Cardiovascular Disease May Accelerate Tumor Growth in Patients With Advanced Breast Cancer

Patients with advanced breast cancer (BC) at diagnosis are more likely to have prevalent cardiovascular disease (CVD), according to study results published in JAMA Network Open. The findings build on existing evidence, which have found that tumor growth may be accelerated in the presence of heart failure and other CVD diseases, and may be specific to hormone receptor–positive (HR+) and human epidermal growth factor receptor 2 (HER2) BC.¹

HER2 receptors on cancer cells | Image Credit: © Man888 - stock.adobe.com

Cancer and CVD are the leading causes of mortality in the United States and prior studies have identified a potential link between them, noting the multiple shared risk factors and the potential for acceleration of tumor growth and disease progression. In a 2023 study published in JACC: CardioOncology, researchers found that among 27,195,088 individuals, those with CVD were 13% more likely to develop cancer than those without CVD.²

BC is the most common cancer among women, accounting for about 30% of all women’s cancer cases in the United States. Considering the link between CVD and cancer, researchers have started to investigate how heart health impacts BC. Study findings suggest that the consequences of cancer treatment toxicity and changes to lifestyle behaviors increase risk of CVD in patients. According to a mouse model, researchers identified that myocardial infarction disrupts systemic homeostasis, initiating cross-disease interactions that drive the progression of BC. This underscores the need for comprehensive cancer treatment regimens that include cardiovascular care.^3,4

In the study published in JAMA Network Open, researchers found that patients with advanced disease at diagnosis are more likely to have prevalent CVD. They developed and initiated a population-based case-control study using data from the Surveillance, Epidemiology, and End Results–Medicare linked databases from 2009 to 2020, of which their analysis was completed in May 2023 to August 2024. The study enrolled over 19,000 female patients with invasive BC (median age 73 years (IQR, 70-79); 1676 (8.7%) Black, 16,681 (86.5%) White, 9478 (49.1%) had prevalent CVD). The primary measurement was odds of locally advanced (T3-4 or N+) or metastatic BC (MBC) status at diagnosis.¹

According to the study results, propensity score–matched, multivariable-adjusted models found that women with locally advanced or MBC at diagnosis had significantly higher odds of prevalent CVD (odds ratio [OR], 1.10; 95% CI, 1.03-1.17; P = .007). This was observed particularly among those with HR+ (OR, 1.11; 95% CI, 1.03-1.19; P = .006); however, this was not seen among participants with hormone receptor–negative BC (OR, 1.02; 95% CI, 0.86-1.21; P = .83). This finding was largely influenced by the strong association observed in HR+ and HER2 BC.¹

These data highlight the critical intersection between cardiovascular health and BC outcomes, particularly for patients with HR-positive or HER2-negative disease. By integrating cardiovascular care into cancer management, health care teams can address shared risk factors and potentially mitigate disease progression.

“Prior studies support our findings. The Atherosclerosis Risk In Communities study demonstrated that adherence to cardiovascular health metrics was associated with a 50% decreased risk of incident cancer, particularly for breast, lung, and colorectal cancers,” the authors stated in the study.¹

The findings pave the way for opportunities to reduce disease risk, which can include early detection of cardiovascular conditions, targeted interventions to improve heart health, and lifestyle modifications tailored to the needs of BC patients. For example, medical interventions such as initiation of statin therapy following BC diagnosis is associated with improved BC-specific survival.

Improving outcomes for patients with BC, especially those with HR+ and HER2 disease, is crucial. Emphasis on a collaborative approach between oncology and cardiology could improve patient outcomes, emphasizing the importance of a multidisciplinary strategy in modern cancer care.

REFERENCES

1. Angelov I, Haas AM, Brock E, et al. Cardiovascular disease and breast cancer stage at diagnosis. JAMA Netw Open. January 2, 2025. doi:10.1001/jamanetworkopen.2024.52890

2. Bell C, Lei X, Haas A, et al. Risk of Cancer After Diagnosis of Cardiovascular Disease. JACC: CardioOncology. April 11, 2023. doi.org/10.1016/j.jaccao.2023.01.010

3. American Cancer Society. Key statistics for breast cancer. Accessed January 3, 2025. https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html

4. Koelwyn, G.J., Newman A, Afonso M, et al. Myocardial infarction accelerates breast cancer via innate immune reprogramming. Nat Med. July 13, 2020. doi: 10.1038/s41591-020-0964-7