BOSTON -- More than half of women treated for invasive breast cancer elect to have breast reconstruction with implants after mastectomy. And the demand for reconstructive surgeries is expected to grow in the coming decade. But how breast implants may affect the interpretation of cardiovascular imaging studies has not been rigorously investigated, according to a Viewpoint article published in JAMA Cardiology.
“There have been several reports in the medical literature of women with breast cancer and implants in whom the results of cardiac studies, such as echocardiography and nuclear tests, were inaccurate,” says first author Ohad Oren, MD, fellow in Cardiovascular Medicine at Massachusetts General Hospital. Oren emphasizes that inaccuracies in cardiac imaging are infrequent in women with breast implants who underwent mastectomy. But at the same time, he highlights that it is important to identify the best use of imaging technologies in these women to maximize accuracy.
“Women diagnosed with breast cancer are at high risk of developing cardiovascular disease due to their treatment with chemotherapy drugs and radiation, especially to the left breast,” says Oren. “Radiation, in particular, increases the risk of coronary artery disease and heart attacks, and also predisposes women to diseases of the pericardium (the covering surface of the heart) and heart valves, as well as to heart-rhythm abnormalities. Currently there is no uniform recommendation for screening women with breast cancer for the presence of heart disease, despite the fact that the most common cause of death among women diagnosed with early-stage breast cancer is heart disease.”
The authors call for research to better understand the frequency of imaging artifacts and inaccuracies in women who underwent breast reconstruction. “We need to identify the optimal imaging tests that would detect heart problems in women with implants and minimize the potential for missed or incorrect cardiovascular diagnoses,” says co-author Ron Blankstein, MD, associate director of the Cardiovascular Imaging Program at Brigham and Women’s Hospital and professor of Medicine and Radiology at Harvard Medical School (HMS). Research needs to be a concerted effort involving cardiologists, oncologists, radiologists, plastic and reconstructive surgeons, implant manufacturers, and regulators, the authors maintain.
“Although cancer outcomes have been the primary focus of breast cancer research, survivorship also hinges on the optimization of cardiovascular health,” states senior author Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital and a professor of Medicine at HMS. In developing strategies for the prevention and treatment of cardiovascular disease in this high-risk population, it is imperative to understand how breast implants affect imaging quality and accuracy when selecting between different imaging tests, the authors conclude.
About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of “America’s Best Hospitals.”
Method of Research
Subject of Research
Addressing Imaging Pitfalls to Reduce Cardiovascular Disease Misdiagnosis in Patients With Breast Cancer Following Reconstruction
Article Publication Date
Dr Bhatt discloses the following relationships: advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier PracticeUpdate Cardiology, Janssen, Level Ex, Medscape Cardiology, MyoKardia, Novo Nordisk, PhaseBio, PLx Pharma, and Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; chair: American Heart Association Quality Oversight Committee; data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the EXCEED trial, funded by Edwards), Contego Medical (chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), and the Population Health Research Institute; honoraria: American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; vice chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (editor in chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (editor in chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), K2P (co-chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), and Society of Cardiovascular Patient Care (secretary/treasurer),WebMD (CME steering committees); other funding: Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), VA CART Research and Publications Committee (chair); research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Lexicon, Lilly, Medtronic, MyoKardia, Novartis, Novo Nordisk, Owkin, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, The Medicines Company, and 89bio; royalties: Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); site co-investigator: Abbott, Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), and Svelte; trustee: American College of Cardiology; and unfunded research: FlowCo, Merck, Takeda. No other disclosures were reported.