Here’s a startling fact: surviving breast cancer might just be the beginning of a new health battle for many women—one that involves their hearts. With breast cancer survival rates soaring—over 4.3 million women in the U.S. are living with a history of the disease, and that number is expected to rise by another million in the next decade—heart health has emerged as a critical, yet often overlooked, aspect of survivorship care. But here’s where it gets controversial: while certain breast cancer treatments are lifesaving, they can also strain the heart, leaving survivors and healthcare providers grappling with a crucial question: Does every breast cancer survivor need to see a cardiologist?
A groundbreaking editorial published in JAMA Oncology, led by UCLA Health Jonsson Comprehensive Cancer Center experts Dr. Patricia Ganz and Dr. Eric Yang, challenges the one-size-fits-all approach to heart monitoring in survivors. Their findings? The answer is far more nuanced than you might think. Current guidelines recommend cardiac imaging during and immediately after systemic cancer therapies, but long-term surveillance remains uncharted territory, with evidence-based protocols still lacking. Biomarker tests, like B-type natriuretic peptide, show promise but haven’t yet proven their worth in this population.
Understanding the Heart-Cancer Connection
Treatments like anthracycline chemotherapy and HER2-targeted drugs such as Herceptin (trastuzumab) are known to stress the heart in some patients. For years, doctors have monitored patients during treatment to catch early signs of heart dysfunction. But this is the part most people miss: it’s unclear how long survivors should be monitored post-treatment, or whether all survivors truly benefit from cardiology referrals.
Dr. Ganz and Dr. Yang analyzed a study introducing a risk calculator designed to identify which breast cancer survivors are most likely to develop heart failure or cardiomyopathy in the decade following treatment. Using data from over 26,000 patients within a Southern California healthcare system, the tool revealed surprising insights. While treatments like anthracyclines and HER2-targeted drugs do increase risk, most women don’t go on to develop serious cardiac issues. Instead, the strongest predictors of heart disease had less to do with cancer treatment and more to do with overall health—```json
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