The following is a comment on an article from the ASCO Breast Cancer Symposium.
It is different sets of genes/biochemistry/physiology (for different diseases), but that which “turns on” breast cancer is the very same thing(s) as that which “turns on” heart disease activation: same for diabetes, diverticulitis, high BP, high cholesterol, cancer of the colon/pancreas/ovaries/uterus/prostate and all those preventable disease that occur in technically advanced cultures and are entirely unknown in pretechnological societies that do not ever have these conditions even in those (many) who live into their 80-90’s. A should-be Nobel laureate once said, “Most diseases occur if, and only if those with a particular genetic tendency do what is necessary to express that genetic tendency.”
While people have the tendency to high cholesterol, high blood pressure, diabetes, gall stones, etc., these diseases occur if, and only if these susceptible people do what is necessary to cause the expression of that genetic tendency/disease. In that sense, virtually all diseases are “genetic” and merely represent the interaction of that person’s genetic tendency coming in contact with a specific (and disease generating) behavior, very much as a lighted match + gasoline creates fire.
original article being commented on is below.
ASCO Breast: Heart Also Long-Term Risk for Breast Cancer Survivors
Published: October 09, 2009
* Note that this study was published as an abstract and presented at
a conference. These data and conclusions should be considered
preliminary until published in a peer-reviewed journal.
SAN FRANCISCO — Although breast cancer survivors may focus on their
long-term risk of recurrence, most should be just as concerned about
their hearts, researchers found.
The 10-year risk of a serious cardiovascular event was at least as high
as the risk of breast cancer for 78% of women, Aditya Bardia, MD, MPH,
of Johns Hopkins, and colleagues reported here at the ASCO Breast Cancer
These findings don’t negate the importance of long-term management of
breast cancer risk, Bardia said, but suggest more attention to the
bigger picture. “Other things are also important,” he said.
Rowan Chlebowski, MD, PhD, of Harbor-UCLA Medical Center in Los Angeles
and chair of the session where the results were presented, said this is
a consistent message emerging in breast oncology.
“Breast cancer patients need more attention to cardiovascular health
regardless of their risk level,” he said. “We need more interaction with
That may mean referrals of high-risk patients for appropriate managment,
Bardia said. But counseling about risk reduction strategies common to
cardiology and oncology, such as physical activity, may help avoid both
hazards, he suggested.
His group analyzed data from 242 postmenopausal women (mean age 61) with
hormone-responsive, up-to-stage-III breast cancer who had baseline
cardiovascular risk factor data available in the Exemestane Letrozole
Pharmacogenetic (ELPh) trial.
The researchers calculated 10-year modified Framingham risk scores as
well as 10-year breast cancer recurrence risk computed from age, tumor
size and grade, and lymph node status using the Adjuvant! Online tool.
They found that 3% and 12% of the women were at high risk (greater than
25% ) for breast cancer and cardiovascular disease, respectively.
Another 55% and 52%, respectively, were at moderate risk (10% to 25%),
while 42% and 36% were at low risk (less than 10% over 10 years),
The analysis indicated that breast cancer characteristics do not
interact with cardiovascular risk.
But comparing the two, just 22% of women had a breast cancer recurrence
risk over 10 years that was greater than the risk of heart disease,
stroke, or peripheral vascular disease.
The two risks were equal for 43% of the breast cancer survivors, and
cardiovascular risk dominated for the remaining 35%.
Cardiovascular disease risk was more likely to be the predominant
concern for women who had small breast tumors (PR 5.7 for smaller versus
larger than 2 cm), low grade tumors (OR 3.0 for grades 1 and 2 versus
grade 3), node negative disease (OR 2.9), and early stage cancer (OR 5.1
for stage I versus stages II or III).
Bardia cautioned that these results were estimates, based on prognostic
tools, rather than actual outcome data, and he noted that the study did
not factor in potentially important variables, including obesity,
diabetes, and the effect of breast cancer treatment on risk.
While it’s easy to point the finger at chemotherapy in regard to
cardiovascular risk in this population, hypertension may be just as
important, said Jean-Bernard Durand, MD, a cardiologist at the M.D.
Anderson Cancer Center in Houston, who was not involved in the study.
He recommended that oncologists develop relationships or partnerships
with cardiologists to help manage these risks and to weigh competing
health morbidities. This is particularly important for women with very
early stage breast cancer, to minimize use of cardiotoxic agents, and to
offer early cardiac prevention strategies.
The study was based on a trial funded by the National Institutes of
Health, Pfizer, and Novartis. The researchers reported receiving
research funding from AstraZeneca, Eli Lilly, Pfizer, and Novartis.
Chlebowski reported conflicts of interest with AstraZeneca, Pfizer,
Novartis, Lilly, sanofi-aventis, and Genetech. Duran reported no
conflicts of interest.
*Primary source: *ASCO Breast Cancer Symposium
Bardia A, et al “Comparison of breast cancer recurrence risk and
cardiovascular disease risk among postmenopausal breast cancer
survivors” /ASCO Breast/ 2009; Abstract 133.