Abstract
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.
MeSH terms
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Antineoplastic Agents, Hormonal / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Breast Neoplasms / drug therapy*
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Breast Neoplasms / epidemiology*
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Breast Neoplasms / genetics
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Breast Neoplasms / radiotherapy
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Breast Neoplasms / surgery
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Cardiovascular Diseases / epidemiology*
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Cardiovascular Diseases / prevention & control
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Chemotherapy, Adjuvant / adverse effects
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Comorbidity
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Drug Therapy, Combination
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Exercise
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Female
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Heart / drug effects
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Humans
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Life Style
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Myocardial Infarction / chemically induced
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Neovascularization, Pathologic / prevention & control
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Obesity / epidemiology
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Overweight
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Radiotherapy, Adjuvant / adverse effects
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Receptor, ErbB-2 / drug effects
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Risk Assessment
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Risk Factors
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Stroke Volume
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Ventricular Dysfunction, Left / chemically induced
Substances
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Antineoplastic Agents, Hormonal
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Receptor, ErbB-2