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 over 4.3 million breast cancer survivors in the U.S. and another million expected in the next decade, the focus is shifting to long-term health, particularly heart health. But here’s where it gets controversial: while certain breast cancer treatments are lifesaving, they can also strain the heart, leaving many to wonder, Does every survivor need to see a cardiologist? The answer, according to UCLA experts, is far from straightforward.
In a thought-provoking editorial published in JAMA Oncology, UCLA Health Jonsson Comprehensive Cancer Center investigators Patricia Ganz, MD, and Eric Yang, MD, argue that the approach to heart monitoring in survivors should be individualized rather than one-size-fits-all. They point out that while current guidelines recommend cardiac imaging during and immediately after treatment, there’s a glaring lack of evidence-based guidance for long-term surveillance. Biomarker tests, like B-type natriuretic peptide, show promise but aren’t yet proven to be reliable for survivors. And this is the part most people miss: the biggest risk factors for heart disease in survivors often have less to do with their cancer treatment and more to do with overall health.
Take, for example, anthracycline chemotherapy and HER2-targeted drugs like Herceptin—these treatments are known to stress the heart in some patients. Doctors have long monitored patients during treatment to catch early signs of heart dysfunction. But how long should this monitoring continue after treatment ends? And should all survivors be treated the same? Dr. Ganz and Dr. Yang evaluated a study that introduced a risk calculator based on data from over 26,000 breast cancer patients in Southern California. The findings were eye-opening: while certain treatments did increase heart risk, most women did not develop serious cardiac issues. Instead, factors like high blood pressure, diabetes, obesity, smoking, and a history of heart disease played a bigger role in long-term heart health.
Here’s the kicker: for younger women, cancer treatment alone rarely pushed them 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 is, it depends. Women who received high-risk chemotherapy, developed heart issues during treatment, are older, or have multiple cardiovascular risk factors may benefit from cardiology care. Similarly, those experiencing symptoms like shortness of breath, fatigue, or swelling should seek specialized care.
Instead of blanket heart screenings, the editorial emphasizes the importance of fundamentals: managing blood pressure, controlling cholesterol, maintaining a healthy weight, and recognizing early warning signs of heart disease. For most survivors, regular check-ins with a primary care clinician, alongside an oncologist’s input, may be enough. As Dr. Ganz and Dr. Yang put it, “What all breast cancer survivors need is access to primary care that focuses on prevention or management of established cardiac risk factors, as well as regular clinical assessment of their functioning.”
But here’s a question to ponder: Are we doing enough to educate survivors about their heart health risks, or are we relying too heavily on medical interventions without addressing lifestyle factors? Share your thoughts in the comments—let’s spark a conversation that could shape the future of survivorship care.
