Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug 17;11(8):2286.
doi: 10.3390/biomedicines11082286.

Racial Disparity in Anthracycline-induced Cardiotoxicity in Breast Cancer Patients

Swetha Balaji  1 , Antu K Antony  1 , Harry Tonchev  1 , Giorgia Scichilone  1 , Mohammed Morsy  1 , Hania Deen  1 , Imaduddin Mirza  1 , Mohamed M Ali  1 , Abeer M Mahmoud  1   2
Affiliations
Review

Racial Disparity in Anthracycline-induced Cardiotoxicity in Breast Cancer Patients

Swetha Balaji et al. Biomedicines. .

Abstract

Breast cancer has become the most common cancer in the US and worldwide. While advances in early detection and treatment have resulted in a 40% reduction in breast cancer mortality, this reduction has not been achieved uniformly among racial groups. A large percentage of non-metastatic breast cancer mortality is related to the cardiovascular effects of breast cancer therapies. These effects appear to be more prevalent among patients from historically marginalized racial/ethnic backgrounds, such as African American and Hispanic individuals. Anthracyclines, particularly doxorubicin and daunorubicin, are the first-line treatments for breast cancer patients. However, their use is limited by their dose-dependent and cumulative cardiotoxicity, manifested by cardiomyopathy, ischemic heart disease, arrhythmias, hypertension, thromboembolic disorders, and heart failure. Cardiotoxicity risk factors, such as genetic predisposition and preexisting obesity, diabetes, hypertension, and heart diseases, are more prevalent in racial/ethnic minorities and undoubtedly contribute to the risk. Yet, beyond these risk factors, racial/ethnic minorities also face unique challenges that contribute to disparities in the emerging field of cardio-oncology, including socioeconomic factors, food insecurity, and the inability to access healthcare providers, among others. The current review will address genetic, clinical, and social determinants that potentially contribute to this disparity.

Keywords: anthracyclines; breast cancer; cardiometabolic health; cardiotoxicity; genetic polymorphism; racial disparity; socioeconomic determinants.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Graphical representation of the molecular pathways and functional outcomes in numerous cell types affected by anthracycline-induced cardiotoxicity.
Figure 2
Figure 2
Graphical representation of some of the genetic variants linked to differential toxicity to anthracyclines.
Figure 3
Figure 3
A visual representation of some of the major factors contributing to racial/ethnic disparities in anthracycline-induced cardiotoxicity.
See this image and copyright information in PMC

References

    1. American Cancer Society . Cancer Facts and Figures. American Cancer Society; Atlanta, GA, USA: 2022. [(accessed on 30 November 2022)]. Available online: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-c....
    1. Yedjou C.G., Tchounwou P.B., Payton M., Miele L., Fonseca D.D., Lowe L., Alo R.A. Assessing the Racial and Ethnic Disparities in Breast Cancer Mortality in the United States. Int. J. Environ. Res. Public Health. 2017;14:486. doi: 10.3390/ijerph14050486. - DOI - PMC - PubMed
    1. Waks A.G., Winer E.P. Breast Cancer Treatment: A Review. JAMA. 2019;321:288–300. doi: 10.1001/jama.2018.19323. - DOI - PubMed
    1. Burstein H.J., Curigliano G., Thurlimann B., Weber W.P., Poortmans P., Regan M.M., Senn H.J., Winer E.P., Gnant M. Panelists of the St Gallen Consensus Conference. Customizing local and systemic therapies for women with early breast cancer: The St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann. Oncol. 2021;32:1216–1235. doi: 10.1016/j.annonc.2021.06.023. - DOI - PMC - PubMed
    1. Venkatesh P., Kasi A. Anthracyclines. StatPearls; Treasure Island, FL, USA: 2022.

LinkOut - more resources