Abstract Treatment for premenopausal women with high- or intermediate-risk hormone receptor (HR)-positive breast cancer (BC) often includes concurrent ovarian function suppression (OFS) and aromatase inhibitors (AIs) to induce near-complete estrogen deprivation (NCED). The long-term cardiovascular (CV) consequences of NCED are unknown. In non-cancer populations, premature menopause is associated with increased CV morbidity. Given the cardiotoxicity of standard BC therapies and the extended life expectancy of these women, the CV impact of NCED warrants focused investigation. The CROWN study integrates advanced imaging to assess cardiac dysfunction alongside biomarker and demographic analyses, aiming to better understand the progression of CV injury and develop tools to assess and mitigate CV risk. CROWN is an NIH-funded, prospective cohort study conducted across three NCI-designated cancer centers: Duke University, Virginia Commonwealth University, and Wake Forest University. Eligible participants include premenopausal women aged ≤55 years with Stage I-III BC, ECOG performance status 0-2, who have completed chemotherapy, surgery, and radiation. Women with HR-positive BC receive OFS plus an AI; those with HR-negative BC are included as comparators. CV assessments occur at baseline, 1 year, and 2 years, and include cardiac magnetic resonance imaging (CMR), coronary computed tomography angiography (CCTA), and laboratory biomarkers, including exploratory biomarkers (Table). The primary objective is to assess the 24-month difference in myocardial blood flow, measured by adenosine stress CMR, between the NCED and HR-negative groups. Correlative analyses will evaluate the relationship between CMR results and CCTA-based coronary plaque characteristics. Additional analyses will explore the impact of pre-existing CV risk factors and dynamic treatment-related risk changes on CV outcomes. Primary statistical analyses will include both between-group (NCED vs. HR-negative) and within-group (longitudinal changes within the NCED group) comparisons. Secondary analyses will develop predictive models using clinical, demographic, and biomarker data to identify factors associated with CV changes. To date, we have enrolled 90 participants (73 NCED, 17 HR-negative), with a 13% attrition rate. Six patients have completed their Year 2 imaging and 23 have completed Year 1 imaging. Participant retention is essential for endpoint completion and statistical power. Retention strategies include IRB-approved newsletters and small study-branded items (magnets, sticky notes, pens) provided to participants, fostering a sense of community and engagement. Citation Format: S. Hatcher, R. B. D’Agostino, Jr., N. O’Connell, R. Bansal, C. Anders, S. Telloni, K. Westbrook, A. Natarajan, N. J. Pagidipati, D. Wendell, E. Douglas, K. Ansley, C. J. Park, K. M. Richardson, S. R. Sirkisoon, M. Hackney, H. Vachhani, M. Ross, L. N. Vélez-Torres, W. Bottinor, W. Hundley, A. Thomas, J. H. Jordan. The CROWN Study (CaRdiac Outcomes With Near-complete estrogen deprivation) abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-07-14.
Hatcher et al. (Tue,) studied this question.