.

HCQ is a drug that was originally developed to treat malaria, but it’s also used to treat diseases like lupus and arthritis. The researchers added HCQ to the mice’s treatment with tamoxifen and discovered that the malaria did in fact increase tumor responsiveness to the breast cancer drug.

How does it work? The reason some woman become resistant to tamoxifen is that a “pro-survival” cell pathway in the breast cancer cells becomes switched. HCQ turns off the modified cell pathway, which helps prevent resistance to tamoxifen.

It’s still early to draw any conclusions on how HCQ could be used clinically for cancer, and so far, research has been reserved in mice. Still, the researchers think it’s encouraging that there may be a solution for women not responding to cancer drugs.

TIME Cancer

Skin Moles Cannot Predict Breast Cancer Despite What Studies Say

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4FR—Getty Images

Two new studies link moles to breast cancer, but don't worry about it

Two new studies suggest that having moles is linked to an increased risk of breast cancer, with one finding women with 15 or more moles were 35% more likely to be diagnosed with breast cancer than women who had none.

Before you frantically start counting all the moles on your body, know that these studies are a couple of the first to ever make this connection, and these findings are not causal. The first study used the Nurses’ Health Study a study of over 74,500 female nurses and the second study looked at E3N Teachers’ Study Cohort which includes over 89,900 women. In the first study, the researchers asked the Nurse’s Health Study participants to report the number of moles larger than 3mm on their left arm (left-side mole counts are usually used because the assumption is that many people drive to work and get incidental sun exposure from the drivers’ side window). They found that women with 15 or more had a 35% higher risk of breast cancer, with an absolute risk of 11.4% for women with over 15 moles and 8.48% for women with no moles.

In the second study, the researchers asked the participants to report if they had no, a few, many, or very many moles, and found that women with very many moles had a 13% higher risk of breast cancer than women with no moles.

The researchers did not find that moles cause—or even predict—breast cancer. But they think they link may be genetic or hormonal. The author of the second study, Marina Kvaskoff of Brigham & Women’s Hospital and Harvard Medical School, says it’s possible it’s a hormonal issue, since it is known that moles get darker during pregnancy and skin pigment is responsive to hormones. There could also be a genetic component, since when Kvaskoff and her colleagues adjusted for history of breast disease, they found the association decreased. But significantly more research is needed if any solid connection is to be made.

“It should really not panic women who have a lot of [moles] since these are very new findings. The association is very modest,” says Kvaskoff. “We are noticing this link, and we hope that it will generate more knowledge. If it is confirmed with other research, it could become a risk marker for breast cancer or other hormonal conditions, but it’s too soon to be associated with a breast cancer diagnosis. We hope this will generate more research.”

Dr. Freya Schnabel of NYU Perlmutter Cancer Center says the modest connection doesn’t tell us much at all. “From the perspective of why there’s an association, there is really not much to say,” she says. “This is one of those situations where you have statistical connection, but there is no sense of underlying mechanism. There’s no clear causality and nothing to explain why. As a result, I don’t have a sense how this would change practice.” Dr. Schnabel acknowledges that the researchers tried to look at hormonal levels, but to do that properly, they would need to really look at all these levels at various points throughout a person’s life, like before during and after menopause.

Dr. Schnabel says women who do have a lot of skin moles are better off paying attention to skin cancer and skin checks.

“Breast cancer is a common disease and we are always looking for ways to find out who is more at risk,” says Dr. Schnabel. “We know some strong risk factors like family history that have a much greater risk than this. Paying attention to these is a more effective thing to do for your health than paying attention to a link that doesn’t have much explanation behind it.”

 

TIME Cancer

The Serious Heart Risks That Come With Chemo

Certain classes of drugs—often used in breast cancer treatment—have possibly fatal side effects. Cardio-oncologists are on the case

When you hear you have cancer, you get tunnel vision—and so might your oncologist. Together, you want to annihilate this invader. And together, you select a treatment that’ll give you the best shot. If there’s a warning about the potential side effects of your cancer cocktail, it probably sounds like a whisper to you, because, come on—you have cancer. That’s how Kim Sander, 54, felt when she was first diagnosed with one of three bouts with breast cancer. “I just wanted my cancer to go away, that’s all I was thinking about,” she says. Eventually, Sander’s doctors discovered she had severe muscle damage caused by the very drugs that were saving her life.

Stephanie Cirilo, 57, has a similar story. She beat stage 2 breast cancer in the late 1990s and enjoyed prime health afterward. But in 2009, a routine cardiac ultrasound showed her heart was pumping at only 35%. Her doctor assumed she had a blockage and scheduled emergency surgery. Instead, she called her oncologist who told her not to go under the knife: her heart problems were related to her past cancer treatment—and they could probably restore her heart function without surgery. “I have a dear friend who ended up with a pacemaker,” says Cirilo. “She had the same chemo I did. That very well could’ve happened to me had I gone [ahead with surgery].”

Sander’s and Cirilo’s stories are sadly not uncommon, and a growing field of cardio-oncology is trying to address the growing number of women who experience heart failure after undergoing chemo. “We’re dealing with two devils. We need to balance heart effects with chemo potency, and still get cancer into remission,” says Dr. Gagan Sahni, who directs the new cardio-oncology clinic at Mount Sinai in New York.

Today, Kaiser Permanente researchers presented findings at the American Heart Association’s scientific sessions that show many breast cancer patients do not get treatment for their heart problems. But those that do, are likely to get proper therapy.

“You have to consider the whole patient,” says study author Dr. Jersey Chen, a researcher and cardiologist at Kaiser Permanente. “It’s a new age of collaborative medicine where no physician is treating patients on their own.”

In earlier years, if a patient was suffering from serious heart damage during cancer treatment, they would have to stop therapy to take care of their heart. Now, doctors are trying to figure out the best way to treat both simultaneously.

At the Cleveland Clinic, every cancer patient receiving chemo drugs known to cause heart problems will see a cardiologist before and during their treatment. Patients undergo advanced cardiac imaging aimed at the early detection of damage. “What I really hope for is a change in paradigm,” says Dr. Juan Carlos Plana, co-director of the cardio-oncology center.“We should employ strategies that kill cancer and do not damage the rest of the organs.” Plana’s own mother developed heart failure from her lymphoma treatment.

Both Sander and Cirilo were treated at Cleveland Clinic, and have renewed function in their hearts thanks to drugs that prevented their hearts from overworking. Cirilo says she doesn’t want the damage her treatment had on her heart to hold her back—she recently started talking jazzercise classes. “I don’t want to carry a oxygen tank,” she says. “It doesn’t go with my clothes.”

 

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