Introduction: Breast cancer affects over 25,000 women annually in Canada and has seen improved survival rates due to advances in screening and treatment. However, cardiotoxic therapies including anthracyclines and trastuzumab have made cardiovascular disease a leading cause of death among survivors. Baseline left ventricular ejection fraction is a reliable predictor of heart failure, and various guidelines recommend pretreatment cardiac imaging; however, its utility is largely based on expert opinion. Methods: This retrospective cohort study analyzed 93 breast cancer patients treated at a single cancer centre in Northwestern Ontario between 2012 and 2017 to determine the yield (defined as imaging leading to clinically actionable changes in care) of imaging. Results: Patients were grouped by treatment regimen: trastuzumab-only (cohort A,n= 3, mean age = 73.55 ± 9.90), anthracycline-only (cohort B,n= 60, mean age = 58.83 ± 9.83), and combination therapy with both trastuzumab and anthracyclines (cohort C,n= 30, mean age = 59.37 ± 10.91). Due to the very small sample size in cohort A, findings are presented for qualitative insight only. Cohort B had the highest imaging yield (13.33%), while cohorts A and C showed lower yields (7.14% and 4.17%) with more frequent imaging. Predictors of higher yield varied, with cohort B identifying the most, including diabetes and coronary artery disease. Conclusions: These findings underscore the need for targeted cardiac imaging to optimize resource allocation and patient outcomes, particularly in resource-limited settings such as Northwestern Ontario. Subsequent investigations should seek to stratify proactive versus reactive interventions, evaluate outcomes, refine imaging guidelines, and gather more data on patients receiving trastuzumab.
引言：乳腺癌每年影响加拿大超过25,000名女性，由于筛查和治疗技术的进步，其生存率有所提高。然而，包括蒽环类药物和曲妥珠单抗在内的心脏毒性疗法，已使心血管疾病成为幸存者的主要死因。基线左心室射血分数是心力衰竭的可靠预测指标，多项指南推荐进行预处理心脏成像检查；但其应用价值主要基于专家意见。方法：本回顾性队列研究分析了2012年至2017年间在安大略省西北部单一癌症中心接受治疗的93例乳腺癌患者，以评估心脏成像的检出率（定义为导致临床治疗策略发生可操作性改变的影像学检查）。结果：患者按治疗方案分组：仅使用曲妥珠单抗（队列A，n=3，平均年龄=73.55±9.90岁）、仅使用蒽环类药物（队列B，n=60，平均年龄=58.83±9.83岁）以及曲妥珠单抗与蒽环类药物联合治疗（队列C，n=30，平均年龄=59.37±10.91岁）。由于队列A样本量过小，其研究结果仅作定性参考。队列B的影像检出率最高（13.33%），而队列A和队列C虽然影像检查频率更高，但检出率较低（分别为7.14%和4.17%）。不同队列中较高检出率的预测因素各异，队列B识别出的预测因素最多，包括糖尿病和冠状动脉疾病。结论：这些发现强调了针对性心脏成像对优化资源配置和患者预后的必要性，特别是在安大略省西北部等资源有限的环境中。后续研究应致力于区分主动干预与被动干预策略、评估临床结局、完善影像学指南，并收集更多关于接受曲妥珠单抗治疗患者的数据。
Evaluating the Necessity and Impact of Cardiac Imaging on Breast Cancer Care in Northwestern Ontario
肿瘤(癌症)患者之家