Female Cardiovascular Health After Childhood Cancer

Female survivors of childhood cancer represent a growing population at increased risk for long-term cardiovascular and thrombotic complications related to prior cancer-directed therapies. This review summarizes the mechanisms, clinical manifestations, and sex-specific vascular considerations that influence cardiovascular health across the lifespan, with particular emphasis on reproductive and pregnancy-associated risk.

Exposure to anthracyclines, chest-directed radiation, and other cardiotoxic therapies during childhood are associated with increased lifetime risk of cardiomyopathy, heart failure, coronary artery disease, valvular disease, and metabolic syndrome. Female survivors can experience additional vascular risk modification related to reproductive physiology, including premature ovarian insufficiency, estrogen deficiency, and pregnancy-associated hemodynamic stress. Pregnancy among survivors with pre-existing cancer therapy-related cardiac dysfunction is associated with substantially increased risk of recurrent ventricular dysfunction and heart failure. Female childhood cancer survivors require lifelong cardiovascular surveillance that incorporates prior oncologic exposures, traditional cardiovascular risk factors, thrombotic history, and reproductive health considerations. Multidisciplinary survivorship models integrating cardio-oncology, cardio-obstetrics, oncology, hematology, and primary care are essential to optimize preconception counseling, pregnancy management, cardiovascular prevention, and long-term vascular outcomes.