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Cardiovascular Concerns in BRCA1 and BRCA2 Mutation Carriers

Current Treatment Options in Cardiovascular Medicine volume 20, Article number: 18 (2018) Cite this article

Abstract

Purpose of review

BRCA1 and BRCA2 mutation carriers can be at increased cardiovascular risk. The goal of this review is to provide information about factors associated with increased cardiovascular risk, methods to prevent cardiovascular toxicities, and recommended screening guidelines.

Recent findings

BRCA1/2 mutation carriers who are diagnosed with cancer are often exposed to chemotherapy, chest radiotherapy, and/or HER2 directed therapies, all of which can be cardiotoxic. In addition, BRCA1/2 carriers often undergo prophylactic salpingoopherectomies, which may also increase cardiovascular risks.

Summary

Understanding the potential for increased cardiovascular risk in individuals with a BRCA1 or BRCA2 mutation, as well as gold standard practices for prevention, detection, and treatment of cardiac concerns in this population, is important.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Roy R, Chun J, Powell SN. BRCA1 and BRCA2: different roles in a common pathway of genome protection. Nat Rev Cancer. 2011;12(1):68–78. https://doi.org/10.1038/nrc3181.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  2. Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402–16. https://doi.org/10.1001/jama.2017.7112.

    CAS  PubMed  Article  Google Scholar 

  3. Cavanagh H, Rogers KM. The role of BRCA1 and BRCA2 mutations in prostate, pancreatic and stomach cancers. Hered Cancer Clin Pract. 2015;13(1):16. https://doi.org/10.1186/s13053-015-0038-x.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  4. Foulkes WD. Inherited susceptibility to common cancers. N Engl J Med. 2008;359(20):2143–53. https://doi.org/10.1056/NEJMra0802968.

    CAS  PubMed  Article  Google Scholar 

  5. Ovarian Epithelial, Fallopian tube, and primary peritoneal cancer treatment (PDQ(R)): health professional version. PDQ Cancer Information Summaries. Bethesda, 2002.

  6. Friedenson B. The BRCA1/2 pathway prevents hematologic cancers in addition to breast and ovarian cancers. BMC Cancer. 2007;7(1):152. https://doi.org/10.1186/1471-2407-7-152.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  7. Mathew CG. Fanconi anaemia genes and susceptibility to cancer. Oncogene. 2006;25(43):5875–84. https://doi.org/10.1038/sj.onc.1209878.

    CAS  PubMed  Article  Google Scholar 

  8. Eisinger F, Stoppa-Lyonnet D, Longy M, Kerangueven F, Noguchi T, Bailly C, et al. Germ line mutation at BRCA1 affects the histoprognostic grade in hereditary breast cancer. Cancer Res. 1996;56(3):471–4.

    CAS  PubMed  Google Scholar 

  9. Karp SE, Tonin PN, Begin LR, Martinez JJ, Zhang JC, Pollak MN, et al. Influence of BRCA1 mutations on nuclear grade and estrogen receptor status of breast carcinoma in Ashkenazi Jewish women. Cancer. 1997;80(3):435–41. https://doi.org/10.1002/(SICI)1097-0142(19970801)80:3<435::AID-CNCR11>3.0.CO;2-Y.

    CAS  PubMed  Article  Google Scholar 

  10. Atchley DP, Albarracin CT, Lopez A, Valero V, Amos CI, Gonzalez-Angulo AM, et al. Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer. J Clin Oncol. 2008;26(26):4282–8. https://doi.org/10.1200/JCO.2008.16.6231.

    PubMed  Article  Google Scholar 

  11. Evans DG, Lalloo F, Howell S, Verhoef S, Woodward ER, Howell A. Low prevalence of HER2 positivity amongst BRCA1 and BRCA2 mutation carriers and in primary BRCA screens. Breast Cancer Res Treat. 2016;155(3):597–601. https://doi.org/10.1007/s10549-016-3697-z.

    CAS  PubMed  Article  Google Scholar 

  12. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41. https://doi.org/10.1056/NEJMoa022152.

    PubMed  Article  Google Scholar 

  13. Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, van’t Veer L, Garber JE, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22(6):1055–62. https://doi.org/10.1200/JCO.2004.04.188.

    PubMed  Article  Google Scholar 

  14. American Cancer Society. Cancer Statistics Center: Ovary. https://cancerstatisticscenter.cancer.org/?_ga=2.216272405.2025305630.1511832977-370879628.1511832977#!/cancer-site/Ovary. Accessed 27 Nov 2017.

  15. Couch FJ, Johnson MR, Rabe KG, Brune K, de Andrade M, Goggins M, et al. The prevalence of BRCA2 mutations in familial pancreatic cancer. Cancer Epidemiol Biomark Prev. 2007;16(2):342–6. https://doi.org/10.1158/1055-9965.EPI-06-0783.

    CAS  Article  Google Scholar 

  16. Hahn SA, Greenhalf B, Ellis I, Sina-Frey M, Rieder H, Korte B, et al. BRCA2 germline mutations in familial pancreatic carcinoma. J Natl Cancer Inst. 2003;95(3):214–21. https://doi.org/10.1093/jnci/95.3.214.

