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KEYWORDS • anthracyclines • breast cancer • cardiac toxicity • cardio-oncology • monitoring • trastuzumab The prognosis of breast cancer has improved over time due to earlier diagnoses as a result of screening programs and patient awareness and the increased use of more effective systemic therapies. Oncologists are more and more concerned with the long-term side effects of some anticancer treatments, which should be carefully evaluated. Aromatase inhibitors are associated with an increased risk of osteoporosis, tamoxifen is associated with uterine cancer and chemotherapy is associated with myelodysplasia and secondary leukemia. In addition, long-term cardiac toxicity is an important issue in breast cancer survivors [1]. Since many patients with early-stage breast cancer can be cured by surgery and radiotherapy alone or with the addition of systemic therapy without cardiotoxicity, it is important that the benefits associated with potential cardiotoxic regimens outweigh the risks of short-term and long-term toxicity. Left ventricular (LV) dysfunction has become a common cause of death in breast cancer survivors. Oncological and cardiac risk factors must be carefully evaluated when deciding on adjuvant treatment regimens for breast cancer. Cancer survivors & long-term cardiotoxicity It has long been known that chemotherapy and radiotherapy – either alone or in combination – exposes a patient to an increased risk of cardiac morbidity and mortality [2]. Anti-HER2 therapies such as trastuzumab are also associated with cardiotoxicity [3]. Anthracycline-related cardiotoxicity (car-diotoxicity type 1) is generally considered to be irreversible, cumulative and dose-dependent; type 2 cardiotoxicity related to trastuzumab is more reversible. Long-term follow-up of 51,246 patients suffering from T1a,bN0M0 breast cancer registered in the SEER Program from 1988 to 2001 revealed that more patients died from heart disease (n = 1727) than from breast cancer (n = 1340) [4]. This study also revealed that the risk of dying from other causes was five-times higher than the risk of dying from breast cancer 10 years after diagnosis. It is important to keep in mind that in the general population a woman " A careful cardiac and oncological risk factor evaluation should allow for more individualized treatment planning; it is important to better predict patients at risk for cardiotoxicity. " " The prognosis of breast cancer has improved over time due to earlier diagnoses as a result of screening programs and patient awareness and the increased use of more effective systemic therapies. " For reprint orders, please contact: reprints@futuremedicine.com

future oncology

The European Association of Cardiovascular Imaging/Heart Failure Association Cardiac Oncology Toxicity Registry: long-term benefits for breast cancer treatment