With breast cancer survival rates steadily climbing—currently 4.3 million women in the U.S. have a history of the disease, projected to increase by another million within the next decade—heart health has become an increasingly critical component of survivor care.
While certain breast cancer therapies can be life-saving, they may also stress the heart, raising important questions about who might benefit from closer monitoring. However, according to a new JAMA Oncology editorial led by UCLA researchers, the answer is more nuanced than many assume.
Understanding the Cancer Therapy-Heart Connection
Some breast cancer treatments, including anthracycline chemotherapy and HER2-targeted drugs like Herceptin (trastuzumab), are known to stress the heart in certain patients. For years, physicians have monitored patients during treatment for early signs of cardiac dysfunction.
What remains unclear is how long survivors should be monitored after treatment ends and whether all survivors benefit from seeing a cardiologist. Current cardio-oncology guidelines recommend cardiac imaging during and immediately after systemic cancer treatment, but long-term monitoring strategies lack evidence-based guidance.
Risk Stratification Research Offers New Insights
In their editorial, Dr. Patricia Ganz and Dr. Eric Yang evaluated a study that introduced a novel tool to identify which breast cancer survivors face the highest chance of developing heart failure or cardiomyopathy within ten years post-treatment. Using real-world clinical data from over 26,000 breast cancer patients, the research team created a risk calculator.
Results showed that while certain breast cancer treatments increased risk, most women did not develop significant heart disease. Instead, the strongest predictors were related to overall health rather than cancer-specific factors.
Identifying Who Needs Specialist Care
The editorial suggests that women who may benefit from cardiology consultation include those who received high-risk chemotherapy, developed cardiac issues during treatment, are older, or have multiple cardiovascular risk factors.
Notably, cancer treatment alone rarely placed younger women into high-risk categories—few women under 40 had increased risk at diagnosis, suggesting routine long-term cardiac imaging may be unnecessary for all survivors. “We’re not saying every survivor needs to see a cardiologist,” emphasized Drs. Ganz and Yang.
Core Heart Health Management Strategies
Rather than comprehensive cardiac screening for every survivor, the editorial highlights the importance of fundamental preventive care: controlling blood pressure, managing cholesterol, maintaining a healthy weight, and recognizing early warning signs of heart disease.
For most survivors, regular visits with a primary care clinician—in consultation with their oncologist—are likely sufficient. “All breast cancer survivors need access to primary care focused on preventing or managing established cardiac risk factors, along with regular clinical functional assessments,” the authors wrote.
Implications for Clinical Practice
This approach supports a more targeted monitoring strategy, avoiding overtreatment of low-risk individuals while ensuring appropriate care for those at greater risk. By focusing on primary prevention and risk factor management, the likelihood of heart failure or cardiomyopathy can be significantly reduced.
The editorial provides an evidence-informed framework for optimizing long-term care in breast cancer survivors, potentially guiding more efficient allocation of healthcare resources while maintaining a patient-centered approach to survivorship care.
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