Cardiovascular toxicity of breast cancer treatments: from understanding to enhancing survivorship care

The significant decline in breast cancer (BC) mortality, largely driven by advancements in drug development, makes survivorship an absolute priority. Adverse events induced by anticancer treatments, particularly long-term and irreversible complications, have emerged as a major concern for BC survivors. Many anticancer therapies used in BC are associated with an increased risk of cardiovascular (CV) toxicity which may lead to treatment discontinuation and negatively affect clinical outcomes including long-term survival. Moreover, the occurrence of late CV adverse events can significantly impact the quality of life of BC survivors. Timely recognition and management of CV toxicity is therefore crucial. Before the initiation of potentially cardiotoxic therapies, a careful risk-benefit evaluation should be carried out in all patients with BC. Over the past decades, the field of cardio-oncology has emerged to deal with these challenges. Importantly, a better understanding of the mechanisms underlying CV toxicity is crucial in order to improve strategies to diagnose, monitor, and treat and ideally prevent the CV events related to different cancer treatments. In this review, we aim to provide an overview of the main CV toxicities associated with contemporary BC treatments. Moreover, we highlight the need to balance the expected benefits of anticancer therapies while preserving CV health in both the early and advanced settings.