Pictures of health
Imaging expert helps to advance care and knowledge
Cardio-Oncology has only been studied closely since about 2005, says Dr. Jassal, Principal Investigator, Cardiovascular Imaging, Institute of Cardiovascular Sciences at St. Boniface Hospital. The field looks at the impacts of cancer treatment on the human heart.
“What we have noticed since 2006 is although these cancer drugs are good at killing the cancer cells, they’re bad for the heart,” he explains. “When we look at breast cancer patients, we have found that when women receive chemotherapy – this drug called Doxorubicin and then this other drug called Trastuzumab – there’s a one in four chance that these anti-cancer drugs may damage the heart.”
“Can we actually protect the heart by giving a magical pill? That’s our next step.”
Over the past decade, Dr. Jassal and his colleagues started to analyze the effects of chemotherapy on the heart. The first step was to understand when a woman’s heart symptoms were related to her cancer treatment.
The second question for Dr. Jassal and company was whether the negative effects on the heart could be detected earlier, and therefore treated earlier.
“In women who receive chemotherapy, we routinely measure the pumping function of the heart throughout treatment. Although both Doxorubicin and Trastuzumab may damage the heart after six months of treatment, maybe we can detect changes in the function of the heart three months earlier so that we don’t have to wait for the heart to fall apart,” says Dr. Jassal in describing the motivation behind his research. “We were the first in the world, not only in the lab, but also in women with breast cancer, to show that if you do an ultrasound of the heart, you can actually detect changes in the function of the heart as early as three months.”
Thanks to Dr. Jassal’s work on this in 2009–2010, regular heart ultrasounds are now part of Canadian guidelines for breast cancer treatment and the American Society of Clinical Oncology has also endorsed the practice. With early detection of heart problems caused by chemotherapy, the cancer specialists can consider different approaches.
“The next question then is how to prevent these cancer drugs from damaging the heart and making sure this doesn’t even happen in the first place,” says Dr. Jassal.
To that end, Dr. Jassal has teamed up with partners in Edmonton on a special study. “We have a total of 90 women so far. When the women get diagnosed with breast cancer, before we administer any chemotherapy, radiation, or surgery, we are actually giving the patient specific medication at time zero to protect the heart and we’re seeing what happens as we follow her for a year and a half,” he explains. “Can we actually protect the heart by giving a magical pill? That’s our next step.”
The work also led to the ASICS study, a major collaboration between St. Boniface Hospital Research and the Mayo Clinic. The Avastin and Sutent induced cardiotoxicity study is evaluating the impact of kidney and colon cancer medication on the heart. Again, the goals are early detection and, ultimately, prevention. The work is funded in part by St-Boniface Hospital Foundation.
The kidney and colon cancer work is fascinating and essential, but for Dr. Jassal, the heart is where the heart is. Some of his other work on cardiac imaging has led to key, universally accepted understanding about what happens to the hearts of marathon runners, pregnant women, and people with sleep apnea.
“The heart is the engine in your care that pumps blood to the rest of the body; what you want to see is whether the heart pumping or if is it failing and you want to take pictures,” he explains. “I’m the photographer of the heart. If we see that the heart is failing – if it can’t pump anymore – then it might need to be replaced. Then we become like contractors, renovating the heart. In cardiology, you could say that we’re renovators, we’re electricians, we’re plumbers, and we’re photographers.”
But they’re also caring women and men of medicine, and Dr. Jassal is still inspired by his direct work with patients. And he’s driven by bringing them comfort and helping them understand what’s happening to them. One of the keys, he says, is plain language.
Rather than describing something in “medical lingo,” he’d rather the physician say something like: “You had a heart attack, which means your heart is not pumping. Your pipes are blocked so I fixed them. I put in a stent. A stent is a metal fence that helps keep your blood flowing.”
Can you tell that this photographer is the son of a skilled mechanic?
“You use every-day language,” he says. “Patients will remember that.”