Early breast cancer therapy and cardiovascular injury.
Although recent advances in curative-intent therapies are beginning to produce significant survival gains in early breast cancer, these improvements may ultimately be attenuated by increased risk of long-term cardiovascular mortality. This paper reviews emerging evidence on the cardiovascular effects of breast cancer adjuvant therapy and proposes a new entity that we have labeled the "multiple-hit" hypothesis. The evidence that lifestyle modification, especially exercise therapy, may mitigate these adverse effects is also reviewed. These issues are of considerable practical importance for cardiovascular clinicians, as identification and intervention in those at high risk for cardiovascular complications may reduce a major cause of mortality in women with early breast cancer.
Jones
Lee W
LW
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. lee.w.jones@duke.edu
Haykowsky
Mark J
MJ
Swartz
Jonas J
JJ
Douglas
Pamela S
PS
Mackey
John R
JR
D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics / Q000532:radiotherapy / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015897:Comorbidity; D004359:Drug Therapy, Combination; D015444:Exercise; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D008019:Life Style; D009203:Myocardial Infarction / Q000139:chemically induced; D009389:Neovascularization, Pathologic / Q000517:prevention & control; D009765:Obesity / Q000453:epidemiology; D050177:Overweight; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases