Coronary artery disease and risk in breast cancer patients identified with FDG PET-CT

Introduction: Coronary artery disease (CAD) and cancer are the leading causes of hospitalization and mortality in high-income countries. It is well established that women with CAD have worse clinical outcomes, mortality, and developing heart failure compared to med. Additionally, most major cardiology trials and registries have excluded patients with cancer. This has resulted in limited information on the effects of coronary artery disease in cancer patients, particularly for women with breast cancer. We have retrospectively evaluated the utility of calculating a calcium score based on the initial FDG PET-CT in women without known CAD presenting to the Mayo Clinic Jacksonville Breast Clinic, and how inclusion of the calcium score could have altered referral to cardiology and clinical management.

Methods: Patients with known breast carcinoma presenting to the Mayo Clinic Jacksonville Breast Clinic from 02/209-07/2021 were evaluated. Inclusion criteria included an initial FDG PET-CT evaluation, and who were without known CAD or had prior chest CT imaging. In total, 290 patients were identified which met inclusion criteria. Calcium scoring of the CT portion of the FDG PET-CT was performed and chart analysis including age, race, hormone status, smoking history, hypertension, family history, prior cardiac intervention, BMI, creatinine, lipids, among others variables was obtained if available for each patient at the time of initial PET-CT. MESA risk score and ASCVD risk estimates at the time of initial FDG PET-CT were able to be obtained for 162 of the 291 patients. Chart review of the initial FDG PET-CT was done to evaluate for radiologist note of CAD at time of initial report and any subsequent referrals to cariology or cardiac evaluation or events.

Results: Patients had an average calcium score of 175.7 (range 0 – 11088). Average MESA calculated 10 year CHD event score of those patients with information available in the clinical record was 4.8% (range 0.6 – 70.9%). Of the 78 patients with positive calcium scores, only 18 patients had the CAD noted in the FDG PET-CT. Of the 78 patients with CAD, 32 later saw a cardiologist. Of the 18 patients with CAD that was mentioned in the FDG PET-CT 6 later saw a cardiologist. 21 of the 290 patients had a subsequent ED admission for chest pain.

Conclusions: Breast cancer patients have an increased risk of developing CAD and subsequent cardiac events which may be easier managed prior to starting treatment for breast cancer. Radiologist reporting of CAD on the initial FDG PET-CT was poor which is likely responsible for the poor referral to cardiology for complete evaluation.