    CAS  PubMed  Article  Google Scholar 

  17. Hampel H, Bennett RL, Buchanan A, Pearlman R, Wiesner GL, Guideline Development Group ACoMG, et al. A practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: referral indications for cancer predisposition assessment. Genet Med. 2015;17(1):70–87. https://doi.org/10.1038/gim.2014.147.

    PubMed  Article  Google Scholar 

  18. Giri VN, Obeid E, Gross L, Bealin L, Hyatt C, Hegarty SE, et al. Inherited mutations in men undergoing multigene panel testing for prostate cancer: emerging implications for personalized prostate cancer genetic evaluation. JCO Precision Oncol. 2017;1:1–17. https://doi.org/10.1200/po.16.00039.

    Google Scholar 

  19. Wellons M, Ouyang P, Schreiner PJ, Herrington DM, Vaidya D. Early menopause predicts future coronary heart disease and stroke: the multi-ethnic study of atherosclerosis. Menopause. 2012;19(10):1081–7. https://doi.org/10.1097/gme.0b013e3182517bd0.

    PubMed  PubMed Central  Article  Google Scholar 

  20. Singh KK, Shukla PC, Quan A, Desjardins JF, Lovren F, Pan Y, et al. BRCA2 protein deficiency exaggerates doxorubicin-induced cardiomyocyte apoptosis and cardiac failure. J Biol Chem. 2012;287(9):6604–14. https://doi.org/10.1074/jbc.M111.292664.

    CAS  PubMed  Article  Google Scholar 

  21. Pierce LJ, Strawderman M, Narod SA, Oliviotto I, Eisen A, Dawson L, et al. Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol. 2000;18(19):3360–9. https://doi.org/10.1200/JCO.2000.18.19.3360.

    CAS  PubMed  Article  Google Scholar 

  22. Jethwa KR, Kahila MM, Whitaker TJ, Harmsen WS, Corbin KS, Park SS, et al. Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT). Breast Cancer Res Treat. 2017;164(1):237–44. https://doi.org/10.1007/s10549-017-4241-5.

    CAS  PubMed  Article  Google Scholar 

  23. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106. https://doi.org/10.1016/S0140-6736(05)67887-7.

    CAS  PubMed  Article  Google Scholar 

  24. van den Bogaard VA, Ta BD, van der Schaaf A, Bouma AB, Middag AM, Bantema-Joppe EJ, et al. Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. J Clin Oncol. 2017;35(11):1171–8. https://doi.org/10.1200/JCO.2016.69.8480.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Mutter RW, Remmes NB, Kahila MM, Hoeft KA, Pafundi DH, Zhang Y, et al. Initial clinical experience of postmastectomy intensity modulated proton therapy in patients with breast expanders with metallic ports. Pract Radiat Oncol. 2017;7(4):e243–e52. https://doi.org/10.1016/j.prro.2016.12.002.

    PubMed  Article  Google Scholar 

  26. Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol. 2007;25(21):3031–7. https://doi.org/10.1200/JCO.2006.08.6595.

    PubMed  Article  Google Scholar 

  27. Carmel RJ, Kaplan HS. Mantle irradiation in Hodgkin's disease. An analysis of technique, tumor eradication, and complications. Cancer. 1976;37(6):2813–25. https://doi.org/10.1002/1097-0142(197606)37:6<2813::AID-CNCR2820370637>3.0.CO;2-S.

    CAS  PubMed  Article  Google Scholar 

  28. Ahmad SS, Duke S, Jena R, Williams MV, Burnet NG. Advances in radiotherapy. BMJ. 2012;345(dec04 1):e7765. https://doi.org/10.1136/bmj.e7765.

    PubMed  Article  CAS  Google Scholar 

  29. MacDonald SM, Patel SA, Hickey S, Specht M, Isakoff SJ, Gadd M, et al. Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2013;86(3):484–90. https://doi.org/10.1016/j.ijrobp.2013.01.038.

    PubMed  Article  Google Scholar 

  30. Ruddy KJ, Van Houten HK, Sangaralingham LR, Freedman RA, Thompson CA, Hashmi SK, et al. Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer. Breast Cancer Res Treat. 2017;164(3):515–25. https://doi.org/10.1007/s10549-017-4280-y.

    PubMed  Article  Google Scholar 

  31. Jiang T, Shi W, Wali VB, Pongor LS, Li C, Lau R, et al. Predictors of chemosensitivity in triple negative breast cancer: an integrated genomic analysis. PLoS Med. 2016;13(12):e1002193. https://doi.org/10.1371/journal.pmed.1002193.

    PubMed  PubMed Central  Article  Google Scholar 

  32. Markman M. Pegylted liposomal doxorubicin: appraisal of its current role in the management of epithelial ovarian cancer. Cancer Manag Res. 2011;3:219–25. https://doi.org/10.2147/CMR.S15558.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  33. Moazeni S, Cadeiras M, Yang EH, Deng MC, Nguyen KL. Anthracycline induced cardiotoxicity: biomarkers and “omics” technology in the era of patient specific care. Clin Transl Med. 2017;6(1):17. https://doi.org/10.1186/s40169-017-0148-3.

