What question did this study set out to answer?

This study aims to investigate the relationship between oral health and cancer therapy-related cardiac dysfunction in patients undergoing HER2-targeted therapy.

January 10, 2026Cardio-Oncology0 citationsOpen Access

The ROOT-CTRCD study: exploring the relationship of oral health to cancer therapy-related cardiac dysfunction in HER2-positive breast cancer patients

Q: What does this research mean for the field?

Poor oral health is associated with a 3.54-fold higher risk of cancer therapy-related cardiac dysfunction in HER2-positive breast cancer patients (p < 0.001). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

ABAhmed BasuoniSultan Qaboos University Hospital KAKhalid Al-BaimaniSultan Qaboos University Hospital FAFatma Abdullah Salim ALKINDISultan Qaboos University Hospital

Key Result

Poor oral health was associated with a 3.54-fold higher risk of cancer therapy-related cardiac dysfunction in HER2-positive breast cancer patients (p < 0.001).

Key Points

This study aims to investigate the relationship between oral health and cancer therapy-related cardiac dysfunction in patients undergoing HER2-targeted therapy.
Conducted a retrospective study at a tertiary oncology center.
Screened adult women with HER2-positive breast cancer receiving specific treatment regimens.
Assessed oral health using DMFT index and periodontal staging before chemotherapy.
Included patients who developed CTRCD and matched controls for comparison.
In patients with CTRCD, 64.5% had poor oral health compared to 33.8% in controls (p < 0.001).
Poor oral health increased CTRCD risk (OR = 3.54; 95% CI: 1.76–7.14).
Patients with poor oral health experienced delayed recovery (8 weeks vs. 4 weeks, p = 0.011).
Poor oral health correlated with a threefold higher likelihood of significant LVEF decline (> 10%, p = 0.0023).

Structured PICO

Does poor oral health increase the incidence of cancer therapy-related cardiac dysfunction in adult women receiving HER2-targeted therapy for breast cancer?

Population

127 adult women with early-stage or locally advanced HER2-positive breast cancer who received anthracycline-trastuzumab or anthracycline-free trastuzumab regimens (62 with cancer therapy-related cardiac dysfunction [CTRCD] and 65 matched controls). Mean age ~49. Excluded: prior chemotherapy, diabetes mellitus, hypertension, dyslipidemia, smoking, chronic kidney disease, ischemic heart disease, heart failure, and risk factors for periodontitis.

Intervention

Poor oral health (defined as DMFT score > 13 and/or evidence of periodontitis based on radiographic and clinical findings)

Comparator

Good oral health (defined as DMFT score ≤ 13 and no radiographic or clinical signs of periodontitis)

Outcome

Incidence and severity of cancer therapy-related cardiac dysfunction (CTRCD)composite

Poor oral health is a significant, potentially modifiable risk factor associated with a more than three-fold increased risk of developing cancer therapy-related cardiac dysfunction in patients receiving HER2-targeted therapy.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Cancer therapy-related cardiac dysfunction (CTRCD) is a significant complication of cancer therapy. While several factors contribute to its development, the role of oral health remains unexplored. This study examines the relationship between oral health, a potential modifiable risk factor, and the development of CTRCD in patients undergoing HER2-targeted therapy. A retrospective study was conducted at a tertiary oncology center (SQCCCRC) with integrated cardio-oncology and specialized dental services. Adult women with early-stage or locally advanced HER2-positive breast cancer who received anthracycline-trastuzumab or anthracycline-free trastuzumab regimens between 2022 and 2025 were screened. Among 604 patients treated with trastuzumab, 307 completed all planned cycles and had at least one year of follow-up. After excluding patients with prior chemotherapy, major cardiovascular comorbidities, smoking, chronic kidney disease, ischemic heart disease, heart failure, dyslipidemia, and established risk factors for periodontitis, 62 patients who developed cancer therapy–related cardiac dysfunction (CTRCD) and 65 matched controls were included in the final analysis. Oral health was assessed using the DMFT index and periodontal staging/grading based on baseline dental evaluations performed before initiation of chemotherapy containing trastuzumab. Patients were then categorized into good or poor oral health groups. CTRCD was diagnosed and classified using echocardiographic findings, with recovery time documented. The primary outcome was CTRCD incidence; secondary outcomes included recovery time and significant changes in left ventricular ejection fraction (LVEF). Among patients with CTRCD, 64.5% had poor oral health, compared to 33.8% in the control group ( p 10%) ( p = 0.0023). Associations with cardiac biomarkers (BNP and troponin) trended toward significance. Poor oral health is significantly associated with increased risk and delayed recovery of CTRCD in patients receiving HER2-targeted therapy. These findings highlight oral health as a modifiable risk factor that may impact cardiac and oncologic outcomes. Future randomized controlled trials are needed to investigate further the potential benefits of dental interventions in preventing CTRCD.

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