Abstract
Cardio-oncology is an emerging field tasked with identifying and treating cancer therapy related cardiac dysfunction (e.g., cytotoxic agents, immunotherapies, radiation, and hormone therapies) and optimizing the cardiovascular health of cancer patients exposed to these agents. Novel cancer therapies have led to significant improvements in clinical outcomes for breast cancer patients. In this article, we review the current literature on assessing cardiovascular risk of breast cancer therapies and discuss strategies (including pharmacological and lifestyle interventions) to prevent cardiovascular toxicity.
Highlights
Breast cancer is the most prevalent cancer diagnosis among women in the United States, with 1 in 8 women affected [1]
We focus on the CV toxicity associated with anthracycline-containing regimens including those incorporating HER2-targeted therapy, which are of particular interest given their association with increased risk of cardiotoxicity
Several position statements and guidelines have been published by the American Society of Clinical Oncologists (ASCO), the European Society for Medical Oncology (ESMO), the European Society of Cardiology (ESC), and the American Heart Association (AHA) that provide direction for identifying patients at risk of CV morbidity; beyond anthracyclines and trastuzumab, guidelines on other potentially cardiotoxic breast cancer therapies are often based on expert opinion due to the lack of high-quality evidence
Summary
Breast cancer is the most prevalent cancer diagnosis among women in the United States, with 1 in 8 women affected [1]. The use of anthracyclines has led to significant improvements in disease-free and overall survival, as have targeted agents such as trastuzumab, in patients with human epidermal growth factor receptor positive (HER2+) breast cancer [9,10]. These treatments are associated with an increased risk of heart failure, CV hospitalization, and morbidity [11,12,13]. Radiation therapy is associated with an increased risk of ischemic heart disease, for those individuals who are exposed to left-sided chest wall or breast radiation where the heart is in the radiation field [14]. Assessment of CV risk and the role of cardioprotective strategies prior to the initiation of cancer therapy are reviewed
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