    PubMed  PubMed Central  Article  Google Scholar 

  34. Gulati G, Heck SL, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37(21):1671–80. https://doi.org/10.1093/eurheartj/ehw022.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  35. Tashakori Beheshti A, Mostafavi Toroghi H, Hosseini G, Zarifian A, Homaei Shandiz F, Fazlinezhad A. Carvedilol administration can prevent doxorubicin-induced cardiotoxicity: a double-blind randomized trial. Cardiology. 2016;134(1):47–53. https://doi.org/10.1159/000442722.

    CAS  PubMed  Article  Google Scholar 

  36. Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, et al. Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010;55(3):213–20. https://doi.org/10.1016/j.jacc.2009.03.095.

    CAS  PubMed  Article  Google Scholar 

  37. Minotti G. Pharmacology at work for cardio-oncology: ranolazine to treat early cardiotoxicity induced by antitumor drugs. J Pharmacol Exp Ther. 2013;346(3):343–9. https://doi.org/10.1124/jpet.113.204057.

    CAS  PubMed  Article  Google Scholar 

  38. Oleksowicz L, Bruckner HW. Prophylaxis of 5-fluorouracil-induced coronary vasospasm with calcium channel blockers. Am J Med. 1988;85(5):750–1. https://doi.org/10.1016/S0002-9343(88)80268-7.

    CAS  PubMed  Article  Google Scholar 

  39. Eskilsson J, Albertsson M. Failure of preventing 5-fluorouracil cardiotoxicity by prophylactic treatment with verapamil. Acta Oncol. 1990;29(8):1001–3. https://doi.org/10.3109/02841869009091790.

    CAS  PubMed  Article  Google Scholar 

  40. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25. https://doi.org/10.1056/NEJMoa1011923.

    CAS  PubMed  Article  Google Scholar 

  41. Carnevale J, Ashworth A. Assessing the significance of BRCA1 and BRCA2 mutations in pancreatic cancer. J Clin Oncol. 2015;33(28):3080–1. https://doi.org/10.1200/JCO.2015.61.6961.

    CAS  PubMed  Article  Google Scholar 

  42. El-Awady el SE, Moustafa YM, Abo-Elmatty DM, Radwan A. Cisplatin-induced cardiotoxicity: mechanisms and cardioprotective strategies. Eur J Pharmacol. 2011;650(1):335–41. https://doi.org/10.1016/j.ejphar.2010.09.085.

    Article  CAS  Google Scholar 

  43. Dieckmann KP, Struss WJ, Budde U. Evidence for acute vascular toxicity of cisplatin-based chemotherapy in patients with germ cell tumour. Anticancer Res. 2011;31(12):4501–5.

    CAS  PubMed  Google Scholar 

  44. Robson M, Im SA, Senkus E, Xu B, Domchek SM, Masuda N, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med. 2017;377(6):523–33. https://doi.org/10.1056/NEJMoa1706450.

    CAS  PubMed  Article  Google Scholar 

  45. Guglin M, Munster P, Fink A, Krischer J. Lisinopril or Coreg CR in reducing cardiotoxicity in women with breast cancer receiving trastuzumab: a rationale and design of a randomized clinical trial. Am Heart J. 2017;188:87–92. https://doi.org/10.1016/j.ahj.2017.03.010.

    CAS  PubMed  Article  Google Scholar 

  46. Ledermann J, Harter P, Gourley C, Friedlander M, Vergote I, Rustin G, et al. Olaparib maintenance therapy in patients with platinum-sensitive relapsed serous ovarian cancer: a preplanned retrospective analysis of outcomes by BRCA status in a randomised phase 2 trial. Lancet Oncol. 2014;15(8):852–61. https://doi.org/10.1016/S1470-2045(14)70228-1.

    CAS  PubMed  Article  Google Scholar 

  47. Coleman RL, Oza AM, Lorusso D, Aghajanian C, Oaknin A, Dean A, et al. Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390(10106):1949–61. https://doi.org/10.1016/S0140-6736(17)32440-6.

    CAS  PubMed  Article  Google Scholar 

  48. Swisher EM, Lin KK, Oza AM, Scott CL, Giordano H, Sun J, et al. Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 Part 1): an international, multicentre, open-label, phase 2 trial. Lancet Oncol. 2017;18(1):75–87. https://doi.org/10.1016/S1470-2045(16)30559-9.

    CAS  PubMed  Article  Google Scholar 

  49. Ewer MS, Ewer SM. Cardiotoxicity of anticancer treatments. Nat Rev Cardiol. 2015;12(9):547–58. https://doi.org/10.1038/nrcardio.2015.65.

    CAS  PubMed  Article  Google Scholar 

  50. Angsutararux P, Luanpitpong S, Issaragrisil S. Chemotherapy-induced cardiotoxicity: overview of the roles of oxidative stress. Oxidative Med Cell Longev. 2015;2015:795602. https://doi.org/10.1155/2015/795602.

