Breast cancer survival continues to rise, with 4.3 million U.S. women living with a history of the disease and projections predicting another million more in the next decade. As survival grows, heart health has become a central concern for survivorship care. Some cancer treatments can strain the heart, prompting questions about who truly needs closer monitoring.
A new editorial in JAMA Oncology, led by UCLA Health Jonsson Comprehensive Cancer Center researchers Patricia Ganz, MD, and Eric Yang, MD, argues that the answer is nuanced.
The authors note that current cardio-oncology guidelines call for cardiac imaging during and soon after systemic therapies for breast cancer and other cancers, but long-term surveillance strategies are not well studied, and evidence-based guidelines remain sparse. Biomarker tests, such as B-type natriuretic peptide, show promise, but their role in cancer survivorship remains uncertain.
Understanding treatment-heart links
Anthracycline chemotherapy and HER2-targeted drugs like Herceptin (trastuzumab) can stress the heart in some patients. Doctors have long monitored patients during treatment to catch early heart dysfunction. Yet, questions linger about how long survivors should be watched after therapy ends and whether all survivors need cardiology care.
The editorial reviews a study that introduced a risk calculator to identify which breast cancer survivors face the highest risk of heart failure or cardiomyopathy in the decade after treatment. Using real-world data from more than 26,000 patients within a Southern California integrated health system, researchers found that while certain therapies elevate risk, most women do not develop serious cardiac disease. The strongest predictors were linked to overall health rather than the chemotherapy itself.
Most study participants aged 65 and older faced a high cardiovascular risk regardless of cancer therapy. Hypertension, diabetes, obesity, smoking, and a prior history of heart disease contributed more to long-term heart outlook than chemotherapy regimens. The study also suggested that younger women, particularly those under 40 at diagnosis, were rarely found in high-risk groups, indicating that routine long-term cardiac imaging for all survivors may not be necessary.
Who should see a cardiologist?
“It depends,” Ganz and Yang said. Women who might benefit from cardiology input include those who received higher-risk chemotherapy, developed heart issues during treatment, are older or have multiple cardiovascular risk factors, or report symptoms such as shortness of breath, fatigue, or swelling.
Rather than blanket heart screening for every survivor, the editorial emphasizes essential steps: controlling blood pressure, managing cholesterol, maintaining a healthy weight, and recognizing early heart disease signs. For most survivors, regular visits with a primary care clinician, with input from an oncologist, may suffice.
Access to preventive care matters, the authors concluded. With a focus on cardiac prevention and risk factor management, heart failure and cardiomyopathy become less likely for many survivors.
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