Here’s a startling fact: surviving breast cancer might just be the beginning of a new health battle for many women. With over 4.3 million breast cancer survivors in the U.S. and another million expected in the next decade, the focus is shifting to a critical yet often overlooked issue: heart health. But here’s where it gets controversial—do all these survivors really need to see a cardiologist? Let’s dive in.
Breast cancer treatments, while life-saving, can sometimes put a strain on the heart. Therapies like anthracycline chemotherapy and HER2-targeted drugs such as Herceptin (trastuzumab) are known to increase cardiac stress in certain patients. For years, doctors have monitored patients during treatment to catch early signs of heart dysfunction. But the big question remains: how long should this monitoring continue after treatment ends, and is it necessary for everyone?
In a thought-provoking editorial published in JAMA Oncology, UCLA Health Jonsson Comprehensive Cancer Center experts Patricia Ganz, MD, and Eric Yang, MD, argue that the answer isn’t as straightforward as a simple yes or no. They point out that while current cardio-oncology guidelines recommend cardiac imaging during and immediately after systemic cancer therapies, there’s a lack of evidence-based guidelines for long-term surveillance. Biomarker tests, like B-type natriuretic peptide, show promise but their effectiveness in cancer survivors is still uncertain.
And this is the part most people miss: the strongest predictors of heart issues in breast cancer survivors aren’t always tied to the cancer treatment itself. A recent study evaluated by Dr. Ganz and Dr. Yang introduced a risk calculator based on data from over 26,000 breast cancer patients. The findings were eye-opening. While certain treatments did increase the risk of heart failure or cardiomyopathy, most women did not develop serious cardiac disease. Instead, factors like high blood pressure, diabetes, obesity, smoking, and a history of heart disease played a more significant role, especially in women over 65.
For younger survivors, the story is different. The study found that cancer treatment alone rarely pushed women under 40 into a high-risk category, suggesting that routine long-term cardiac imaging for all survivors might be unnecessary. So, who should see a cardiologist? The answer, according to Dr. Ganz and Dr. Yang, is: it depends. Women who received higher-risk chemotherapy, experienced heart issues during treatment, are older, or have multiple cardiovascular risk factors may benefit from cardiology care. Similarly, those reporting symptoms like shortness of breath, fatigue, or swelling should seek specialized attention.
Instead of a one-size-fits-all approach, the editorial emphasizes the importance of personalized care. For most survivors, regular visits with a primary care clinician, combined with an oncologist’s input, may be sufficient. The key lies in managing established cardiac risk factors—controlling blood pressure, managing cholesterol, maintaining a healthy weight, and recognizing early warning signs of heart disease.
Here’s the controversial question: Are we overmedicalizing breast cancer survivorship by pushing every woman to see a cardiologist, or are we missing opportunities to prevent heart issues in those who truly need specialized care? Dr. Ganz and Dr. Yang argue that with proper attention to cardiac prevention and control, heart failure and cardiomyopathy are less likely to occur. But what do you think? Is individualized monitoring the way forward, or should all survivors receive the same level of cardiac care? Let’s start the conversation in the comments below.