    Article  Google Scholar 

  51. Jezovnik MP. Oxidative stress and atherosclerosis. E J Cardiol Practice. 2007;6(6).

  52. Singh KK, Shukla PC, Yanagawa B, Quan A, Lovren F, Pan Y, et al. Regulating cardiac energy metabolism and bioenergetics by targeting the DNA damage repair protein BRCA1. J Thorac Cardiovasc Surg. 2013;146(3):702–9. https://doi.org/10.1016/j.jtcvs.2012.12.046.

    CAS  PubMed  Article  Google Scholar 

  53. Drooger J, Akdeniz D, Pignol JP, Koppert LB, McCool D, Seynaeve CM, et al. Adjuvant radiotherapy for primary breast cancer in BRCA1 and BRCA2 mutation carriers and risk of contralateral breast cancer with special attention to patients irradiated at younger age. Breast Cancer Res Treat. 2015;154(1):171–80. https://doi.org/10.1007/s10549-015-3597-7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  54. Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340(2):77–84. https://doi.org/10.1056/NEJM199901143400201.

    CAS  PubMed  Article  Google Scholar 

  55. Shaitelman SF, Howell RM, Smith BD. Effects of smoking on late toxicity from breast radiation. J Clin Oncol. 2017;35(15):1633–5. https://doi.org/10.1200/JCO.2017.72.2660.

    PubMed  Article  Google Scholar 

  56. Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35(15):1641–9. https://doi.org/10.1200/JCO.2016.72.0722.

    PubMed  PubMed Central  Article  Google Scholar 

  57. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98. https://doi.org/10.1056/NEJMoa1209825.

    CAS  PubMed  Article  Google Scholar 

  58. • Cuomo JR, Sharma GK, Conger PD, Weintraub NL. Novel concepts in radiation-induced cardiovascular disease. World J Cardiol. 2016;8(9):504–19. https://doi.org/10.4330/wjc.v8.i9.504. This article summarizes the most common manifestations of radiation-induced heart disease as well as methods for prevention, screening and detection, and treatment.

    PubMed  PubMed Central  Article  Google Scholar 

  59. Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, et al. Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010;76(3):656–65. https://doi.org/10.1016/j.ijrobp.2009.09.064.

    PubMed  PubMed Central  Article  Google Scholar 

  60. McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol. 2011;100(2):167–75. https://doi.org/10.1016/j.radonc.2011.06.016.

    PubMed  Article  Google Scholar 

  61. Clare GC, Troughton RW. Management of constrictive pericarditis in the 21st century. Curr Treat Options Cardiovasc Med. 2007;9(6):436–42. https://doi.org/10.1007/s11936-007-0038-x.

    PubMed  Article  Google Scholar 

  62. Cutter DJ, Schaapveld M, Darby SC, Hauptmann M, van Nimwegen FA, Krol AD, et al. Risk of valvular heart disease after treatment for Hodgkin lymphoma. J Natl Cancer Inst. 2015;107(4). https://doi.org/10.1093/jnci/djv008.

  63. Saiki H, Petersen IA, Scott CG, Bailey KR, Dunlay SM, Finley RR, et al. Risk of heart failure with preserved ejection fraction in older women after contemporary radiotherapy for breast cancer. Circulation. 2017;135(15):1388–96. https://doi.org/10.1161/CIRCULATIONAHA.116.025434.

    PubMed  Article  Google Scholar 

  64. Writing Committee M, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327. https://doi.org/10.1161/CIR.0b013e31829e8776.

    Article  Google Scholar 

  65. Thorsen LB, Offersen BV, Dano H, Berg M, Jensen I, Pedersen AN, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol. 2016;34(4):314–20. https://doi.org/10.1200/JCO.2015.63.6456.

    PubMed  Article  Google Scholar 

  66. Yeboa DN, Evans SB. Contemporary breast radiotherapy and cardiac toxicity. Semin Radiat Oncol. 2016;26(1):71–8. https://doi.org/10.1016/j.semradonc.2015.09.003.

    PubMed  Article  Google Scholar 

  67. Von Hoff DD, Layard MW, Basa P, Davis HL Jr, Von Hoff AL, Rozencweig M, et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med. 1979;91(5):710–7. https://doi.org/10.7326/0003-4819-91-5-710.

    Article  Google Scholar 

  68. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97(11):2869–79. https://doi.org/10.1002/cncr.11407.

    CAS  PubMed  Article  Google Scholar 

  69. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342(15):1077–84. https://doi.org/10.1056/NEJM200004133421502.

    CAS  PubMed  Article  Google Scholar 

  70. Hequet O, Le QH, Moullet I, Pauli E, Salles G, Espinouse D, et al. Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J Clin Oncol. 2004;22(10):1864–71. https://doi.org/10.1200/JCO.2004.06.033.

    CAS  PubMed  Article  Google Scholar 

  71. McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM. Anthracycline chemotherapy and cardiotoxicity. Cardiovasc Drugs Ther. 2017;31(1):63–75. https://doi.org/10.1007/s10557-016-6711-0.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  72. Curigliano G, Cardinale D, Suter T, Plataniotis G, de Azambuja E, Sandri MT, et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol. 2012;23(Suppl 7):vii155–66. https://doi.org/10.1093/annonc/mds293.

