After Breast Reconstruction, Cardiovascular Imaging Can Be Inaccurate
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.