Abstract
Thanks to increasingly effective treatment, breast cancer mortality rates have significantly declined over the past few decades. Following the increase in life expectancy of women diagnosed with breast cancer, it has been recognized that these women are at an elevated risk for cardiovascular disease due in part to the cardiotoxic side effects of treatment. This paper reviews evidence for the role of exercise in prevention of cardiovascular toxicity associated with chemotherapy used in breast cancer, and in modifying cardiovascular risk factors in breast cancer survivors. There is growing evidence indicating that the primary mechanism for this protective effect appears to be improved antioxidant capacity in the heart and vasculature and subsequent reduction of treatment-related oxidative stress in these structures. Further clinical research is needed to determine whether exercise is a feasible and effective nonpharmacological treatment to reduce cardiovascular morbidity and mortality in breast cancer survivors, to identify the cancer therapies for which it is effective, and to determine the optimal exercise dose. Safe and noninvasive measures that are sensitive to changes in cardiovascular function are required to answer these questions in patient populations. Cardiac strain, endothelial function, and cardiac biomarkers are suggested outcome measures for clinical research in this field.
Highlights
Breast cancer is the most common malignancy among women worldwide [1], and an estimated 1% of the population are survivors of breast cancer [2]
Advances in breast cancer therapy have contributed to dramatic improvements in survival, but many of these therapies, anthracycline chemotherapy, left-sided radiotherapy, and trastuzumab targeted therapy, are associated with cardiovascular toxicities [3]
Substantial preclinical evidence supports the role of exercise in prevention of cardiovascular disease toxicity, and there is some evidence for modification of cardiovascular risk factors in clinical trials
Summary
Breast cancer is the most common malignancy among women worldwide [1], and an estimated 1% of the population are survivors of breast cancer [2]. Breast cancer survivors are at increased risk of cardiovascular disease-related death compared to women without breast cancer [4], likely due in part to these toxicities. As breast cancer survival rates rise, cardiovascular disease becomes an increasingly important competing risk [7]. Combined, these factors contribute to the recent finding that cardiovascular disease has surpassed breast cancer as the leading cause of death in older women diagnosed with breast cancer [8]. The purpose of this paper is to (1) review the potential mechanisms mediating exercise prevention of cardiovascular toxicity; (2) review the available evidence for the role of exercise in prevention of cardiovascular disease in breast cancer survivors, including predominantly preclinical studies of the heart and clinical studies of cardiovascular risk factors; and (3) suggest outcome measures for translation of the preclinical findings to clinical studies
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