    PubMed  Article  Google Scholar 

  73. Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer. 2010;10(1):337. https://doi.org/10.1186/1471-2407-10-337.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  74. • Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015;131(22):1981–8. https://doi.org/10.1161/CIRCULATIONAHA.114.013777. This prospective study evaluated the incidence, onset, clinical risks, and reversiility of cardiotoxicity from anthracyclines. The study determined that the majority of LVEF dysfunction develops within the first year following treatment, cumulative anthracycline dose and LVEF at completion of therapy are important clinical risk factors, and anthracycline-induced cardiotoxicity appears to be at least partially reversible.

    CAS  PubMed  Article  Google Scholar 

  75. Cardinale D, Sandri MT, Martinoni A, Borghini E, Civelli M, Lamantia G, et al. Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy. Ann Oncol. 2002;13(5):710–5. https://doi.org/10.1093/annonc/mdf170.

    CAS  PubMed  Article  Google Scholar 

  76. Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004;109(22):2749–54. https://doi.org/10.1161/01.CIR.0000130926.51766.CC.

    CAS  PubMed  Article  Google Scholar 

  77. Sciences WFUH. Preventing anthracycline cardiovascular toxicity with statins (PREVENT). NIH U.S. National Library of Medicine, Clinicaltrials.gov. 2013. https://clinicaltrials.gov/ct2/show/NCT01988571.

  78. Rosa GM, Gigli L, Tagliasacchi MI, Di Iorio C, Carbone F, Nencioni A, et al. Update on cardiotoxicity of anti-cancer treatments. Eur J Clin Investig. 2016;46(3):264–84. https://doi.org/10.1111/eci.12589.

    Article  Google Scholar 

  79. Arbuck SG, Strauss H, Rowinsky E, Christian M, Suffness M, Adams J, et al. A reassessment of cardiac toxicity associated with Taxol. J Natl Cancer Inst Monogr. 1993;15:117–30.

    Google Scholar 

  80. De Gennaro L, Brunetti ND, Resta M, Rutigliano D, Tarantini L, Caldarola P. Cardiac arrest and ventricular fibrillation in a young man treated with capecitabine: case report and literature review. Int J Cardiol. 2016;220:280–3. https://doi.org/10.1016/j.ijcard.2016.06.117.

    PubMed  Article  Google Scholar 

  81. Layoun ME, Wickramasinghe CD, Peralta MV, Yang EH. Fluoropyrimidine-induced cardiotoxicity: manifestations, mechanisms, and management. Curr Oncol Rep. 2016;18(6):35. https://doi.org/10.1007/s11912-016-0521-1.

    PubMed  Article  CAS  Google Scholar 

  82. Polk A, Shahmarvand N, Vistisen K, Vaage-Nilsen M, Larsen FO, Schou M, et al. Incidence and risk factors for capecitabine-induced symptomatic cardiotoxicity: a retrospective study of 452 consecutive patients with metastatic breast cancer. BMJ Open. 2016;6(10):e012798. https://doi.org/10.1136/bmjopen-2016-012798.

    PubMed  PubMed Central  Article  Google Scholar 

  83. Polk A, Vaage-Nilsen M, Vistisen K, Nielsen DL. Cardiotoxicity in cancer patients treated with 5-fluorouracil or capecitabine: a systematic review of incidence, manifestations and predisposing factors. Cancer Treat Rev. 2013;39(8):974–84. https://doi.org/10.1016/j.ctrv.2013.03.005.

    CAS  PubMed  Article  Google Scholar 

  84. Schober C, Papageorgiou E, Harstrick A, Bokemeyer C, Mugge A, Stahl M, et al. Cardiotoxicity of 5-fluorouracil in combination with folinic acid in patients with gastrointestinal cancer. Cancer. 1993;72(7):2242–7. https://doi.org/10.1002/1097-0142(19931001)72:7<2242::AID-CNCR2820720730>3.0.CO;2-E.

    CAS  PubMed  Article  Google Scholar 

  85. Collins C, Weiden PL. Cardiotoxicity of 5-fluorouracil. Cancer Treat Rep. 1987;71(7–8):733–6.

    CAS  PubMed  Google Scholar 

  86. Jensen SA, Sorensen JB. Risk factors and prevention of cardiotoxicity induced by 5-fluorouracil or capecitabine. Cancer Chemother Pharmacol. 2006;58(4):487–93. https://doi.org/10.1007/s00280-005-0178-1.

    CAS  PubMed  Article  Google Scholar 

  87. Vogel CL, Cobleigh MA, Tripathy D, Gutheil JC, Harris LN, Fehrenbacher L, et al. Efficacy and safety of trastuzumab as a single agent in first-line treatment of HER2-overexpressing metastatic breast cancer. J Clin Oncol. 2002;20(3):719–26. https://doi.org/10.1200/JCO.2002.20.3.719.

    CAS  PubMed  Article  Google Scholar 

  88. van Dalen EC, van der Pal HJ, Kok WE, Caron HN, Kremer LC. Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study. Eur J Cancer. 2006;42(18):3191–8. https://doi.org/10.1016/j.ejca.2006.08.005.

