Breast Cancer Survivorship and Cardiovascular Disease: Emerging Approaches in Cardio-Oncology

Abstract

Cardiovascular disease (CVD) and breast cancer cause substantial morbidity and mortality in women and are major public health concerns in the USA. While aggressive screening and targeted, advanced treatment for breast cancer have had a measurable impact on breast cancer survival, treatment is not without significant cardiotoxic effects. Anthracycline-based chemotherapy can lead to left ventricular dysfunction and failure, as well as a decline in exercise tolerance and cardio-pulmonary reserve despite preserved ejection fraction. Trastuzumab, a newer monoclonal antibody targeting the Her2 receptor used in the treatment of Her2+ cancer, is also linked to left ventricular dysfunction, although the long-term cardiac effects are presently unclear. Radiation treatment particularly for left-sided breast cancer has been associated with increased rates of ischemic heart disease. As women have increasing survival and cure rates from early breast cancer, long-term consequences on the heart that are secondary to therapy are a major concern. These need to be identified, treated, and avoided when possible. Further research and clear surveillance guidelines are needed to aid the practicing clinician in CVD prevention in breast cancer survivors.

Keywords: Breast cancer; Cardio-oncology; Cardiotoxicity; Heart failure.

Fig. 1.

Algorithm for the management of cardiotoxicity in patients receiving anthracyclines. Adapted with permission from Curigliano G. et al. [31••]. ECHO echocardiogram, CTh chemotherapy, TnI troponin I, LVD left ventricular dysfunction.