Systemic chemotherapy in breast cancer often includes anthracyclines, with associated risk of inducing cardiomyopathy. In many units cardiac function is routinely evaluated with measurement of left ventricular ejection fraction by cardiac gated pool (MUGA) scan or echocardiogram. The intent of such evaluations is to identify those who may be more at risk of clinically significant anthracycline induced cardiotoxicity due to poor pre-existing function. The utility and cost effectiveness of this approach in younger patients with no risk factors for cardiac disease has been questioned, and we sought to audit this in our practice.
A retrospective clinical audit of 3 years of breast cancer patients was done and identified 477 patients between January 2008 and December 2010, who were discussed at Breast Multidisciplinary Meetings at Royal Adelaide Hospital. 173 (36.3%) patients received chemotherapy, with 139 (29.1%)having received anthracycline regimen. All patients had cardiac gated pool scans performed, and the results were obtained using computerised results from Nuclear Medicine Department or casenotes. All scans gave a normal results of above 50% ejection fraction, with 87.6% of patients having EF>60%.
This results challenge current practice, and raise the possibility of an alternative approach - to only scan those with known cardiac problems or identifiable risk factors for cardiac disease.
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