    PubMed  Article  CAS  Google Scholar 

  89. Suter TM, Cook-Bruns N, Barton C. Cardiotoxicity associated with trastuzumab (Herceptin) therapy in the treatment of metastatic breast cancer. Breast. 2004;13(3):173–83. https://doi.org/10.1016/j.breast.2003.09.002.

    CAS  PubMed  Article  Google Scholar 

  90. Romond EH, Jeong JH, Rastogi P, Swain SM, Geyer CE Jr, Ewer MS, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2012;30(31):3792–9. https://doi.org/10.1200/JCO.2011.40.0010.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  91. Advani PP, Ballman KV, Dockter TJ, Colon-Otero G, Perez EA. Long-term cardiac safety analysis of NCCTG N9831 (alliance) adjuvant trastuzumab trial. J Clin Oncol. 2016;34(6):581–7. https://doi.org/10.1200/JCO.2015.61.8413.

    CAS  PubMed  Article  Google Scholar 

  92. Cameron D, Piccart-Gebhart MJ, Gelber RD, Procter M, Goldhirsch A, de Azambuja E, et al. 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin adjuvant (HERA) trial. Lancet. 2017;389(10075):1195–205. https://doi.org/10.1016/S0140-6736(16)32616-2.

    CAS  PubMed  Article  Google Scholar 

  93. Tocchetti CG, Ragone G, Coppola C, Rea D, Piscopo G, Scala S, et al. Detection, monitoring, and management of trastuzumab-induced left ventricular dysfunction: an actual challenge. Eur J Heart Fail. 2012;14(2):130–7. https://doi.org/10.1093/eurjhf/hfr165.

    CAS  PubMed  Article  Google Scholar 

  94. Odiete O, Hill MF, Sawyer DB. Neuregulin in cardiovascular development and disease. Circ Res. 2012;111(10):1376–85. https://doi.org/10.1161/CIRCRESAHA.112.267286.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  95. Sendur MA, Aksoy S, Altundag K. Cardiotoxicity of novel HER2-targeted therapies. Curr Med Res Opin. 2013;29(8):1015–24. https://doi.org/10.1185/03007995.2013.807232.

    CAS  PubMed  Article  Google Scholar 

  96. de Azambuja E, Procter MJ, van Veldhuisen DJ, Agbor-Tarh D, Metzger-Filho O, Steinseifer J, et al. Trastuzumab-associated cardiac events at 8 years of median follow-up in the Herceptin Adjuvant trial (BIG 1-01). J Clin Oncol. 2014;32(20):2159–65. https://doi.org/10.1200/JCO.2013.53.9288.

    PubMed  Article  CAS  Google Scholar 

  97. Dang C, Guo H, Najita J, Yardley D, Marcom K, Albain K, et al. Cardiac outcomes of patients receiving adjuvant weekly paclitaxel and trastuzumab for node-negative, ERBB2-positive breast cancer. JAMA Oncol. 2016;2(1):29–36. https://doi.org/10.1001/jamaoncol.2015.3709.

    PubMed  PubMed Central  Article  Google Scholar 

  98. Swain SM, Ewer MS, Cortes J, Amadori D, Miles D, Knott A, et al. Cardiac tolerability of pertuzumab plus trastuzumab plus docetaxel in patients with HER2-positive metastatic breast cancer in CLEOPATRA: a randomized, double-blind, placebo-controlled phase III study. Oncologist. 2013;18(3):257–64. https://doi.org/10.1634/theoncologist.2012-0448.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  99. Yu AF, Yadav NU, Eaton AA, Lung BY, Thaler HT, Liu JE, et al. Continuous trastuzumab therapy in breast cancer patients with asymptomatic left ventricular dysfunction. Oncologist. 2015;20(10):1105–10. https://doi.org/10.1634/theoncologist.2015-0125.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  100. Lynce F, Barac A, Tan MT, Asch FM, Smith KL, Dang C, et al. SAFE-HEaRt: rationale and design of a pilot study investigating cardiac safety of HER2 targeted therapy in patients with HER2-positive breast cancer and reduced left ventricular function. Oncologist. 2017;22(5):518–25. https://doi.org/10.1634/theoncologist.2016-0412.

    CAS  PubMed  Article  Google Scholar 

  101. Witteles RM. Biomarkers as predictors of cardiac toxicity from targeted cancer therapies. J Card Fail. 2016;22(6):459–64. https://doi.org/10.1016/j.cardfail.2016.03.016.

    CAS  PubMed  Article  Google Scholar 

  102. Fallah-Rad N, Walker JR, Wassef A, Lytwyn M, Bohonis S, Fang T, et al. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol. 2011;57(22):2263–70. https://doi.org/10.1016/j.jacc.2010.11.063.

    CAS  PubMed  Article  Google Scholar 

  103. Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, et al. Multidisciplinary approach to novel therapies in cardio-oncology research (MANTICORE 101-breast): a randomized trial for the prevention of trastuzumab-associated cardiotoxicity. J Clin Oncol. 2017;35(8):870–7. https://doi.org/10.1200/JCO.2016.68.7830.

