Calculator May Predict Heart Risks After Breast Cancer – Medscape

Advancing Health Outcomes for Breast Cancer Survivors: A New Risk Prediction Model Aligned with Sustainable Development Goals

Executive Summary: Enhancing Good Health and Well-being (SDG 3)

A new study published in JAMA Oncology introduces a risk prediction model designed to identify women at high risk of developing heart failure and/or cardiomyopathy following treatment for early-stage breast cancer. This development directly supports Sustainable Development Goal 3 (Good Health and Well-being) by offering a tool for reducing premature mortality from non-communicable diseases through prevention and treatment. The calculator prospectively identified high-risk individuals over a 10-year period, emphasizing the critical role of pre-existing cardiovascular risk factors alongside cancer treatment effects. With further validation, this model could become a practical instrument for implementing targeted preventive strategies, promoting long-term health for a growing population of cancer survivors.

Key Findings and Identified Risk Factors

The research was based on data from 26,044 patients diagnosed with stage I-III breast cancer. The study identified several key variables that significantly increase the 10-year risk of heart failure or cardiomyopathy. This data is crucial for creating personalized healthcare plans that align with SDG 3’s target for universal health coverage and access to quality care.

Primary Risk Drivers Identified:

• Age: Women aged 65-74 had a 3.5 times greater risk compared to women under 40 (Hazard Ratio [HR], 3.49).
• Hypertension: Patients with pre-existing hypertension faced a doubled risk (HR, 2.02).
• Cancer Therapies:
  • Treatment with anthracyclines increased risk significantly (HR, 1.95).
  • HER2-targeted therapy without anthracyclines also elevated risk (HR, 1.66).
• Other Cardiovascular Risk Factors: Diabetes, smoking, and obesity were also identified as significant contributors.

Risk Stratification Model:

The model categorizes patients into three risk groups based on weighted scores, allowing for tailored clinical surveillance:

1. Low-Risk Group: 1.3% estimated 10-year risk.
2. Medium-Risk Group: 6.3% estimated 10-year risk.
3. High-Risk Group: 19.4% estimated 10-year risk.

The model demonstrated good discrimination (time-dependent area under the curve of 0.79), indicating its potential for clinical application.

Implications for SDG 5 (Gender Equality) and SDG 10 (Reduced Inequalities)

This research holds significant implications for advancing health equity. By focusing on a disease predominantly affecting women, the study contributes to SDG 5 (Gender Equality) by addressing specific female health challenges and improving long-term outcomes. However, the editorial accompanying the study highlights a critical consideration for SDG 10 (Reduced Inequalities). The initial study population was insured and resided in a region with a low baseline rate of heart failure. Therefore, validation in more diverse populations and healthcare settings is essential to ensure the tool does not exacerbate existing health disparities and is effective for all women, regardless of socioeconomic or geographic status.

Future Directions: Fostering Partnerships for the Goals (SDG 17)

The findings underscore the necessity of an integrated care model, a core principle of effective health systems. The management of cardiovascular health in breast cancer survivors requires robust collaboration between oncology, primary care, and cardiology. This multi-stakeholder approach exemplifies SDG 17 (Partnerships for the Goals). The successful implementation of this risk calculator will depend on partnerships between research institutions, healthcare providers, and policymakers to:

• Conduct further validation studies in diverse populations.
• Integrate the tool into clinical practice guidelines.
• Ensure primary care providers are equipped to manage cardiovascular risk factors in cancer survivors.

As the population of breast cancer survivors grows—projected to increase by one million in the US by 2035—such collaborative and data-driven strategies are paramount to achieving sustainable health and well-being for all.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: This is the primary SDG addressed in the article. The entire focus is on improving health outcomes for a specific population (breast cancer survivors) by preventing a non-communicable disease (heart failure). It discusses medical research, risk prediction, preventive strategies, and the importance of integrated healthcare (oncology, primary care, cardiology) to ensure the long-term well-being of patients.
• SDG 9: Industry, Innovation, and Infrastructure: This goal is relevant through its emphasis on scientific research and innovation. The article’s central topic is a “new risk calculator,” which is a technological and scientific innovation designed to improve healthcare delivery. The study itself, funded by the National Institutes of Health, represents an investment in the research infrastructure needed to create such tools.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article directly addresses this target by focusing on the prevention of heart failure (a non-communicable disease) in breast cancer survivors. The risk calculator is a tool designed for early identification and implementation of “preventive strategies” to reduce the incidence and subsequent mortality from this condition.
• Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…” The article highlights the need for better, more personalized healthcare. It points out that all breast cancer survivors “need, at a minimum, access to primary care that addresses their cardiovascular risk factors.” It also raises concerns about “overimaging” with current protocols, underscoring the need for more efficient and risk-based (quality) healthcare approaches, which is a core component of this target.
• Target 3.b: “Support the research and development of vaccines and medicines for the communicable and non-communicable diseases…” While not focused on vaccines or medicines, this target’s emphasis on supporting research and development for non-communicable diseases is highly relevant. The article is a report on a new study that created and tested a “risk prediction model.” The mention that the study was “funded by the National Institutes of Health” directly reflects the support for R&D called for in this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.4 (Reducing mortality from NCDs):
  • Incidence Rates: The article provides 10-year estimated risks for developing heart failure/cardiomyopathy for different risk groups (1.3% for low-risk, 6.3% for medium-risk, and 19.4% for high-risk). These percentages serve as a baseline indicator of disease incidence that preventive strategies aim to reduce.
  • Risk Factor Prevalence: The article identifies and quantifies key risk factors using Hazard Ratios (HR), such as older age (HR 3.49), hypertension (HR 2.02), and specific cancer treatments (HR 1.95 for anthracyclines). Tracking the prevalence and management of these factors (e.g., hypertension, diabetes, smoking, obesity) in the survivor population would be a key indicator of progress.
  • Population Size at Risk: The article states there are “4.3 million women with a history of breast cancer” in the US, with a projected increase. This number serves as an indicator of the scale of the population that needs monitoring and preventive care.
• For Target 3.8 (Access to quality healthcare):
  • Access to Primary and Specialized Care: The article implies a gap in care by stating that survivors “need… access to primary care” and that “primary care and cardiology should be involved.” An indicator would be the percentage of breast cancer survivors who have regular follow-ups with primary care physicians or cardiologists for cardiovascular risk management.
  • Efficiency of Healthcare Services: The concern about “overimaging” suggests a need for more efficient healthcare. An indicator could be the reduction in unnecessary cardiac assessments for low-risk patients, as identified by the new risk calculator, thereby optimizing resource use.
• For Target 3.b (Support for R&D):
  • Development of New Health Technologies: The creation and validation of the “new risk calculator” itself is a direct indicator of successful research and development.
  • Investment in Research: The mention of funding from the “National Institutes of Health and Georgetown Lombardi Comprehensive Cancer Center” is an indicator of financial support and investment in medical research for non-communicable diseases.

4. Table of SDGs, Targets, and Indicators

Source: medscape.com