Cardiovascular and musculoskeletal health in breast cancer survivors.

• As survival outcomes improve, recognition and management of the late effects of cancer and its treatment become increasingly important. • Lifestyle behaviors, cardiotoxic therapies and estrogen-lowering therapies contribute to cardiovascular risk following breast cancer. • Estrogen depravation as a part of or consequence of breast cancer treatment contributes to musculoskeletal adverse events. • A variety of strategies are available to mitigate treatment-associated cardiovascular and musculoskeletal adverse consequences. As survival outcomes improve, recognition and management of the late effects of cancer and its treatment become increasingly important. Lifestyle behaviors, cardiotoxic therapies and estrogen-lowering therapies contribute to cardiovascular risk following breast cancer. Estrogen depravation as a part of or consequence of breast cancer treatment contributes to musculoskeletal adverse events. A variety of strategies are available to mitigate treatment-associated cardiovascular and musculoskeletal adverse consequences. Most individuals diagnosed with breast cancer will experience long-term survival but often face lasting consequences of cancer and its treatment, including higher rates of heart disease and adverse musculoskeletal effects. Certain chemotherapy agents and targeted therapies are associated with cardiotoxicity. For example, anthracycline chemotherapy drugs and trastuzumab, a monoclonal antibody targeting human epidermal growth factor receptor 2, increase the risk for cardiomyopathy. The induction of early menopause as a consequence of chemotherapy or as a part of breast cancer endocrine therapy can increase risk for both cardiovascular and musculoskeletal adverse events. Use of the selective estrogen receptor modulator tamoxifen increases risk for thromboembolic events. Estrogen-lowering therapies have been associated with worsening of blood pressure, cholesterol, blood sugar control, bone density loss and arthralgias. Strategies to monitor and mitigate these concerns include assessment through history and physical examination, selective testing, addressing co-existing risk factors, enabling healthy behaviors and appropriately treating emergent conditions. Management of the cardiovascular and skeletal consequences of breast cancer treatment often involves a multidisciplinary team that may include oncology, primary care, cardiology, rheumatology, and physical medicine and rehabilitation. A variety of resources are available to help patients and clinicians optimize cardiovascular and musculoskeletal health following a diagnosis of breast cancer.