Priorities in the Cardiovascular Care of Breast Cancer Survivors

Bonnie Ky

Disclosures

J Oncol Pract. 2018;14(4):205-211. 

In This Article

Abstract and Introduction

Abstract

Breast cancer is the most common malignancy in women with more than 3 million breast cancer survivors in the United States alone. Survivors of breast cancer suffer from an increased burden of cardiovascular risk factors and disease. The focus of this review is to describe the epidemiology of cardiovascular disease in breast cancer survivors, including the cardiovascular concerns observed with common cancer therapies. Strategies to improve upon the early detection and treatment of cardiovascular disease, including clinical prediction algorithms, biomarkers, and imaging measures are also reviewed, and the use of cardioprotective therapies to mitigate risk are summarized. Finally, the need for evidence-based research to inform and improve upon the multidisciplinary care of this growing population is highlighted.

Introduction

Breast cancer is the most common malignancy in women. Fortunately, secondary to both early detection and advances in treatment, survival rates are high, on the order of 89%.[1] Thus, it is estimated that there are more than 3 million breast cancer survivors in the United States alone.

Survivors of breast cancer suffer from an increased burden of cardiovascular risk factors and disease. The development of cardiovascular risk factors and disease in survivors may be a result of cancer treatment exposures as well as an inherent susceptibility to disease (Figure 1). Anthracycline chemotherapy, human epidermal growth factor receptor 2 (HER2)–targeted therapy, radiation therapy (RT), and hormonal therapy are all associated with an increased burden of cardiovascular risk factors (obesity, hypertension, metabolic syndrome, dyslipidemia) and cardiovascular disease (heart failure, cardiomyopathy, valvular disease, myocardial infarction, and coronary disease). Moreover, cardiovascular disease and cancer share a number of biologic and clinical risk factors, including increased inflammation and oxidative stress, advanced age, increased body mass index, and tobacco use.

Figure 1.

This schema delineates the potential interaction between cardiotoxic breast cancer therapies and a potential inherent susceptibility to cardiovascular disease and cancer that result in an increased incidence of cardiovascular risk factors and disease in breast cancer survivors.

Cardiovascular concerns are thus of increasing importance to breast cancer survivors. The following are common questions that are relevant to the everyday care of this growing population of patients: What breast cancer therapies are potentially cardiotoxic and how does cardiotoxicity manifest? How can we improve upon the early detection and treatment of cardiovascular disease and what is the role of clinical risk factors or prediction algorithms, biomarkers, and imaging measures? How can we prevent the development of cardiovascular risk factors and disease? The focus of this review is to provide insight into the current state of evidence as it relates to the cardiotoxic risk of various therapies, strategies for diagnosing and predicting the development of incident cardiovascular disease, and the role of cardioprotective strategies in this population.

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