About six years after stopping her breast cancer treatment, Melissa Bell was driving to work one day when she started to feel “awful”.
“I stopped at a chemist for a blood pressure check – they noted that my heart was racing and I was sent to the doctor immediately,” Bell says.
Her resting heart rate was sitting around 120 beats per minute, which she quickly realised was close to her heart rate during exercise (180 or 190 beats per minute). Also concerning was the fact that her heart rate wasn’t dipping below 100 beats per minute.
Following these symptoms, Bell was referred to a cardiologist and diagnosed with tachycardia– a condition where the heart beats too fast when a person is at rest.
“I know now that cancer patients can experience tachycardia many years after treatment,” says Bell, as was the case for herself. “And to be honest, it wasn’t something that was really on my radar to look out for”, she adds.
Ten years ago, Bell was first diagnosed with breast cancer, days before her 41st birthday. She was told she had Stage 3 and multiple tumours, including one that was 10cm. She was triple positive – ER+, PR+ and HER2+, and it was not an early-stage diagnosis.
To treat her breast cancer, Bell received a mastectomy before commencing 12 rounds of chemotherapy. Following this was 5 weeks of radiation treatment.
“After radiation, I started a year of trastuzumab (Herceptin) infusions,” she says. “I experienced some damage to my heart during this phase of the treatment and was diagnosed with a low ejection fraction. I was put on medication and was fortunately able to complete my Herceptin treatment.”
While Bell’s nurses had informed her about the side effects of breast cancer treatments, she still felt shocked to find out later that her heart health had been affected by Herceptin.
“I had incredible specialists and amazing nurses. I knew every possible side effect – which honestly gets a bit overwhelming. I think I had a good run though – I skipped a lot of the bad side effects, especially during chemo. I found radiation strangely relaxing. I never had a chemo delayed because of my blood count.”
“That’s why I think I was a bit blindsided by the heart issues during Herceptin. I thought that the long list of side effects wouldn’t apply to me.”
For now, Bell’s tachycardia is being managed with beta-blockers, and while this may not be the final solution, she says her medication seems to be managing things well at the moment.
“My long-term health is a bit of an unknown really,” says Bell. “I am great right now, but I am careful to keep an eye on my heart rate and look for changes. I try not to be complacent.”
Join Breast Cancer Trials on Wednesday 7 August from 5-6:30pm (AEST) for a free online Q&A, where leading researchers and women with a history of breast cancer will discuss the link between breast cancer and heart health. The session will be moderated by author and journalist Annabel Crabb. To register click here.
Demystifying cardio-oncology
As a fairly new specialty, cardio-oncology focuses on identifying, monitoring and treating cardiovascular diseases caused by cancer therapies.
While it’s a fast growing area of medicine, the specialty has only been around for about 15 years worldwide, and even less in Australia, according to Professor Aaron Sverdlov, a cardiologist with a special interest in heart failure and cardio-oncology at Hunter New England Health.
“Initially, when people hear cardio-oncology, the immediate thought is that it’s about stopping cancer treatment. But that can’t be any further from the truth,” says Professor Sverdlov, who notes that, overall, cardio-oncology is about looking at how to prevent and treat cardiovascular issues that may arise from necessary cancer treatment.
“The aim of our clinical program is to ensure people have whatever cancer treatment they need in the safest possible way from a cardiac perspective,” he says, noting that this is achieved through various strategies.
First, they look at patient risk factors, taking into account that “risk factors for cancer and heart disease are actually somewhat similar in many ways”.
Smoking, a sedentary lifestyle, excess alcohol exposure, environmental exposures and obesity all share an overlapping risk for cancer and heart disease.
“So one of the ways we can reduce cardiovascular issues during and up against the treatment is managing those risk factors early,” says Professor Sverdlov.
The next preventative measure that cardio-oncologists take is to ensure patients receive early screening for heart problems that result from necessary cancer treatment.
“In the older days, when [cardio-oncology] wasn’t as well recognised, people were not screened for early heart problems until the year after treatment,” says Professor Sverdlov, noting that research shows this late detection makes heart problems harder to treat.
“The evidence now is that if we can detect heart problems early enough, we don’t need to stop cancer treatment.”
Professor Sverdlov says this early intervention allows for patients to safely complete their required cancer treatment and have better general health and cardiac outcomes in the long run.
“And then finally, it’s about survivorship,” he says. “Once people have survived cancer, it’s about monitoring for any late effects– cardiac or metabolic problems–- that can turn up after treatments are completed.”
These late effects could range from complications like diabetes, high blood pressure and high cholesterol, which Professor Sverdlov says are important to catch before they develop into a stroke, heart failure or kidney disease down the track.
“What we don’t want is for them to swap one bad disease, being cancer, for another bad disease being, say, heart failure, heart attack,” he says.
“Some people think ‘I’ve survived cancer, I’m good now’, which is fantastic, but it’s still even more important than ever to look after your health in the long run.”
On Wednesday 7 August from 5-6:30 pm (AEST), Professor Aaron Sverdlov will be joining Breast Cancer Trials’ free Q&A webinar, alongside other leading researchers and women with a history of breast cancer, to discuss the link between breast cancer and heart health. The session will be moderated by author and journalist Annabel Crabb. To register click here.