Key result
Prior breast cancer therapy is linked to ~3.1-fold higher odds of mild LV systolic dysfunction.
Why the study?
The long-term prevalence of cardiac dysfunction and changes in cardiac function over time among breast cancer survivors treated with chemotherapy with or without radiation therapy remain unclear.
Does prior breast cancer treatment with chemotherapy and/or radiation therapy increase the long-term prevalence of cardiac dysfunction compared to matched controls?
Cohort (n=336)
Single-blind
No
Does prior breast cancer treatment with chemotherapy and/or radiation therapy increase the long-term prevalence of cardiac dysfunction compared to matched controls?
While long-term breast cancer survivors have a significantly higher odds of mild left ventricular systolic dysfunction nearly two decades post-diagnosis, the absolute prevalence of clinically relevant dysfunction remains low and function mildly improves over time, suggesting routine long-term echocardiographic surveillance may be unnecessary without concurrent cardiovascular risk factors.
Mild LV dysfunction remains more prevalent decades after breast cancer therapy; extends prior cohorts but leaves screening value open.
INTRODUCTION: Breast cancer survivors are known to have a higher prevalence of mild systolic cardiac dysfunction compared to the general population, due to the effects of chemotherapy with/without radiation therapy. However, the long-term prevalence of cardiac dysfunction and changes in (dys)function over time, remain unclear. MATERIALS AND METHODS: We added a follow-up measurement to a matched-cohort study. Women were recruited from general practices, and echocardiographic data and medical records from general practices were collected for analysis. The primary outcome was the prevalence of mild left ventricular systolic dysfunction, defined as a left ventricular ejection fraction (LVEF) <54%. Secondary outcomes were diastolic dysfunction, right ventricular dysfunction and longitudinal changes of LVEF over time. RESULTS: Of the 700 women enrolled in the initial study (T1), 336 (48%) were included in the follow-up (T2). At T2, the median age was 70 years (IQR 65-75) for breast cancer survivors, with a median follow-up time of 19 years (IQR 17-22) after diagnosis. The prevalence of mild left ventricular systolic dysfunction was 10.4% among breast cancer survivors, versus 3.5% of controls (OR 3.1, 95% CI 1.2-8.1). Mixed-effects modeling showed that LVEF slightly improved over time across groups, without interactions between timepoint and group. CONCLUSION AND DISCUSSION: Long-term breast cancer survivors who received chemotherapy with/without radiation therapy are at increased risk of mild left ventricular systolic dysfunction compared to controls. Despite this elevated risk, left ventricular function slightly improved for all women over time and remained clinically irrelevant.
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Wal et al. (2026) conducted a cohort in Breast cancer survivors (n=336). Breast cancer treatment with chemotherapy with or without radiation therapy vs. Matched controls without history of cancer or cancer treatment was evaluated on Prevalence of mild left ventricular systolic dysfunction (LVEF <54%) (OR 3.1, 95% CI 1.2-8.1). Breast cancer survivors treated with chemotherapy and/or radiation therapy had a higher prevalence of mild left ventricular systolic dysfunction compared to matched controls (10.2% vs 3.5%, OR 3.1).
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