Approximately 20 percent of women who develop early breast cancer have
HER2-positive (human epidermal growth factor receptor-2-positive) tumors. If
left untreated, these tumors generally have a worse prognosis than
HER2-negative tumors. The case is the same with advanced breast cancer as well.
Currently, the standard treatment for HER2-positive breast
is chemotherapy with trastuzumab given in combination with one
Recent research published in the Cochrane Database of systematic
reviews, however, reported increased
risk of heart damage
such as congestive heart failure
and LVEF (Left Ventricular Ejection Fraction) decline with
trastuzumab in HER2-positive tumors. The study had reviewed 7 trials involving
1497 patients with metastatic breast cancer undergoing breast cancer treatment.
Similarly, researchers at the University of Louisville,
Kentucky and Kentucky One Health too found that the heart in some patients
'seemed to be weakening under treatment'.
cancer patients treated with either trastuzumab
or lapatanib may have
an increase in stress hormones (catecholamines), a decrease in protective
growth factor (neuregulin), and an increase in blood pressure. This may
contribute to why certain patients have a decline in
function during chemotherapy treatment,' said Dr. Carrie Geisberg Lenneman, the
lead author of the study.
Now we know the 'why' of the
problem, but how to deal with the problem?
duration of therapy may reduce cardiotoxicity and maintain efficacy,' suggested
researchers at University of Milan, Italy. But they could not definitely
conclude this as the evidence was insufficient due to small numbers of patients
in the trials they reviewed.
Breast cancer treatment
So, what does breast cancer treatment actually
involve? Today there are multiple treatment choices for every stage of
. Your doctor will be the right person to guide you regarding
the best treatment options for you. But do get a second opinion about your
diagnosis and treatment plan even though it may feel overwhelming. A slight
delay in starting treatment generally would not pose a risk. Talk to your
doctor about it. Even if you have started treatment, it is not too late to get
a second opinion.
Let's check out the treatment options available.
: Surgery is considered to be the first line of
treatment for breast cancer. Your options are
Lumpectomy or breast conserving surgery where only the tumor and a small amount
of surrounding tissue is removed.
where all of the breast tissue is removed.
Lymph node removal when cancer spreads beyond the breast. This is done along
with lumpectomy or mastectomy.
Cryotherapy to kill the tumor cells by freezing them. It is still in experimental
Other surgeries include preventive surgery of the breast and ovary and
reconstruction surgery of the breast after mastectomy.
: Chemotherapy is the
treatment that uses drugs to destroy cancer cells in the body.
is the treatment
that uses high-energy radiation to effectively destroy cancer cells. Radiation
therapy reduces your chances of breast cancer recurrence by about 70 percent.
is used in people with hormone-receptor-positive breast cancers. The
therapy works by lowering the estrogen levels in the body and by blocking the
action of estrogen on cancer cells.
: Targeted therapies
use drugs that interfere with specific molecules involved in the cancer cell
growth, for example, drugs that interfere with tumor blood vessel development,
or drugs that stimulate the immune system to destroy cancer cells. Trastuzumab
(Herceptin) is the drug used in the targeted therapy for HER2-positive breast
cancers. It destroys the specific proteins that are present in the cancer cells
but not in the normal cells.
meditation, yoga, are some therapies that are used along with conventional
medicines to improve quality of life, treat side effects of treatment, and to
Heart damage symptoms
Although not everyone
undergoing breast cancer treatment will run the risk of getting heart disease,
chemotherapy, radiation therapy, and hormonal therapies do increase the risk of
heart damage. For example, chances of cardiomyopathy
(weakening of the
heart muscle) increase with chemotherapy for HER2-positive breast cancers.
Certain types of
chemotherapies may cause a heart attack or arrhythmias. Arrhythmias generally
occur during the administration of the drug, so if you feel lightheaded or
dizzy, tell your chemo doctor.
with angiogenesis inhibitors are known to increase blood pressure
(hypertension). Radiation therapy, on the other hand, increases the risk of
cardiomyopathy, coronary artery disease, and heart attack.
You may be having
heart problems if you have the symptoms that include -
Rapid or irregular heart beat
Shortness of breath
Swelling in the feet and lower
Need to urinate at night
• Loss of
Inform your doctor as
soon as you get these symptoms, irrespective of whether the symptoms occur
during the treatment or after the treatment.
1. Lenneman, C.,
Abdallah, W., Smith, H., Abramson, V., Mayer, I., Silversteina, C.,
Means-Powell, J., Paranjape, S., Lenihan, D., Sawyer, D. and Raj, S. (2014).Sympathetic Nervous System Alterations with
HER2 Antagonism: An Early Marker of Cardiac Dysfunction with Breast Cancer