For women diagnosed with breast cancer, the news is better than before. Improved detection and treatment have resulted in better five-year survival rates — 91 percent among white women and 78 percent among black women worldwide. Those encouraging numbers, however, are tempered by the aftereffects of therapy.
Breast cancer treatment, in general, has been shown to result in much higher rates of diabetes, metabolic syndrome, atherosclerosis, hypertriglyceridemia (elevated blood levels of fatty molecules) and abdominal obesity — top risks for cardiovascular disease. So healthcare professionals know that patients who undergo radiation therapy tend to develop such conditions as coronary artery disease, congestive heart disease, heart valve disease, pericardial disease, and conduction abnormalities. And certain chemotherapy drugs — including the frequently used doxuribicin and trastuzumab — can decrease the heart’s pumping ability, too.
What’s more, for women who go on anti-estrogens because they have estrogen-sensitive breast cancer, the risks of heart disease spike because a loss of that important hormone is often associated with cardiovascular problems.
Minimally invasive heart surgery provides a safer alternative
In the past, surgery to correct heart problems was often a high-risk procedure for women who had undergone such cancer treatment. That’s because traditional heart surgery, performed through a sternotomy, requires a large incision along the chest and the breaking of the breast bone, all in order to get to the heart.
“As a result of [cancer] treatment, the chest wall and sternum become very fragile,” says Dr. Joseph Lamelas, chief of cardiothoracic surgery at the University of Miami Health System. “There are also problems with wound healing.” The latter was often a result of limited skin and tissue in the area because of a mastectomy and/or reconstruction.
With the advent of minimally invasive surgery, however, breast cancer patients don’t have to undergo such a traumatic operation. Dr. Lamelas, who has pioneered various minimally invasive techniques over the years, cuts a 2-inch incision on the right side of the chest and then uses special instruments that extend past and through the ribs to get to the heart.
“It avoids any injury to the sternum,” adds Dr. Lamelas. “A minimally invasive technique is the least traumatic way to enter the chest.”
In addition, this type of surgery results in shorter hospital stays and recovery time as well as less pain. Dr. Lamelas has even used minimally invasive techniques on breast cancer survivors who have had their breasts reconstructed with muscle flap surgery, which involves taking tissue from the body (usually the abdomen or the back) and using it to create a new breast mound.
Minimally invasive heart surgery is gaining steady and widespread acceptance for most patients, and for breast cancer survivors in particular. “It’s a definite option,” adds Dr. Lamelas, “and far better than what we had before.”
READ MORE: Heart Disease: Is There a Gender Gap?