Evidence map›Paper›PMID 40542432›Full record

ArticleCardio-oncology (London, England)2025

Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study.

Helena Carreira, Helen Strongman, Maria Feychting, Laila Hubbert, Elham Hedayati, Patrick Bidulka, Anthony Matthews, Krishnan Bhaskaran

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Article in Cardio-oncology (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Helena Carreira *Electronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. Helena.carreira@lshtm.ac.uk.
Helen Strongman *Electronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Maria FeychtingUnit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden.
Laila HubbertDepartment of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden.
Elham HedayatiUnit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden.
Patrick BidulkaElectronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Anthony Matthews *Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden.
Krishnan Bhaskaran *Electronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.

Funding

Forte 2020-00029National Institute for Health and Care Research NIHR301730Swedish Research Council 2021-02236Wellcome Trust 220283/Z/20/Z
6 · The paper itself

Abstract

backgroundCardiovascular toxicity concerns have limited the use of anthracyclines and trastuzumab among breast cancer patients with cardiovascular disease (CVD) but evidence on real-world prescribing patterns is scarce. We aimed to describe the use of these drugs in women with and without CVD when diagnosed with non-metastatic breast cancer in Sweden.

methodsUsing Swedish national registers (2010-15), we identified breast cancer treatment and prior CVD from hospital and prescription data. We calculated prevalence of anthracycline and trastuzumab use in women with and without prior CVD, and estimated prevalence ratios (PR) comparing these groups, adjusted for age, stage, and other patient and tumour-related factors.

resultsAmong 32,590 women with breast cancer, 10,702 (33%) had prior CVD. Anthracycline use was lower in those with vs without prior CVD (2,169/10,702 [20.3%] vs 8,654/21,888 [39.5%], crude PR 0.51, 0.49-0.53); the PR attenuated after adjustment for age and other factors (adj-PR 0.90, 0.87-0.93). There was substantial variation by type of CVD: patients with heart failure were much less likely to receive anthracyclines (adj-PR 0.46, 0.35-0.57) while prior venous thromboembolism (VTE) had no impact (adj-PR 0.98, 0.88-1.09). Among HER2 + patients, trastuzumab use showed similar patterns, with prevalence of 630/1,100 [57.3%] vs 2,279/2,866 [79.5%] for any vs no prior CVD (crude PR = 0.72, 0.68-0.76, adjusted PR = 0.95, 0.90-0.99); adjusted PRs for specific outcomes ranged from 0.77 (0.61-0.93) for heart failure, to 1.04 (0.92-1.15) for VTE.

conclusionWhile prior CVD was associated with lower use of potentially cardiotoxic breast cancer therapies, substantial numbers of patients with CVD still received these treatments, with marked variation by type of CVD. These real-world data suggest variable cardiovascular toxicity risk stratification before anticancer therapy and highlight the need for evidence-based guidance on negotiating the risk-benefit balance in these patients.

Identifiers

PMID40542432
PMCPMC12180225

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