God Journal CA: The risk of "three highs" of breast cancer survivors rises by nearly 30 %

*For medical professionals for reading reference

More fatal than cancer itself "accompanied by disease"!

Breast cancer (BC) is the most common malignant tumor for women. Thanks to the promotion of early screening and the emergence of new therapies, the 5 -year survival rate of BC patients in the United States jumped from 75%in 1970 to 90%in the past 10 years. The combination of common illness is becoming more and more obvious, of which "three highs" -the diabetes, abnormal blood lipids, and hypertension have become new challenges that affect the quality of life and prognosis of patients.

Recently, a clinical study of the risk of the "three highs" of the Survivor of the gods reported and discussed the risk of BC survivors [2]. The results of this study show that BC survivors are more risk of diabetes, hypertension, and abnormal blood lipids than women who have never received BC. This study is also the largest size that has so far focused on the problem of heart metabolism facing BC survivors. One of the research.

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The highest risk of three highs can increase by nearly 30 %! Related to treatment methods

The researchers matched at a ratio of 1: 5, and finally incorporated the 14,942 BC survivors and 74,702 cancer -free comparisons, and obtained the social population characteristics data of each subject, including the year of birth, race, ethnicity, family income And education level. The study also collected data from the physical quality index, menopausal conditions, smoking status, and data from the history of the participants. The clinical data of BC survivors also include tumor characteristics and detailed data of diagnosis and treatment.

Researchers compared the cumulative incidence of hypertension, diabetes, and blood lipids of BC survivors and cancer -free comparisons, and used a multi -variable model to calculate the risk ratio. This model considers the characteristics of social population, health behavior, cardiovascular disease risk Factors, as well as cancer and clinical data of BC survivors.

Research Process

Two years after the diagnosis of cancer, the cumulative incidence of high blood pressure of BC survivors was 10.9%, and women who did not suffer from BC were 8.9%, although this difference no longer exists in 10 years after the diagnosis. Compared with cancer-free comparisons, high-blood pressure multi-variable risks have not increased significantly among BC survivors, but they receive left radiotherapy (1.11; 95%CI, 1.02-1.21) and endocrine therapy (1.10; 1.10; 1.10; The sub-groups of 95%CI, 1.03-1.16) showed significant increases.

Whether two years or 10 years after the diagnosis of cancer, the cumulative incidence of diabetes in BC survivors is significantly higher (2 years: 2.1%vs 1.7%; 10 years: 9.3%vs 8.8%). Compared to the control group, the variable risk of diabetes in BC survivors increased by 16%(HR = 1.16 95%CI, 1.07-1.26). In particular, chemotherapy (HR = 1.23; 95%CI, 1.11-1.38), left radiotherapy (HR = 1.29; 95%CI, 1.13-1.48) or endocrine therapy (HR = 1.23; 95%CI, 1.12-1.34) BC survivors have higher risk of diabetes.

The cumulative incidence of hypertension, diabetes and blood lipids of BC survivors and those with no cancer -free

The relative risk of cardiac metabolic risk factors layered in the treatment of breast cancer

Although the overweight is related to diabetes, hypertension, and BC after menopause, even if there is no overweight BC survivors during diagnosis, the risk of diabetes and hypertension will be significantly higher than those without cancer.

The relative risk of the heart metabolic risk factors layered in BMI

The results show that BC patients are susceptible people with a high risk of metabolism in the heart. Compared with BC women, BC survivors have a high incidence of diabetes and hypertension, and are related to BC -related treatment methods. Further study the prevention measures for the risk of cardiac metabolism in BC patients, and it is very important to perform targeted cardiovascular monitoring of specific patients and the treatment characteristics to reduce these risks.

This study is one of the largest research on the problem of heart metabolism facing BC survivors so far. Prior to this, we have not fully understood the impact of Cancer -related treatment of BC survivors to increase the risk of abnormal heart metabolism.

This study emphasizes the importance of notifying the long -term risk of Diabetes and Hypertension of BC survivors. Identification of this high risk is the first step in improving the health of BC survivors, and then it can guide the healthy lifestyle to reduce risks.

Another key information of this study is that in the treatment of BC patients in the future, we should adopt a larger team model strategy including the patient's primary health doctor (PCP). In addition to allowing the tumor team to focus on the best things -achieve cure -PCP communicates with the tumor team, manages complications and related risk factors. Tumor treatment is not only aimed at achieving cure, but also to optimize patients' life and quality of life.

