Connecting the Dots: Breast Cancer and Heart Disease

Last summer, 36-year-old Erin Hatcher had “babies on the brain.” She had a young son and wanted to add to her family. On June 9, Erin underwent fertility testing – the next day, she learned that she had a mass on her left breast. A week later, she was diagnosed with breast cancer.

Erin, who lives in Danville, VA, opted to receive care at Duke because of the health system’s reputation as a leader in cancer treatment and team approach to care. She had a left mastectomy on July 21, 2020. Her chemotherapy and radiation – which Erin refers to as the “cleanup crew” following surgery – lasted from August 2020 to January 2021. Currently, there is no sign of cancer. Erin continues to have follow-up appointments and expects to remain on medication for the next five to ten years.

Susan Dent, MD, is Erin’s medical oncologist. From her first appointment, Erin knew she was in good hands. Not only did Dr. Dent thoroughly explain her diagnosis and recommended treatment plan, but she also took time to answer all of Erin’s questions and even helped her work through her strong desire for another child.

“Dr. Dent gave me all the information I needed to make a decision for myself and my family,” Erin said. “But she never dismissed my strong feelings about having another baby. We really talked about it. I felt heard and validated – Dr. Dent let me have my day in court, and I was able to move on.”

The next phase of Erin’s treatment includes the removal of her right breast and reconstruction surgery, planned for this fall. Since she has the BRCA2 breast cancer gene, Erin will also meet with a gynecological oncologist to discuss a hysterectomy to prevent ovarian cancer.

From cancer treatment to clinical trial

Even as her cancer treatment continues, Erin is now involved in a clinical study that will monitor her heart health for the next 10 years. The Understanding and Predicting Breast Cancer Events After Treatment (UPBEAT) study is being conducted to examine the long-term impacts of chemotherapy and radiation on the cardiovascular health of women treated for breast cancer.

Dr. Dent, who is co-director of the Duke cardio-oncology program, is also a principal investigator in the UPBEAT study. Erin was eager to participate when she learned about it. “The chemo did what it was supposed to do to treat my cancer, but it can be bad on the heart,” she said. “The UPBEAT study will examine my heart, which allows me to stay informed and ahead of any potential issues that could arise. It’s a win-win for me.”

UPBEAT participants undergo heart MRIs, cognitive testing and exercise evaluations at varying intervals to measure heart function and exercise capacity. They receive follow-up phone calls and questionnaires to assess fatigue, behavioral and psychosocial risk factors.

“This study is very important because it will help define which women are at increased risk of developing cardiac problems related to their breast cancer treatment,” Dr. Dent explained. “And if we know, we can think of preventive strategies to attenuate or diminish the risk of long-term cardiovascular effects.”

The many faces of breast cancer

At the beginning of her cancer journey, Erin didn’t want people to know what she was going through, and she wasn’t interested in hearing from others who had faced the same battle. “Their story wasn’t my story,” Erin said. But as she sat in waiting rooms and treatment rooms, she realized that she was part of a larger story. “Breast cancer is the great equalizer. It happens to women of all ages, sizes and ethnicities. It doesn’t discriminate, and there’s no status in the room when you’re all wearing hospital gowns.”

Erin’s family has been an integral part of her story. Her mother traveled to Danville from Ohio to help take care of Erin’s young son and manage things at home so that her husband could accompany her to all of her appointments in Durham. Her husband has been her constant companion and advocate. Her two-year-old son called her “beautiful” when he saw her for the first time after she shaved her head.

Staying “UPBEAT” for the future

Erin is grateful to be part of the UPBEAT study and for its perfect timing in her situation. She’s also very appreciative of her multidisciplinary team at Duke. “Everyone talks to each other; they all know what’s going on with my case and they won’t let me slip through the cracks.”

She is still passionate about having more children and hopes to adopt in the future. She credits her experience at Duke and the way everyone made her feel heard and safe for the ability to keep this dream alive.

As a result of Erin’s breast cancer diagnosis, other women in her family were tested. Her paternal aunt and her sister are both positive for the BRCA2 gene. Erin is pleased that, unlike her, they will have the opportunity to be proactive about their condition.

“I think God did that on purpose,” Erin said. “I’m more bull-headed, so it was easier for me to go through it first. Even though everything has seemed so out of place in the past year, I know it’s falling into place all at the same time.”