Cardiovascular Late Effects and Exercise Treatment in Breast Cancer: Current Evidence and Future Directions

Advances in detection and supportive care strategies have led to improvements in cancer-specific and overall survival after a diagnosis of early-stage breast cancer. These improvements, however, are associated with an increase in competing forms of morbidity and mortality, particularly cardiovascular disease (CVD). Indeed, in certain subpopulations of patients, CVD is the leading cause of mortality after early breast cancer, and these women also have an increased risk of CVD-specific morbidity, including an elevated incidence of coronary artery disease and heart failure compared with their sex- and age-matched counterparts. Exercise treatment is established as the cornerstone of primary and secondary prevention of CVD in multiple clinical populations. The potential benefits of exercise treatment to modulate CVD or CVD risk factors before, immediately after, or in the months/years after adjuvant therapy for early-stage breast cancer have received limited attention. We discuss the risk and extent of CVD in patients with breast cancer, review the pathogenesis of CVD, and highlight existing evidence from select clinical trials investigating the efficacy of structured exercise treatment across the CVD continuum in early breast cancer.