Chinese scholars' first concept- "Breast cancer accompanied by disease"

In October 2016, the Central Government of the Communist Party of China promulgated the "Healthy China 2030 Planning Outline" to list cancer as a chronic disease. By 2030, the health management of chronic diseases and life cycles of the whole population and life cycle. %. To this end, Chinese experts have proposed the innovative treatment concept of breast cancer with diseases (CDBC), and take corresponding measures to promote the implementation of BC's "comprehensive and full cycle" health management model to further improve patients. The quality of life, improve the long -term survival rate [4]. In our country, diabetes, blood lipids, hyperlipidezer, hypertension and cervical plaques in patients with BC are relatively high, and the leakage rates are relatively high, and the cases of irregular diagnosis and treatment are serious. Blood lipid -related cardiovascular disease has become the main cause of death in patients with BC after menopause, and the early cause of cardiovascular disease (CVD) of diabetes and diabetes is also the main cause of cardiovascular disease (CVD).

Chinese scholars have applied oral glucose tolerance test (79 cases), chemotherapy (96 cases), and follow -up (121 cases). The prevalence of patients with diabetes is 25.3%(unknown diabetes accounts for about 80%), and 50.6%in the early stage of diabetes [about 97%is abnormal glucose tolerance (IGT)]; the incidence of diabetes during chemotherapy is 33.3%(unknown Xiao Diabetes accounted for about 84%), 28.1%in the early stage of diabetes (about 96%of IGT); the incidence of diabetes in patients was 21.8%(unknown diabetes accounted for approximately 81%), and 43.7%in the early stage of diabetes (about 92%) Essence

Even for BC patients with a history of diabetes, it is necessary to regularly screen OGTT, insulin release tests (IRT) or C peptide release tests (CPRT), and the screened islet dysfunction, diabetes disorders, diabetes Patients with early or early diabetes give diet and lifestyle intervention in a timely manner, and please consult the Department of Endocrinology to help BC patients successfully complete comprehensive treatment and improve prognosis.

Hypertension is one of the common diseases of patients with BC. The relationship between the two is closely related and can affect each other. When the BC combined with poor hypertension control, it is easy to suspend or interrupt the BC's comprehensive treatment plan and delay the timing of tumor treatment. Hypertension will also increase the risk of cardiovascular and cerebrovascular disease, and it will be related to the bad prognosis of BC patients. Therefore, during the first diagnosis and comprehensive treatment of BC patients, we should strengthen the connection with the Department of Cardiovascular Medicine, pay attention to monitoring blood pressure, and evaluate the important factors affecting the prognosis of cardiovascular patients with hypertension, and effectively prevent and treat hypertension to improve their survival Quality and improvement of prognosis.

BC patients have a significant decline in estrogen levels in the body due to chemotherapy and (or) endocrine therapy, and the risk of abnormal blood lipids and CVD increased significantly. Studies have shown that the mortality rate (15.9%) caused by the 10 -year CVD incident (15.9%) of the 10 -year blood lipid -related CVD incident in the early stage of menopause exceeds the mortality rate (15.1%), and has become the primary cause of death in patients with early menstruation. Li et al. Reported BC's first diagnosis patient's blood lipid abnormal rate was 43.0%, and 68.6%after chemotherapy. Blood lipids are an indicator that can be controlled and reversed. For example, early diagnosis and treatment can significantly improve the prognosis of patients.

For patients with abnormal blood lipids, MDT discussions should be discussed with the Department of Cardiovascular Medicine and Endocrinology. Blood lipid management.

references:

[1]Miller KD,Nogueira L,Devasia T,Mariotto AB,Yabroff KR,Jemal A,Kramer J,Siegel RL.Cancer treatment and survivorship statistics,2022.CA Cancer J Clin.2022 Jun 23.doi:10.3322/caac. 21731.epub ahead of propmid: 35736631.

[2] Fillon M.Breast Cancer Survivors Face Greter Cardiomettabolic Risks.ca CANCER J Clin.2022 Jul; 72 (4): 303-304.doi: 10.3322/CAAC.21746.pmid: 35797038.

[3] Kwan ml, Cheng RK, Iribarren C, neugebauer R, RANA JS, nguyen-huynh m, shi z, laurent ca, lee vs, roh jm, shen h, rillamas-sun e, Santiago-TORRRES M ,Kushi LH,Greenlee H.Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer:The Pathways Heart Study.J Clin Oncol.2022 May 20;40(15):1635-1646.doi:10.1200/JCO .21.01738.epub 2022 Jan 13.PMID: 35025627; PMCID: PMC9113213. [4] Kong Lingquan Li Li, etc. Pay attention to the "2618 sugar lipid project" of breast cancer accompanied by diseases. 2020,2: 89-93.doi: 10.3760/cma.ISSN.115 807-20200225-00041

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The first release of this article: the medical world tumor channel

Author of this article: lily

Review of this article: Yu Jiangyong Beijing Hospital

Editor in charge: Sweet

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