Every year, more than 25,000 Canadian women are diagnosed with breast cancer. Improved survival is increasing recognition of long-term treatment-related cardiac toxicity and subsequent mortality from anthracyclines (ACs) and trastuzumab. Consequently, cardiac function assessment using the left ventricular ejection fraction is widely incorporated into treatment planning. Although clinical guidelines recommend pre-treatment and surveillance imaging, these recommendations are drawn primarily from expert opinion instead of empirical evidence.
This retrospective cohort study examined the relationship between cardiac imaging utilization and care modifications at a regional hospital serving Northwestern Ontario. Female patients receiving AC and/or trastuzumab for a new diagnosis of breast cancer over a five-year period (2012–2017) were included. Patient demographics, therapy regimens, imaging utilization, and resultant changes in care were analyzed. Patients fell into three cohorts based on therapy regimen: trastuzumab (A), anthracyclines (B), and combined trastuzumab and anthracyclines (C).
Of the 125 patients identified, 93 met the inclusion criteria. The mean age was 59.48 (±10.41) years, with most patients having been diagnosed with invasive ductal carcinoma (97.85%). Cohort B (n = 60) had 1.25 scans per patient, leading to 10 changes in clinical management (13.33%). Comparatively, cohort A (n = 3) had 4.67 scans per patient, with one associated change (7.14%), while cohort C (n = 30) had 4.80 scans per patient, with six changes (4.17%).
Despite the higher imaging frequency in cohorts A and C, cohort B demonstrated the highest proportion of clinically meaningful management changes. These findings suggest that imaging frequency alone may not correlate with clinical utility, and they support the development of more targeted, risk-informed cardiac surveillance strategies. Future studies may analyze larger prospective cohorts to validate these results and develop risk-stratified imaging protocols to optimize resource utilization and patient outcomes.
Author Contributions
Conceptualization, O.A., H.A.-Q. and H.S.; methodology, O.A. and H.A.-Q.; software, H.S.; validation, O.A., H.A.-Q., H.S., M.C. and R.S.; formal analysis, H.S.; investigation, H.S., O.A. and M.C.; resources, O.A.; data curation, H.S.; writing—original draft preparation, H.S.; writing—review and editing, H.S., O.A., H.A.-Q., R.S. and M.C.; visualization, H.S.; supervision, O.A.; project administration, O.A., R.S. and H.S.; funding acquisition, O.A. and H.S. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the Mach-Gaensslen Foundation 2024 Student Grant Program.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by the Thunder Bay Regional Health Sciences Centre Research Ethics Board (protocol code #100175, 13 December 2023).
Informed Consent Statement
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors on request.
Acknowledgments
This work was informed by the Wholesale Cardiac Imaging Surveillance with Echocardiography and Radionuclide Assays during Breast Cancer Chemotherapy (WISER) protocol. The authors recognize the instrumental contributions of the WISER protocol in shaping the study design, methodology, and research objectives described herein. The authors further acknowledge Mansoureh (Suri) Ebrahimi for assistance with the Northern Constellations Internal Medicine Conference.
Conflicts of Interest
The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
| Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
, 