Breast Cancer and Heart Health: What Black Women Need to Know

Breast cancer and heart disease are more connected than many women realize. For Black women, higher rates of cardiovascular risk factors and breast cancer mortality make understanding this connection especially important. But how can breast cancer treatment affect the heart, and what can women do to protect themselves?

On this episode of Baptist HealthTalk, host Sandra Peebles speaks with Dr. Heather Johnson, cardiologist and director of preventive cardiology for women's services at Baptist Health, and Dr. Kerry-Ann McDonald, breast surgical oncologist at Baptist Health, about the relationship between breast cancer, cardiovascular disease and long-term women's health.

In this episode, you'll learn:

• Why Black women face higher rates of death from breast cancer despite lower diagnosis rates.
• How chemotherapy, radiation and hormone therapy can affect heart health.
• What breast arterial calcifications on a mammogram may reveal about cardiovascular risk.
• Why blood pressure, cholesterol and blood sugar monitoring are so important.
• When women should begin breast cancer risk assessments and mammogram screenings.
• How cardiologists and oncologists work together to protect patients during cancer treatment.
• Why physical activity and long-term monitoring matter for breast cancer survivors.

Understanding your risks and taking action early can make a meaningful difference. Learn how preventive care, early detection and coordinated treatment can help protect both your breast health and your heart.

Baptist HealthTalk is powered by Baptist Health South Florida.

Host:
Sandra Peebles
Award-Winning Journalist

Guests:
Heather Johnson, M.D.
Cardiologist and Director of Preventive Cardiology for Women’s Services
Baptist Health Heart & Vascular Care

Kerry-Ann McDonald, M.D.
Breast Surgical Oncologist
Baptist Health Cancer Care

Transcript

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Dr. Heather Johnson (00:00:00 -> 00:00:20)

Over 50% of black women have high blood pressure. Additionally, higher rates of diabetes, higher rates of overweight or obesity within the community. Also underlying genetic pathways that play a role. And so all of these risk factors come together and further increase the risk of heart disease and also death related to heart disease.


PreProduced VO (00:00:20 -> 00:00:31)

Welcome to Baptist HealthTalk,  a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness. Hello


Sandra Peebles (00:00:31 -> 00:01:24)

Everyone. I'm your host, Sandra Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your both search questions on trending health topics. Today we're talking about the link between breast cancer and heart health and why it's especially important for black women. We'll look at the risks they share, how cancer treatment can actually affect your heart, and what every woman needs to know before, during, and after cancer treatment. We are joined by Dr. Heather Johnson, cardiologist and director of preventive cardiology for women's services with Baptist Health, Heart and Vascular care, and Dr. Kerry-Ann McDonald, breast surgical oncologist with Baptist Health Cancer Care. Thank you both for being here. Thank you so much for being here. So, um, I guess my first question is for you, Dr. McDonald. Why are breast health and heart health being spoken about in the same conversation?


Dr. Kerry-Ann McDonald (00:01:25 -> 00:02:25)

So, breast health and heart health are more connected than people realize. Um, for one, they share a very close anatomical relationship, so the breast sits on top of the chest wall with the heart directly beneath it. So when we're thinking about caring for our breast cancer patients, we're cognizant of how those treatments will affect the heart. Um, but beyond their proximity, um, you know, cancer treatments can have cardiovascular risk and breast cancer and cardiovascular disease share many of the same risk factors, um, such as smoking, obesity, um, advanced age and, um, inactivity. So, you know, ultimately we wanna care for the patient as a whole, um, and make sure that we focus on both things. The other interesting thing that I think is that breast imaging, um, can give us clues about both diseases. So the mammogram is meant to diagnose or rule out cancer, um, but it can also give us, um, life-saving clues about a patient's cardiovascular risk.


Sandra Peebles (00:02:25 -> 00:02:31)

Dr. Johnson, let's get into why black women face the rates that they do of cardiovascular disease.


Dr. Heather Johnson (00:02:32 -> 00:03:20)

So heart disease or cardiovascular disease is the number one cause of death for both women and men, but across race and ethnicities. Unfortunately, black women or women of African descent tend to have higher rates of death related to heart disease. What's important is that there are certain risk factors such as high blood pressure that tend to increase risk of heart disease, and high blood pressure tends to be much more prevalent or much more common in the black community. Over 50% of black women have high blood pressure, additionally, higher rates of diabetes, higher rates of overweight or obesity within the community, also underlying genetic pathways that play a role. And so all of these risk factors come together and further increase the risk of heart disease and also death related to heart disease.


