CT Scans Identify Breast Cancer Patients with Highest Cardiovascular Disease Risk

CT scans can identify which women with breast cancer also have the most calcium in their arteries, placing them at higher risk for developing cardiovascular disease. Those patients with the most calcium accumulation have a one in four risk, according to newly presented research.

In a presentation during the 12th European Breast Cancer Conference, researchers from the University Medical Center Utrecht in The Netherlands discussed their findings that a deep learning model can help providers pinpoint which patients have the highest cardiovascular disease risk, potentially guiding cancer treatments.

“We’ve seen great improvement in breast cancer survival, thanks in part to better treatment. However, treatments have side effects and some treatments, such as radiotherapy and certain types of cancer drugs, can increase the risk of cardiovascular disease,” said Helena Verkooijen, research presenter and professor in the imaging and oncology division of the University Medical Center. “In my opinion, treating breast cancer means finding the right balance between maximizing changes of tackling the tumor, while minimizing the risks of side effects, including the risk of cardiovascular disease.”

This is the largest scale study of its kind to-date, she said.

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To determine which women face the highest risk, Verkooijen and her team examined the CT scans from approximately 14,000 women with breast cancer who received radiotherapy treatment at one of three large hospitals in the Netherlands between 2005 and 2016.

Using a deep learning algorithm they developed, the team evaluated coronary artery calcium (CAC) – calcium built up in the arteries that could potentially cause blockages – identified in each woman’s scans. The artificial intelligence tool enabled them to automate the measurement of CAC for each patient, giving them a CAC score with only minimal extra workload, Verkooijen said.

The researchers followed the women for an average of 52 months to see which ones developed cardiovascular disease. Based on their analysis, they found that women who have the highest CAC score (those with scores of 400) also face the most significant cardiovascular disease risk –28.3 percent were hospitalized or died from the disease. Hospitalization or death rates among the other study participants were:

• CAC Score 101-400: 17.5 percent
• CAC Score 11-100: 13.5 percent
• CAC Score 1-10: 8.9 percent
• CAC Score 0: 5 percent

After accounting for age and year of diagnosis, the team determined that women with the highest CAC scores were 3.7 times more likely to develop cardiovascular disease than women with no calcifications. The news was worse for women who had been treated with a particular type of chemotherapy – anthracycline. For these participants, the association between a high CAC score and cardiovascular disease was even stronger.

Although the team was unable to take other cardiovascular risk factors, such as smoking, high blood pressure, and diabetes, into account with this study, these results, Verkooijen said, highlight the beneficial role that imaging can play with these patients beyond initially detecting their breast cancer.

“We’ve shown that we can use routine CT scans to indicate which breast cancer patients are most likely to develop cardiovascular disease,” she said. “Now, we need to do more research to find out what can be done to help minimize this risk, for instance whether patients’ cardiovascular health should be monitored or treated.”

In an effort to reach that goal, she said, her team is working to implement their technique in several radiotherapy units across The Netherlands. Patients who participate and are diagnosed with an increased cardiovascular risk will not only have their CAC scores integrated into their cancer treatment planning, but they will also be offered further screening services and lifestyle advice.

According to Nadia Harbeck, University of Munich professor and chair of the European Breast Cancer Conference, these findings could help control the overuse of cancer therapies that can have negative long-term side-effects. Harbeck did not participate in the research.

“This is a clever study because it shows us how the CT scans we are already taking can also be used to discover which women have the highest risk of cardiovascular disease,” she said. “We look forward to further results from these researchers and hope they might show us how best to hope women who are at higher risk of cardiovascular disease.”