    CAS  PubMed  Article  Google Scholar 

  104. Boekhout AH, Gietema JA, Milojkovic Kerklaan B, van Werkhoven ED, Altena R, Honkoop A, et al. Angiotensin II-receptor inhibition with candesartan to prevent trastuzumab-related cardiotoxic effects in patients with early breast cancer: a randomized clinical trial. JAMA Oncol. 2016;2(8):1030–7. https://doi.org/10.1001/jamaoncol.2016.1726.

    PubMed  Article  Google Scholar 

  105. Meattini I, Curigliano G, Terziani F, Becherini C, Airoldi M, Allegrini G, et al. SAFE trial: an ongoing randomized clinical study to assess the role of cardiotoxicity prevention in breast cancer patients treated with anthracyclines with or without trastuzumab. Med Oncol. 2017;34(5):75. https://doi.org/10.1007/s12032-017-0938-x.

    PubMed  Article  CAS  Google Scholar 

  106. Lord CJ, Ashworth A. PARP inhibitors: synthetic lethality in the clinic. Science. 2017;355(6330):1152–8. https://doi.org/10.1126/science.aam7344.

    CAS  PubMed  Article  Google Scholar 

  107. Livraghi L, Garber JE. PARP inhibitors in the management of breast cancer: current data and future prospects. BMC Med. 2015;13(1):188. https://doi.org/10.1186/s12916-015-0425-1.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  108. Mateo J, Carreira S, Sandhu S, Miranda S, Mossop H, Perez-Lopez R, et al. DNA-repair defects and Olaparib in metastatic prostate cancer. N Engl J Med. 2015;373(18):1697–708. https://doi.org/10.1056/NEJMoa1506859.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  109. Mirza MR, Monk BJ, Herrstedt J, Oza AM, Mahner S, Redondo A, et al. Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. N Engl J Med. 2016;375(22):2154–64. https://doi.org/10.1056/NEJMoa1611310.

    CAS  PubMed  Article  Google Scholar 

  110. Honrado E, Benitez J, Palacios J. Histopathology of BRCA1- and BRCA2-associated breast cancer. Crit Rev Oncol Hematol. 2006;59(1):27–39. https://doi.org/10.1016/j.critrevonc.2006.01.006.

    PubMed  Article  Google Scholar 

  111. Daly MBPR, Berry M, Buys SS, Farmer M, Friedman S, Garber JE. NCCN Clinical Practice Guidelines Genetic/Familial High-Risk Assessment: Breast and Ovarian. Version 1.2018 ed. NCCN.org 2017.

  112. Francis PA, Regan MM, Fleming GF. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med. 2015;372(17):1673–4. https://doi.org/10.1056/NEJMc1502618.

    PubMed  Article  Google Scholar 

  113. Arimidex TAoiCTG, Buzdar A, Howell A, Cuzick J, Wale C, Distler W, et al. Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol. 2006;7(8):633–43. https://doi.org/10.1016/S1470-2045(06)70767-7.

    Article  CAS  Google Scholar 

  114. Breast International Group 1–98 Collaborative G, Thurlimann B, Keshaviah A, Coates AS, Mouridsen H, Mauriac L, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med. 2005;353(26):2747–57. https://doi.org/10.1056/NEJMoa052258.

    Article  Google Scholar 

  115. • Khosrow-Khavar F, Filion KB, Al-Qurashi S, Torabi N, Bouganim N, Suissa S, et al. Cardiotoxicity of aromatase inhibitors and tamoxifen in postmenopausal women with breast cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Oncol. 2017;28(3):487–96. https://doi.org/10.1093/annonc/mdw673. This systematic review and meta-analysis evaluated cardiovascular risks associated with aromatase inhibitors compared to tamoxifen and determined the increased risk associated with aromatase inhibitors is more likely due to cardioprotective effects of tamoxifen.

    CAS  PubMed  Google Scholar 

  116. Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75. https://doi.org/10.1001/jama.2010.1237.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  117. • Rocca WA, Gazzuola-Rocca L, Smith CY, Grossardt BR, Faubion SS, Shuster LT, et al. Accelerated accumulation of multimorbidity after bilateral oophorectomy: a population-based cohort study. Mayo Clin Proc. 2016;91(11):1577–89. https://doi.org/10.1016/j.mayocp.2016.08.002. This large population-based cohort study evaluated the risk of development of multiple medical conditions following oophorectomy and determined that oophorectomy is associated with higher risk of multimorbidity.

    PubMed  PubMed Central  Article  Google Scholar 

  118. Parker WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study. Obstet Gynecol. 2009;113(5):1027–37. https://doi.org/10.1097/AOG.0b013e3181a11c64.

    PubMed  PubMed Central  Article  Google Scholar 

  119. Ingelsson E, Lundholm C, Johansson AL, Altman D. Hysterectomy and risk of cardiovascular disease: a population-based cohort study. Eur Heart J. 2011;32(6):745–50. https://doi.org/10.1093/eurheartj/ehq477.

    PubMed  Article  Google Scholar 

  120. Parker WH, Feskanich D, Broder MS, Chang E, Shoupe D, Farquhar CM, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses’ health study. Obstet Gynecol. 2013;121(4):709–16. https://doi.org/10.1097/AOG.0b013e3182864350.