Sandra Peebles (00:03:21 -> 00:03:29)

Do you think that a lot of time women are not so aware that they have perhaps blood pressure, which we know is silent or some of these other risks?


Dr. Heather Johnson (00:03:29 -> 00:04:15)

That's an excellent point. And so what we talk about is the concept of understanding our risk or knowing your numbers. Many times we may not feel if our blood pressure is high, we may not feel if our blood sugar is high. And so when we talk about the importance of understanding what is our blood pressure, what is our cholesterol, what is our blood sugar, all of those things play a role in helping to reduce our risk and not just having them checked, but effectively treated and controlled to the correct numbers. Lifestyle is also important as Dr. McDonald said as far as having a healthy lifestyle. So movement, physical activity, avoiding nicotine, healthy sleep, all play a role as far as making sure we protect our heart.


Sandra Peebles (00:04:16 -> 00:04:39)

Um, Dr. McDonald, this is a very interesting question I'm about to ask you, and it's why is it that we see higher rates of death among black women that have breast cancer even though they're diagnosed less? I want that to sink in with people that are listening, because I had to think about it. You have a higher rate of death despite the fact that there's less being diagnosed. So can you explain that?


Dr. Kerry-Ann McDonald (00:04:40 -> 00:05:38)

Sure. Um, so black patients, um, do have about a 38% higher mortality than Caucasian patients. Um, and a major biological, um, factor that contributes to that disparity, um, is that black women are twice as likely to be diagnosed with triple negative breast cancer, which is a more aggressive phenotype of breast cancer. So it lacks the hormone targets and the HER two targets that modern therapies rely on. So beyond kind of the biological risk factors, there are also systemic healthcare barriers that contribute to that disparity. Um, recent studies have shown that black women, um, take a little bit longer to act on an abnormal mammogram, and obviously you can imagine that causes delays in diagnosis, um, you know, women presenting at more advanced stages, um, requiring more aggressive treatments and potentially worsening outcomes.


Sandra Peebles (00:05:39 -> 00:05:56)

So we were having a conversation before, and the good news in this a silver lining is that there is less, there are less cases, there's less of a risk for black women to develop breast cancer. Is that so correct? Can you explain that? Yeah, correct. Only because it's, uh, you know, it gives us hope.


Dr. Kerry-Ann McDonald (00:05:56 -> 00:05:57)

Yes. Um,


Sandra Peebles (00:05:57 -> 00:05:58)

It's good news in the midst of all


Dr. Kerry-Ann McDonald (00:05:59 -> 00:06:26)

Correct. I mean, we all need to be aware of it. We all need to make sure we're doing our screening appropriately. You know, at our center, um, less than 5% of our patients are minorities. Um, um, but when they do present, the disease is a little bit more aggressive. So we do see this kind of play out. Um, so, you know, we take a, a big stance on education and getting into the community and making sure people are aware of their risk.


Sandra Peebles (00:06:27 -> 00:06:46)

Um, Dr. Johnson, let's talk about the heart cancer overlap. Um, a breast cancer diagnosis can add to a cardiovascular risk. Black women already face, so a, a black, a woman has a higher, uh, risk of cardiovascular disease. Now she's diagnosed with breast cancer. What happens?


Dr. Heather Johnson (00:06:47 -> 00:07:36)

So when we talk about the connection between breast cancer and also heart health, we are excited that as far as the treatment and the survivorship of breast cancer has significantly improved over time. Unfortunately, heart disease tends to be the primary cause of death of many of our breast cancer survivors. And so we are focusing very closely on helping to understand as far as what someone's risk factors are for heart disease. As we talked about diabetes, blood pressure, cholesterol monitoring closely, making sure that women understand that protecting their heart and their overall whole body care is absolutely important as they continue through their journey and their survivorship, and making sure that we keep a close eye on heart health factors and overall risk factors.


Sandra Peebles (00:07:36 -> 00:07:48)

Uh, so Dr. McDonald, what can a mammogram reveal, uh, for a cancer patient that they might not, I imagine, in other words, what could it tell us about our heart health? What could it potentially reveal?


Dr. Kerry-Ann McDonald (00:07:49 -> 00:08:35)

Yeah, so beyond, um, breast cancer, a mammogram can reveal, can reveal breast arterial calcifications, and, um, those are calcium deposits that we see in the arteries of the breast. And it's usually an incidental finding. Um, so it is not cancer, it's, uh, not, um, the calcifications that a radiologist would look at to diagnose in early breast cancer, um, but rather can be a clue that this is a patient that may be at cardiovascular risk. So at the Baptist Health Lynn Women's Institute, our radiologists do report the presence of breast arterial calcifications on the mammogram. And as a breast surgeon, I will make sure that this patient has a connection to a cardiologist who can then further, um, you know, evaluate that finding


Sandra Peebles (00:08:35 -> 00:08:41)

If they find BAC, can we infer that there may be calcification in other artery arteries.


