Follow-up care for older breast cancer survivors needs to be all-encompassing
Older women who have overcome breast cancer are likely to struggle with heart disease, osteoporosis and hypertension further on in their lives. Whether these conditions occur or not is influenced by the treatment that patients received to fight cancer, their overall weight and their age. Breast cancer survivors therefore should watch their weight and get regular exercise so that they can enjoy a high quality of life. These findings, by lead author Nadia Obi of the University Medical Center Hamburg-Eppendorf, who collaborated with the group of Prof. Chang-Claude from the German Cancer Research Center in Heidelberg, were published in Springer's Journal of Cancer Survivorship.
Obi's research group set out to identify risk factors that could trigger the development of heart disease, osteoporosis and hypertension in breast cancer survivors. They therefore assessed the health status of 2,542 breast cancer patients between 50 and 74 years old who were part of the Mamma carcinoma Risk factor Investigation (MARIEplus) study in the city and state of Hamburg and the Rhine-Neckar Karlsruhe region in Germany. Patients were asked about their health conditions before and after being diagnosed with breast cancer. Demographic information, lifestyle factors, the type of treatment they received and their levels of education were also noted.
It was found that known risk factors for cardiovascular diseases, such as being overweight, also play a role in the health of breast cancer survivors. Older women with a higher body mass index (BMI) and patients who received trastuzumab to reduce the risk of cancer relapse had an increased risk for hypertension. (A BMI of >30 kg/m2 almost doubled the risk ratio.) In addition, women with higher education levels had less hypertension.
Women with a lower body weight were more likely to develop osteoporosis, having a two-fold higher risk when they had a BMI of <22.5 kg/m2. The findings support those of previous research that showed that treatment with aromatase inhibitors could trigger the development of osteoporosis and cardiovascular diseases in breast cancer survivors. These inhibitors are generally used to prevent the reoccurrence of breast cancer in postmenopausal women.
Obi's research team advised that the follow-up health care that breast cancer survivors receive should include screening for any treatment-related health problems. Cancer survivors should especially be monitored for signs of cardiovascular disease and osteoporosis.
"New health problems can be prevented by advising the older, less educated breast cancer survivor and those with higher body weight indexes to lose weight and perform regular physical activity," said Obi. "The higher risk for osteoporosis in low weight patients may be balanced by the use of medications that prevent the loss of bone mass."