Men With Breast Cancer: Watch the Heart

Male breast cancer patients commonly showed signs of elevated cardiovascular risk, according to a small retrospective study of this rare population.

Cardiovascular risk factors highly prevalent among the 24 male breast cancer patients studied at MedStar Washington Hospital Center and Georgetown Lombardi Comprehensive Cancer Center included:

• Overweight: 88% of patients
• Hypertension: 58%
• Hyperlipidemia: 54%

Before cancer treatment, 8% of patients had pre-existing tachyarrhythmias; during treatment, another 13% developed them. Cancer treatment was also followed by two people showing drops in ejection fraction and two developing heart failure.

Michael Ibrahim, BSc, fourth year medical student at Georgetown University, and collaborators reported their work at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient virtual course.

“Cardio-oncologists or cardiologists should pay close attention to the proposed treatment plan and be part of a multidisciplinary cancer care team to evaluate the patients’ cardiovascular risk prior to and through cancer treatments,” Ibrahim concluded in a press release.

“This very small study suggests that hypertension, hyperlipidemia, and arrhythmia may be quite common in male breast cancer survivors, perhaps in part due to high rates of obesity. However, it is unclear if the burden of these diseases in male survivors differs from that in the general population of men or from that in female survivors of similar age,” commented Kathryn Ruddy, MD, MPH, of the Mayo Clinic in Rochester, Minnesota.

“As a breast medical oncologist, I recommend that breast cancer survivors (men and women alike) exercise at least 150 minutes per week, avoid tobacco, lose weight if overweight, and follow recommendations from their primary care providers regarding blood pressure and cholesterol control,” she told MedPage Today in an email.

The study adds to the literature on the known relationship between cardiovascular disease and breast cancer, which has mainly focused on women. Breast cancer survivors have a higher risk of CVD, while cardiovascular events have been linked to subsequent cancer recurrence.

“How similar or dissimilar male and female breast cancer patients are is the fundamental, unanswered question,” Ibrahim said in a press release.

He noted the uncertainty around whether the lessons learned from female breast cancer patients may be applied to cardiovascular care for their male counterparts, who are typically older. “An older population could mean more cardiovascular comorbidities. More comorbidities could require more comprehensive and frequent serial monitoring,” he suggested.

“It is also unknown if risk of cardiotoxicity from anthracycline or HER-2 targeted therapy is greater or less in male versus female breast cancer patients, and more studies are warranted,” Ibrahim added.

All 24 male breast cancer patients in the report received mastectomy. The various treatments included anthracycline chemotherapy in 17%, HER2-targeted therapy in 8%, radiation in 16%, and hormone therapy in 71%.

The study involved retrospective chart review of male breast cancer patients with a median age of 61 years (range 38 to 79). Among them, 42% were African American.

Four out of every five had invasive ductal carcinoma, and one out of five a ductal carcinoma in situ.

Nearly all of the tumors (96%) were estrogen receptor-positive, while 75% were progesterone receptor positive and 13% were HER2 positive.

Half the group had a family history of breast cancer. Two patients had a BRCA2 mutation.

Additionally, a quarter of patients were diagnosed with a second primary malignancy (e.g., prostatic adenocarcinoma, basal cell carcinoma), and 13% were diagnosed with a third primary malignancy.

“Due to the rarity of male breast cancer, there is no cardiovascular data from larger clinical trials or population studies. The lack of large data makes it even more important to individualize cardiovascular assessment and management based on each patient’s unique oncologic, therapeutic and pre-existing cardiovascular risk profile to support them through cancer treatment into survivorship,” said Ibrahim in the press release.