Dr. Kerry-Ann McDonald (00:08:42 -> 00:08:52)

You can make that inference. And the cardiologist, um, will definitely do some, you know, interrogative testing to, um, to check on those things.


Sandra Peebles (00:08:53 -> 00:08:59)

So as a cardiologist, let me ask you, what does that BAC that, uh, calcification reveal about the heart health?


Dr. Heather Johnson (00:09:00 -> 00:10:01)

So in general, when we talk about breast artery calcification or BAC, we're really trying to determine what are some contributors that are affecting the vascular health or the artery health of that particular individual. And so what we understand is that the research continues to grow, showing that yes, there is a risk regarding relationship of heart artery disease, so coronary artery disease. So we see it in the breast, but of course we want to make sure that we evaluate the heart. We also know that breast artery calcification in general with recent research has been associated with higher risk of heart events down the road. And the goal is not to cause scare or worry, but to make sure that women are evaluated and monitored and having their heart evaluated at a appropriate interval of time. We also understand that this is a great time for women, not just have their screening mammogram, but many times we may forget about checking everything else. And so making sure that they're plugged in for routine physicals, also for other evaluation that may be needed for the heart.


Sandra Peebles (00:10:01 -> 00:10:23)

And, you know, sometimes it's scary. Of course, you go in for a mammogram, you don't really know what to expect. Um, where does it come in? Where, in other words, where is this te where, where does this team begin to be built? The cardiologist and the cardiology team with the oncology team? Uh, does the woman say, I'd like to see, uh, uh, a cardiologist as well, or where does, where does this begin the synergy begin? So


Dr. Heather Johnson (00:10:23 -> 00:11:02)

What's nice about the Christine L Women's Health and Wellness Institute is that we work together as a team. So if Dr. McDonald sees breast artery rec calcification, she refers to cardiology and any of our referring physicians who may work with the institute. And they also understand that we are available to be able to help women evaluate and have a preventive cardiovascular assessment. The other thing too is that we also make sure that other specialists that may be needed regarding whole body health and whole body care is also important. So we refer and women themselves, yes, we encourage them to be advocates for their health, and if they say yes, they would like to see a particular specialist, we're also happy to help coordinate.


Sandra Peebles (00:11:02 -> 00:11:18)

So important that we take our power and speak up, uh, about our health. Yes. Um, in, in all instances. So let's talk about the risk of treatment and, and how that cancer treatment can affect the heart down the line, not only during treatment, but also down the line.


Dr. Kerry-Ann McDonald (00:11:19 -> 00:12:53)

So sub breast cancer treatment, um, can have cardiovascular side effects. Um, so many of our patients undergo a lumpectomy and will require radiation following that surgery to lower the risk of cancer coming back in the breast. Um, our radiation oncologists are very good at planning the radiation, so it does not affect the heart, especially if the cancer is on the left side. Patients will often worry about, will radiation get to my heart? And so the radiation oncologists have ways to make sure that doesn't happen. Special techniques, um, to push the heart out of, of the radiation field. And we also have our newly developed proton center, um, that also helps to, uh, lower dose to the heart. Some patients, um, with breast cancer will also require chemotherapy. So chemotherapy such as anthracyclins and her two targeted therapies, um, can cause cardiomyopathy. And so we try to get our cardiologists involved early to help mitigate some of those effects. Um, our medical oncologists will also do an investi, you know, an investigation of the patient's cardiac health, uh, before they start chemotherapy. Um, so we're actively monitoring cardiac health during cancer treatment, but we also need to monitor it while patients are on maintenance therapies. So many breast cancer patients are on hormone therapies commonly referred to as tamoxifen or anastrozole. Um, and these medications can cause changes in lipids as well as hypertension. And so, you know, we're constantly thinking about cancer care and heart health at the same time.


