Division of Cardiology, MedStar Georgetown University Hospital Physicians Group, Washington, DC (R.B.).
Division of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (F.L., K.U.).
Circulation. 2019 Feb 19;139(8):1110-1120. doi: 10.1161/CIRCULATIONAHA.118.039371.
Cardio-oncology is a rapidly developing field which seeks to improve patient outcomes through enhanced clinical and research collaboration across the disciplines of oncology and cardiology. Breast cancer (BC) is the most common cancer diagnosis among women in the United States and, as decades of research have resulted in decreased mortality rates, there has been an increasing focus on reducing short- and long-term treatment toxicity and improving morbidity among survivors. Preexisting or emergent cardiovascular disease in a patient with BC requires a multidisciplinary, team-based approach to balance the need for curative cancer treatment while preventing increased cardiovascular disease morbidity and mortality. Given the overlap in risk factors for BC and cardiovascular disease, such as smoking, sedentary lifestyle, and obesity, there are opportunities for cardiovascular disease prevention and detection before, during, and after BC treatment. Cardiology providers also play an important role in preventing, diagnosing, and treating cardiac dysfunction and other cardiovascular complications that may develop as a result of BC treatment. A number of recent clinical practice guidelines address approaches to cardiotoxicity, however, they focus on specific agents or treatment modality, rather than on collaborative disease management. In this review we present cardiovascular concerns associated with contemporary, multimodality BC treatment and illustrate how current guideline recommendations apply to clinical cardiology and oncology questions. We provide a cardio-oncology team-based approach to cardiovascular assessment and management of patients with BC from diagnosis through treatment and in survivorship.
心脏肿瘤学是一个快速发展的领域，旨在通过肿瘤学和心脏病学领域的临床和研究合作来改善患者的预后。乳腺癌（BC）是美国女性最常见的癌症诊断，随着数十年的研究导致死亡率降低，人们越来越关注降低短期和长期治疗毒性并提高幸存者的发病率。BC 患者的预先存在或新发心血管疾病需要多学科、团队合作的方法来平衡治愈癌症治疗的需求，同时预防增加的心血管疾病发病率和死亡率。鉴于 BC 和心血管疾病的危险因素重叠，如吸烟、久坐不动的生活方式和肥胖，因此在 BC 治疗之前、期间和之后都有机会进行心血管疾病的预防和检测。心脏病专家在预防、诊断和治疗可能因 BC 治疗而导致的心脏功能障碍和其他心血管并发症方面也发挥着重要作用。最近的一些临床实践指南解决了心脏毒性的方法，但它们侧重于特定的药物或治疗方式，而不是协作性疾病管理。在这篇综述中，我们介绍了与当代多模式 BC 治疗相关的心血管问题，并说明了当前指南建议如何适用于临床心脏病学和肿瘤学问题。我们提供了一种基于心脏肿瘤学团队的方法，用于从诊断到治疗和生存期间对 BC 患者进行心血管评估和管理。
