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Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer

Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer

Title: Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer
Author: Broberg, Agneta Månsson
Geisler, Jürgen
Tuohinen, Suvi
Skytta, Tanja
Hrafnkelsdóttir, Þórdís Jóna   orcid.org/0000-0002-4398-2898
Nielsen, Kirsten Melgaard
Hedayati, Elham
Omland, Torbjørn
Offersen, Birgitte V.
Lyon, Alexander R.
... 1 more authors Show all authors
Date: 2020-09-26
Language: English
Scope: 397-408
University/Institute: Háskóli Íslands
University of Iceland
School: Heilbrigðisvísindasvið (HÍ)
School of Health Sciences (UI)
Department: Læknadeild (HÍ)
Faculty of Medicine (UI)
Series: Current Heart Failure Reports;17(6)
ISSN: 1546-9530
1546-9549 (eISSN)
DOI: 10.1007/s11897-020-00486-8
Subject: Anthracyclines; Breast cancer; Cardiotoxicity; Heart failure; Radiation therapy; Trastuzumab; Brjóstakrabbamein; Geislameðferð; Hjartasjúkdómar
URI: https://hdl.handle.net/20.500.11815/2315

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Broberg, A.M., Geisler, J., Tuohinen, S. et al. Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer. Current Heart Failure Reports 17, 397–408 (2020). https://doi.org/10.1007/s11897-020-00486-8


Purpose of Review: Long-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment. Recent Findings: Baseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin antagonists. Early detection of cardiotoxicity with cardiac imaging and circulating cardiovascular biomarkers is currently evaluated in clinical trials. Chest wall irradiation accelerates atherosclerotic processes and induces fibrosis. Immune checkpoint inhibitors require consideration for surveillance due to a small risk of severe myocarditis. Cyclin-dependent kinases4/6 inhibitors, cyclophosphamide, taxanes, tyrosine kinase inhibitors, and endocrine therapy have a lower-risk profile for cardiotoxicity. Summary: Preventive and management strategies to counteract cancer treatment–related left ventricular dysfunction or heart failure in breast cancer patients should include a comprehensive cardiovascular risk assessment and individual clinical evaluation. This should include both patient and treatment-related factors. Further clinical trials especially on early detection, cardioprevention, and management are urgently needed.


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