Cardiovascular Considerations in Breast Cancer Treatment and Survivorship

In this episode, CancerNetwork® spoke with Joseph S. Wallins, MD, MPH, cardiology fellow at Weill Cornell Medicine, about a review of cardiotoxicities associated with breast cancer treatment he coauthored in the June 2025 issue of ONCOLOGY® titled, “Cardio-Oncology Considerations for Breast Cancer: Risk Stratification, Monitoring, and Treatment.” Therein, he touched upon data for risk stratification tools for oncologists, as well as the development of cardiovascular testing for individual treatment regimens.

Wallins discussed the basis for conducting the systemic review as well as noteworthy cardiotoxicities associated with specific classes of breast cancer therapies. Specifically, he highlighted an increase in cancer remission and survivorship for breast cancer, which has, in turn, created alternative health risks impacting survival outcomes, such as cardiovascular risks. Citing a study showing a nearly 2-fold risk in cardiovascular-related fatalities for breast cancer survivors vs the general population, he suggested that the review was warranted to identify cardiotoxicities, strategies for preventing and managing them, and tools for risk stratification and monitoring.

Wallins further outlined considerations for optimizing risk stratification and monitoring strategies in patients at risk of experiencing cardiovascular toxicities as well as treatments that may help with their prevention or mitigation. To that end, he discussed identifying patients who are at a higher risk before initiating treatment and outlined risk assessment tools that serve to do so. Furthermore, he suggested that patients who experience a greater than moderate risk for cardiovascular issues should undergo cardioprotective strategies and have in-depth conversations with providers regarding treatment risks.

He concluded by highlighting future steps to enhance cardiovascular outcomes for patients with breast cancer, among additional key takeaways. Of note, Wallins expressed that genetic testing may help elucidate cardiomyopathy-associated genes while calling for a more personalized approach to risk stratification and more sensitive and specific imaging techniques to better identify at-risk patients. Finally, he emphasized a need for upfront risk assessment to identify patients at a higher risk who could benefit from additional testing as well as more pronounced collaboration between oncologists and cardiologists.

Reference

Bradshaw PT, Stevens J, Khankari N, Teitelbaum SL, Neugut AI, Gammon MD. Cardiovascular disease mortality among breast cancer survivors. Epidemiology. 2016;27(1):6-13. doi:10.1097/EDE.0000000000000394