    PubMed  PubMed Central  Article  Google Scholar 

  121. Matthews KA, Gibson CJ, El Khoudary SR, Thurston RC. Changes in cardiovascular risk factors by hysterectomy status with and without oophorectomy: study of women’s health across the nation. J Am Coll Cardiol. 2013;62(3):191–200. https://doi.org/10.1016/j.jacc.2013.04.042.

    PubMed  PubMed Central  Article  Google Scholar 

  122. Rivera CM, Grossardt BR, Rhodes DJ, Brown RD Jr, Roger VL, Melton LJ 3rd, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause. 2009;16(1):15–23. https://doi.org/10.1097/gme.0b013e31818888f7.

    PubMed  PubMed Central  Article  Google Scholar 

  123. Harmsen MG, Arts-de Jong M, Hoogerbrugge N, Maas AH, Prins JB, Bulten J, et al. Early salpingectomy (TUbectomy) with delayed oophorectomy to improve quality of life as alternative for risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a prospective non-randomised multicentre study. BMC Cancer. 2015;15(1):593. https://doi.org/10.1186/s12885-015-1597-y.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  124. •• Armenian SH, Lacchetti C, Lenihan D. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline summary. J Oncol Pract. 2017;13(4):270−+. https://doi.org/10.1200/Jop.2016.018770. This article identifies individuals at increased risk for cardiovascular disease and provides recommended screening guidelines.

    PubMed  Article  Google Scholar 

  125. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40. https://doi.org/10.1093/jnci/djs207.

    PubMed  PubMed Central  Article  Google Scholar 

  126. Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship. Oncology (Williston Park). 2013;27(6):580–5.

    Google Scholar 

  127. de Rezende LF, Rodrigues Lopes M, Rey-Lopez JP, Matsudo VK, Luiz Odo C. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9(8):e105620. https://doi.org/10.1371/journal.pone.0105620.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  128. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74. https://doi.org/10.3322/caac.21142.

    PubMed  Article  Google Scholar 

  129. Ritvo P, Obadia M, Santa Mina D, Alibhai S, Sabiston C, Oh P, et al. Smartphone-enabled health coaching intervention (iMOVE) to promote long-term maintenance of physical activity in breast cancer survivors: protocol for a feasibility pilot randomized controlled trial. JMIR Res Protoc. 2017;6(8):e165. https://doi.org/10.2196/resprot.6615.

    PubMed  PubMed Central  Article  Google Scholar 

  130. Hewitt MGS, Stoval E. In: Council IoMaNR, editor. From cancer patient to cancer survivor: lost in transition. Washington, D.C: The National Academies Press; 2006.

    Google Scholar 

  131. Hoerger M, Epstein RM, Winters PC, Fiscella K, Duberstein PR, Gramling R, et al. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer. 2013;13(1):188. https://doi.org/10.1186/1471-2407-13-188.

    PubMed  PubMed Central  Article  Google Scholar 

  132. Arora NK, Weaver KE, Clayman ML, Oakley-Girvan I, Potosky AL. Physicians' decision-making style and psychosocial outcomes among cancer survivors. Patient Educ Couns. 2009;77(3):404–12. https://doi.org/10.1016/j.pec.2009.10.004.

    PubMed  PubMed Central  Article  Google Scholar 

  133. Davis SW, Oakley-Girvan I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv. 2017;11(4):498–504. https://doi.org/10.1007/s11764-017-0608-1.

    PubMed  Article  Google Scholar 

  134. Baseman J, Revere D, Baldwin LM. A mobile breast cancer survivorship care app: pilot study. JMIR Cancer. 2017;3(2):e14. https://doi.org/10.2196/cancer.8192.

    PubMed  PubMed Central  Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA

    Kelly C. Gast MD & Paul V. Viscuse MD

  2. Mayo Clinic Graduate School of Biomedical Sciences, Medical Scientist Training Program, Mayo Clinic School of Medicine, Rochester, MN, USA

    Somaira Nowsheen

  3. Department of Oncology, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55095, USA

    Tufia C. Haddad MD, Andrea E. Wahner Hendrickson MD & Kathryn J. Ruddy MD, MPH

  4. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Robert W. Mutter MD

  5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Fergus J. Couch PhD

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  1. Kelly C. Gast MD
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Kelly C. Gast, Paul V. Viscuse, Somaira Nowsheen, Tufia C. Haddad, Robert W. Mutter, Andrea E. Wahner Hendrickson, and Kathryn J. Ruddy each declare no potential conflicts of interest. Fergus J. Couch reports research funding to the institution from GRAIL Inc.

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Gast, K.C., Viscuse, P.V., Nowsheen, S. et al. Cardiovascular Concerns in BRCA1 and BRCA2 Mutation Carriers. Curr Treat Options Cardio Med 20, 18 (2018). https://doi.org/10.1007/s11936-018-0609-z

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Keywords

  • BRCA mutation
  • Cardio-oncology
  • Chemotherapy cardiotoxicity
  • Radiation cardiotoxicity