Sandra Peebles (00:12:54 -> 00:13:03)

Um, Dr. Johnson speak to us about the increased risk of blood clots during treatment for cancer, for breast cancer. When


Dr. Heather Johnson (00:13:03 -> 00:14:23)

We talk about blood clots during a cancer diagnosis, cancer treatment, we're talking about clots within the veins, and it's another form of what we call vascular health. But clots can form in the veins either because of multiple reasons such as the cancer cells or the tumor cells can release certain chemicals that increase clots in the veins. So our community may be aware of what's called DVT or a blood clot in the leg, or a blood clot in the lung called pulmonary embolism. Other times the inflammation associated with the cancer itself can trigger it. We know that individuals can have less activity, be less physically active, um, during time of cancer treatment. It can also precipitate blood clots and other factors that can play a role in this. What we talk about though is listening to your body. And so important symptoms related to clots, be it sudden shortness of breath racing, heartbeats, lightheadedness, passing out, feeling suddenly dizzy, pain in your arm, in your leg, especially if it's one-sided, sudden swelling, maybe sudden redness or color changes. Pay attention to those changes. Yes, please be seen in an emergent setting. So appropriate testing can be done to quickly be able to assess for a blood clot because time is important


Sandra Peebles (00:14:24 -> 00:14:36)

Now. Exactly. Time is important. So why should we not ignore something that we might say, oh, I do have this pain, it came back, but you know, I'm not gonna be a fuss. I'm not gonna be a problem. I'm not gonna go to the doctor. 'cause I, you know, I'm overreacting.


Dr. Heather Johnson (00:14:37 -> 00:15:00)

It's a great question because those blood clots that are in our vein can be a medical emergency. And not only do we talk about as far as damage to the lungs, but unfortunately they can also travel through and affect the heart. And when we talk about very unfortunate outcomes, we wanna make sure that people are checked quickly and appropriately treated. And it's okay if it ends up not being a clot at the end, but please get checked out.


Sandra Peebles (00:15:01 -> 00:15:11)

Absolutely. Better to be safe than sorry. That's so cliche. It's so true. Uh, I think I asked Dr. Johnson, but I wanna ask you Dr. McDonald, at what point, um, do does the cardiologist join the oncology team?


Dr. Kerry-Ann McDonald (00:15:12 -> 00:15:49)

So a cardiologist will join the team, um, for patients with, uh, pre-existing cardiac disease, um, cardiovascular risk factors, or when we know that our breast cancer treatments, um, could have, you know, effects on the heart. And so we wanna get the cardiologist involved early on. Um, and so we have very good collaboration between the oncology specialist and the cardiologist in this kind of field we call cardio-oncology. So if a program does not have, um, a cardio-oncology program, that's not a problem. You know, the oncology specialist can refer to a cardiologist who can provide the same kind of coordinated approach.


Sandra Peebles (00:15:50 -> 00:16:02)

What can women expect Dr. Johnson? Um, as far as when it comes to protecting their heart, not only before, uh, their surgery, but during treatment and perhaps even afterwards.


Dr. Heather Johnson (00:16:03 -> 00:16:52)

So during treatment, there are certain imaging that may be done such as an ultrasound of the heart or what's called an echocardiogram yet. And that's when we take pictures to see how well the heart is squeezing. As Dr. McDonald referred to, there could be weakening of the heart muscle or a cardiomyopathy that can occur. We also pay attention to the electrical system, so an EKG or an ECG. And those are the stickers that go on our chest to be able to see also electrically are there changes. We pay attention to your symptoms as there's certain shortness of breath, swelling, other factors that can play a role, but then also monitoring blood pressure, cholesterol, and other risk factors associated with heart disease. This continues, the frequency may change as far as during treatment or after treatment, but it is long-term monitoring that takes place because making sure that we look at both short-term and long-term related heart conditions.


Sandra Peebles (00:16:53 -> 00:17:12)

And, uh, Dr. McDonald, what should women know about breast cancer screening? Mm-hmm <affirmative>. And when to start, because I know, and I remember when there was that controversy that, um, that it, it came out that you should do it every two years. Yeah. And then people were up in arms. So if you could please clear this up for us, <laugh>. Sure.


Dr. Kerry-Ann McDonald (00:17:12 -> 00:19:02)

So breast cancer screening should be two things. I think it should be proactive and it should also be very personalized. So at the age of 25, I think women should start thinking about getting a formal risk assessment. And in that risk assessment, we look at a lot of variety of frac factors, um, such as family history, genetic testing, previous breast biopsies, starting menopause. When did you have your menarchy, all of these things to calculate a risk that will put a patient into a risk category being either average risk or high risk. So average risk woman should be screened with a mammogram starting at the age of 40. And interestingly, the US presented, uh, preventative task force, um, in 2024, used to say, have a mammogram starting at the age of 50, but they dropped it to the age of 40. So, um, so that's the standard for average risk risk woman. Um, we add ultrasound based on breast density, um, for high risk women, we add MRI screening, so they're screened in a little bit more of an enhanced way, and we alternate that every six months. So I think it's important for patients to kind of stick to their screening schedule, um, because early detection does save lives and we see it every day. Um, and, um, to be kind of like involved in that. The other thing I would say about screening is like the, the act of being proactive is so important for young people to really be on top of their breast health because the trend across the United States right now is that we're seeing a lot more premenopausal breast cancer. So breast cancer does not discriminate based on age. Um, and so the earlier you can think about your breast health, you know, the better, hopefully the better position you'll be in in the long run. You spoke


Sandra Peebles (00:19:02 -> 00:19:10)

About risk assessment as early as 25. Yes. That sounds really young. Is that particularly true in the black community? That is for black women?


