Prevention and Treatment of Cardiac Dysfunction in Breast Cancer Survivors

As recurrence free survival following a breast cancer diagnosis continues to improve, cardiovascular morbidity and mortality will assume greater importance in the breast cancer survivorship research agenda particularly for women receiving potentially cardiotoxic therapy. Development of (1) tools to readily identify pre-diagnostic risk factors for cardiac dysfunction, (2) well-tolerated prophylactic treatments to reduce the risk of cardiac injury, and (3) sensitive and affordable monitoring techniques which can identify subclinical toxicity prior to a drop in left ventricular ejection fraction are or should be focus areas of cardio-oncology research. Since weight as well as cardiorespiratory fitness generally decline after a breast cancer diagnosis, behavioral approaches which can improve energy balance and fitness are important to optimize cardiovascular health in all breast cancer survivors not just those undergoing cardiotoxic therapy. These goals are likely best achieved by partnerships between cardiologists, oncologists and internists such as those initiated with the formation of the International CardiOncology Society (ICOS) and the NCI Community Cardiotoxicity Task Force.