Cape Cod Resident Now "Doing Better than Ever" After Surviving Breast Cancer and Related Heart Issues

Kathleen Mingle, 66, received her first shock when she was told she had breast cancer. The second shock came when she learned that her chemotherapy therapy, albeit effective, was damaging her heart.

Mingle, a former English teacher in Boston and resident of Allston and Arlington, now lives in Harwich on Cape Cod. Her journey began in 2006 with her annual mammogram.

“I’ll never forget when I got the call,” she said. “My doctor told me I had breast cancer. It was so scary. I was running up to 20 miles a week and thought I was in perfect in health.”

Mingle had three lumpectomies at BIDMC to remove the mass on her right breast. Next, she underwent chemotherapy infusions at BIDMC’s Breast Care Center once every other week for a year. Then, under the coordination of BIDMC, Mingle had six weeks of radiation therapy at Cape Cod Hospital.

Cardio Concerns

Shortly thereafter came the next surprise, when Mingle learned that her chemotherapy had reduced her heart function and put her at risk for heart failure.

Mingle had been on Herceptin, a preferred chemotherapy treatment for HER2 breast cancer, a type of cancer that tests positive for a protein called Human Epidermal Growth Factor Receptor. According to a study published by the Journal of Clinical Oncology, 5%-10% of patients who receive Herceptin for at least one year will experience some sort of heart problem.

James D. Chang, MD, director of the recently formed Cardio-Oncology Program at BIDMC’s CardioVascular Institute, says that cardiotoxicity resulting from cancer treatment can, ironically, be more life-threatening than the cancer itself. Because of this, patients undergoing certain chemotherapy and radiation treatments need to be closely monitored.

“In Kathleen’s case,” says Dr. Chang, “we were particularly concerned based on the elevated risk presented by her type of breast cancer. While she originally didn’t present with any symptoms, we needed to keep monitoring her, and on a follow-up visit, we performed an echocardiogram and discovered that her left ventricle ejection fraction (LVEF) rate was dangerously low.”

According to Nurse Practitioner Monique Nestor, a key player on Mingle’s team, LVEF measures the percentage of blood leaving the heart each time it contracts. Anything 55% or more is considered normal. Before starting the Herceptin treatment, Mingle’s LVEF was 63%. During this particular echocardiogram, her LVEF was only 28%, showing a markedly reduced cardiac function.

Dr. Chang prescribed medication to raise Kathleen’s LVEF. She started taking Lisinopril and Metoprolol Succinate, a combination of medications that can help improve cardiac function, as documented in studies. In addition, since the Herceptin had proved to be effective in treating her cancer, which was in remission, Dr. Chang and his oncology colleagues decided stop the chemotherapy treatment.

Slowly, Mingle’s heart started to return to normal. Over the next two years, Dr. Chang and his team performed multiple echocardiograms to check her progress. In December 2009, her LVEF reached 55% and has been fine ever since.

“Our program fills a great need through the collaboration of specialists in cardiology, oncology and non-invasive imaging,” says Dr. Chang. “Kathleen’s case is a prime example. Without such collaboration, patients may trade one deadly disease (cancer) for another (heart failure).”

Better than Ever

Through all the changes in Mingle’s life, one constant has been her trust in BIDMC.

“The distance and traffic weren’t major considerations since I didn’t want to take chances,” she says. “My doctors at BIDMC have been fantastic. Dr. Chang is so smart and kind; you know he’s going to do the best for you. And I think of Monique as my friend. She’s so easy to talk to and makes me feel good every time I go in.”

Eight years after her initial diagnosis, Kathleen says, “I’m doing better than ever, even more active than I was before the cancer.” She enjoys golf, workouts, tennis, and spending time with her son and granddaughters.

To provide maximum protection for her heart function, she is still on a low dose of Lisinopril and Metoprolol Succinate and will be for the foreseeable future.

“I had no hesitation about following the treatment plan because I trust Dr. Chang. Anything he tells me to do, I’m going to do it,” she says.

For check-ups once a year, Kathleen now sees BIDMC’s Christina Herold, MD, for oncology and Dr. Chang for heart appointments

“I would never go anywhere else,” she says. “This hasn’t been easy to go through, but all the staff is so supportive. For my cancer and my heart, I feel I had the best care possible.”

About the CardioVascular Institute at Beth Israel Deaconess Medical Center

The Cardiovascular Institute at Beth Israel Deaconess Medical Center combines cardiology, cardiac surgery and vascular surgery in a structure designed to facilitate collaboration across disciplines. The CVI delivers outstanding outcomes, easy access, and better service, earning BIDMC recognition from U.S. News & World Report as one of the best 100 hospitals or a distinguished hospital in heart care and surgery since 2006. Community-based cardiologists and vascular surgeons at convenient offices in Massachusetts and New Hampshire provide a wide range of services and, when advanced care is needed, refer patients to Beth Israel Deaconess Medical Center in Boston. For more information, visit www.bidmc.harvard.edu/CVI.