Dr. Kerry-Ann McDonald (00:19:10 -> 00:19:20)

Um, that is particularly true. Um, black women are diagnosed at younger ages with more advanced disease. So, um, the earlier the better. The


Sandra Peebles (00:19:20 -> 00:19:36)

Earlier the better. The more we know about our health, the better we have more control, more power. Um, Dr. Johnson, what should we know about long-term monitoring after we go through uh, treatment? What should women do to monitor their heart health long-term? So


Dr. Heather Johnson (00:19:36 -> 00:20:51)

Long-term monitoring, we focus on healthy lifestyle, which is absolutely important. Many times people don't realize as much as we ask about blood pressure and cholesterol. We ask about your physical activity and other healthy lifestyle components. But then also imaging that can sometimes be done, including repeating a heart ultrasound, EKG. Some women have other imaging related to their heart arteries, such as CAT scans that can be done to look at our heart arteries. But then also making sure that women know their numbers for those very important risk factors. We know that high blood pressure over time increases risk of heart failure. High cholesterol also increases risk as far as heart attacks and strokes. We also continue to assess other risk factors such as family history. And what's unique in women and is not asked a lot is prior pregnancy history, particularly what we call adverse pregnancy outcomes. So prior history of high blood pressure during pregnancy such as preeclampsia, diabetes during pregnancy, gestational diabetes can also increase our risk in the long term related to heart disease. So all more as far as we really have to make sure that we ask these additional questions and also proactively treat high blood pressure, high cholesterol, diabetes, and support a healthy lifestyle.


Sandra Peebles (00:20:51 -> 00:21:21)

I wanna come back to that healthy lifestyle point and, and staying active because no matter what the topic is, it always comes back to that somehow getting the blood moving, getting the blood going. And sometimes people think, oh, I can, you know, start a workout routine. It's overwhelming. But what can you share about the importance of say, walking or getting up every few minutes, you know, if we, if we have a job or we're at a desk, the importance of making sure that you're aware of maybe setting an alarm and getting up because just that bit of movement can count towards our activity.


Dr. Heather Johnson (00:21:22 -> 00:22:01)

You're correct. A little bit goes a long way. It all counts. Many time. If I ask about physical activity or exercise, someone may share. They may not have time to go to the gym and I say, we don't have to go to the gym. You are correct. We can walk around as far as our place of employment. If we work at home, we can walk around home. Are there set of stairs you can take? I also say, guess what? You can dance anywhere. So take a few minutes and dance. That sounds exactly, it goes a long way. <laugh>, <laugh>. So little bits. And so you may have five minutes, 10 minutes, that adds up. So in general, if we're able to a minimum of 150 minutes per week of aerobic activity, but it all adds up pretty quickly.


Sandra Peebles (00:22:02 -> 00:22:23)

And that's the thing. And the reason why I bring this up is 'cause I don't want people to feel overwhelmed like, oh, I have to undertake this, you know? Mm-hmm <affirmative>. Difficult workout. No, it's really just walking around the block. There you go. Possibly. Um, any last thoughts that you would like to share with our viewers on, on this topic? Dr. McDonald? What would you like them to walk away knowing and definitely take away as a pearl of wisdom?


Dr. Kerry-Ann McDonald (00:22:25 -> 00:22:40)

I would say that, um, you know, thinking early about your breast health, um, knowing that your oncology team will certainly keep your heart health in the center of that, um, to give you the best oncologic outcome as well as cardiac outcome.


Sandra Peebles (00:22:41 -> 00:22:41)

Dr. Johnson,


Dr. Heather Johnson (00:22:42 -> 00:22:47)

As we just talked about, lifestyle is important for your heart health and breast health.


Sandra Peebles (00:22:48 -> 00:23:20)

Absolutely. Yes. Thank you ladies so much. Honestly, you're a, a treasure for our community. Thank you so much, uh, for this conversation and for empowering us all, uh, to live a better life. Thank you so much. Thank you for sharing everything and all these insights with our viewers. And remember viewers, make sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts. So tune in anytime, anywhere. Thanks for watching.


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