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Adverse Vascular Functional and Structural Changes Secondary to Breast Cancer and its Treatments with Adjuvant Therapy: a Systematic Review

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Abstract

Cardiovascular disease (CVD) is a leading cause of death in people with breast cancer (BCa). Vascular dysfunction and adverse arterial remodelling are important contributors to the development of CVD. Antineoplastic (chemotherapy, targeted therapies, hormonal therapies) and radiation therapies may lead to adverse vascular structural and functional remodelling in BCa survivors. This systematic review will summarize the current evidence on the effects of breast cancer and its treatments on vascular function and structure in BCa survivors. The MEDLINE, PsycINFO, CINAHL, EMBASE and EBM databases were searched. The PICO-guided search strategy included (1) Population: human studies of BCa survivors; (2) Intervention: chemotherapy, targeted therapies, radiation and hormonal therapies; (3) Comparison: healthy controls, multiple time points or BCa survivors with naive treatment status; (4) Outcomes: predefined vascular structure and function measures. Sixteen studies were identified involving participants treated with hormonal therapies, radiation, targeted therapies, anthracyclines and other chemotherapies. With the exception of tamoxifen, therapies were consistently associated with maladaptive changes in vascular structure (increases in arterial stiffness and increases in intima-media thickness) and function (endothelial dependant brachial-artery flow-mediated dilation) up to 12 months post initiating therapy. Long-term changes (>12 months) in vascular health remains equivocal, with the exception of radiation which lead to long-term deficits in vascular structure. Cytotoxic chemotherapy, targeted therapies and radiation elicit negative changes in vascular health, which may contribute to increased CVD risk in BCa survivors. Closer cardiac monitoring and optimizing cardiac risk factors through cardiac (exercise) rehabilitation is suggested to offset the CVD burden following a BCa diagnosis.

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Funding

Alis Bonsignore was supported by the Canadian Institute of Health Research Fredrick Banting and Charles Best Canada Graduate Doctoral Scholarship.

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Authors and Affiliations

  1. Faculty of Kinesiology and Physical Education, Department of Exercise Sciences, University of Toronto, 100 Devonshire Place, Toronto, ON, M5S 2C9, Canada

    Alis Bonsignore, Priya Brahmbhatt, Daniel Santa Mina, Jack Goodman & Scott Thomas

  2. Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, ON, Canada

    Alis Bonsignore, Maureen Pakosh & Paul Oh

  3. Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Priya Brahmbhatt & Daniel Santa Mina

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  1. Alis Bonsignore
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Contributions

All the authors have contributed substantially to this work and have approved the final manuscript. The authors contributed to the inception of the article (all authors), performed the literature search (MP, AB and PB), data analysis (AB and PB), and drafted and/or critically revised the work (all authors).

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Correspondence to Scott Thomas.

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This article does not contain any studies with human participants performed by any of the authors.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Medicine

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Bonsignore, A., Brahmbhatt, P., Mina, D.S. et al. Adverse Vascular Functional and Structural Changes Secondary to Breast Cancer and its Treatments with Adjuvant Therapy: a Systematic Review. SN Compr. Clin. Med. 3, 1561–1574 (2021). https://doi.org/10.1007/s42399-021-00859-7

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