Kidane Redet D, Ruddy Kathryn J, Lin Grace, Sandhu Nicole P
Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Mayo Clin Proc. 2025 Jan;100(1):124-140. doi: 10.1016/j.mayocp.2024.08.014. Epub 2024 Dec 5.
Breast cancer (BC) survivors are at increased risk for cardiovascular disease (CVD) and require their primary care physicians to manage their long-term general medical care, including cardiovascular (CV) health. Yet, evidence exists that some primary care physicians possess insufficient knowledge about survivorship care. With the goal of bridging these knowledge gaps, a PubMed review was conducted from July 7, 2020, through October 2, 2020, with an updated PubMed review from January 3, 2024, through April 28, 2024, focusing on CV health considerations in the primary care of BC survivors. Search terms included variations of "breast cancer survivors" and "cardiovascular." In total, 152 publications were included. Breasts cancer survivors may have increased CVD risk because some anticancer therapies are cardiotoxic and risk factors for BC often also increase the risk for CVD. Multiple risk factors overlap for BC and CVD such as older age, Western diet, early menarche, physical inactivity, high body mass index, and smoking. In this review, results are summarized from studies that report the presence of CV risk factors and CVD in BC survivors. Also described are the CV effects of BC therapies (chemotherapy, hormonal agents, targeted therapies, and radiotherapy) and the type of CV evaluation (cardiac imaging and measurement of biomarkers) that these patients may need. Primary care physicians have an important role in managing the CV health of BC survivors from preventing, assessing, and managing CV risk factors to referring patients to appropriate specialists when needed.
乳腺癌(BC)幸存者患心血管疾病(CVD)的风险增加,需要其初级保健医生管理他们的长期综合医疗护理,包括心血管(CV)健康。然而,有证据表明一些初级保健医生对幸存者护理的知识不足。为了弥合这些知识差距,于2020年7月7日至2020年10月2日进行了PubMed综述,并于2024年1月3日至2024年4月28日进行了更新的PubMed综述,重点关注BC幸存者初级保健中的CV健康考虑因素。搜索词包括“乳腺癌幸存者”和“心血管”的变体。总共纳入了152篇出版物。乳腺癌幸存者可能有更高的CVD风险,因为一些抗癌疗法具有心脏毒性,而且BC的风险因素通常也会增加CVD的风险。BC和CVD存在多种重叠的风险因素,如年龄较大、西式饮食、初潮早、缺乏身体活动、高体重指数和吸烟。在本综述中,总结了报告BC幸存者中CV风险因素和CVD存在情况的研究结果。还描述了BC治疗(化疗、激素药物、靶向治疗和放疗)的CV影响以及这些患者可能需要的CV评估类型(心脏成像和生物标志物测量)。初级保健医生在管理BC幸存者的CV健康方面发挥着重要作用,从预防、评估和管理CV风险因素到在需要时将患者转诊给合适的专科医生。
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