Cardiotoxicity in Breast Cancer Treatment

Breast cancer is the most frequently diagnosed malignancy in women worldwide. Therapeutic advances have significantly improved cancer outcomes resulting in a growing cohort of breast cancer survivors. However, these improved treatments are counterbalanced by not only an increased risk of on-treatment cardiotoxicity (cancer therapy-related cardiovascular toxicity, CTR-CVT), but also by an increased risk of long-term toxicity as well as a predisposition for premature cardiovascular disease (CVD). Appropriate surveillance is recommended in all patients undergoing potentially cardiotoxic treatments, especially anthracyclines and HER2-targeted therapies. Cardio-oncological care should start at the initiation of cancer treatment by means of a comprehensive baseline cardiovascular (CV) assessment in order to estimate the risk of CTR-CVT. Further toxicity surveillance should take place in parallel to the cancer treatment, using pre-defined surveillance protocols and toxicity definitions, in order to allow for timely detection and treatment of new-onset toxicity. Upon completing breast cancer treatment, an end-of-treatment reassessment is recommended, followed by structured, albeit less intensive, long-term CV follow-up.