Personalizing cardiovascular disease prevention among breast cancer survivors

With the advancement of breast cancer therapies, most women diagnosed with breast cancer in the United States are now expected to survive their disease, and management of competing comorbidities, particularly cardiovascular disease (CVD), is crucial.

Recent studies have suggested that CVD is the most common cause of death for women diagnosed with ductal carcinoma in situ or stage I disease and for women aged more than 80 years with stage II disease. Various breast cancer therapies, including targeted therapies, can accentuate CVD risk; referrals for cardiology opinion are not uncommon at the time at which treatment options are under consideration. The use of less cardiotoxic alternatives, such as liposomal doxorubicin, and intensity-modulated radiation therapy should be considered when appropriate. Doppler myocardial imaging and cardiac MRI might allow early recognition of cardiotoxicity.

It is important to weigh both the risk of CVD and that of breast cancer recurrence in a breast cancer survivor. Certain interventions for the primary prevention of CVD, including diet, physical activity, smoking cessation and aspirin, can reduce breast cancer risk as well. The management of CVD risk factors is of increasing importance in the management of breast cancer survivors.