Possible late effects of breast cancer treatment on the heart
Some treatments for breast cancer may increase the risk of getting heart problems years later. Small changes to your lifestyle can help to reduce the risk of these problems and of other health problems.
You will have been monitored closely during and after treatment to reduce the risk of heart problems developing. Most women won’t ever experience any effects on the heart. But it may help to understand more about them and how you can help look after your heart.
You can find out more about the treatments and side effects that can potentially affect the heart:
The standard chemotherapy for early breast cancer usually includes drugs known as anthracyclines (epirubicin or doxorubicin). This is an effective treatment for breast cancer as evidence shows that these drugs are better at reducing the risk of it coming back.
In some women, treatment with anthracyclines may result in slight damage to the heart muscle. Because these changes are slight, they usually don’t cause any immediately noticeable effects. But, they may lead to an increased risk of heart problems developing much later in life.
The most important risk factors for heart problems developing in the future are pre-existing heart disease, including high blood pressure. Women at risk are carefully monitored before and during their treatment to find out if their treatment needs to be changed. And many women who have these drugs won’t ever experience heart problems.
After radiotherapy to the chest, there is a very small risk of damage to the heart muscle or the major blood vessels around the heart. This is only a potential problem if you’ve had cancer in your left breast, as the heart is on the left side of the chest. Radiotherapy is now very carefully planned, so that the heart is either not within the radiation area or only a small amount of the heart will receive any radiation. As a result, the risk of developing any heart problems is now very low.
Having an early menopause due to your treatment may also increase the risk of heart problems. This is because oestrogen and progesterone help protect the heart. Hormonal drugs, called aromatase inhibitors, may also increase the risk of high cholesterol, which can lead to heart problems.
Trastuzumab (Herceptin) can cause changes in the heart, particularly in women who already have heart disease. Because of this, it’s not given to women with some types of heart conditions. Tests are done before treatment and women are checked regularly throughout and after treatment.
If heart problems occur during treatment with trastuzamab, they are usually temporary, improve with medication and get better after treatment finishes.
We’ve included a list of symptoms that can be linked with heart problems. But they can be caused by lots of other things. As problems can occur many years after treatment, you may need to remind your doctor about the cancer treatments you’ve had.
Let your doctor know if you have any of these symptoms:
feeling your heart beating fast, hard or irregularly
pain or discomfort in your chest
getting breathless, for example when climbing stairs
feeling weak or dizzy
getting tired very easily
swelling of your feet and lower legs.
If you have heart problems, your doctor will refer you to a heart specialist (cardiologist).
Making small changes to your lifestyle can reduce your risk of developing heart problems. And, even if you already have problems, small changes can help to reduce your risk of further problems.
Look after yourself by keeping physically active, eating a healthy diet, not smoking, reducing your stress and being aware of the dangers of drinking too much. The British Heart Foundation has lots of information and advice on keeping your heart healthy.
Keep physically active
Physical activity can help your heart health and has other benefits too. It helps you to keep to a healthy weight and reduces your risk of bone thinning (osteoporosis). It can reduce stress and improve fatigue and you’ll look and feel better.
There’s also some evidence that regular exercise may help to reduce the risk of breast cancer coming back as well the risk of getting some other cancers.
Our section on physical activity has more information about the benefits of exercise.
This helps to protect your heart and keeps your weight healthy as well. Try to eat five portions of fruit and vegetables a day, more chicken and fish (especially oily fish) and high fibre foods. Eat less saturated fats (such as pastries, cakes, cheese), less red and processed meat and cut down on salt.
After breast cancer, some women want to know if they should avoid dairy foods or if there’s a particular diet they should follow. Studies that have looked for a connection between diets that are high in dairy products and breast cancer haven’t shown a clear link. So cancer experts don’t recommend following a dairy-free diet. Dairy products are also a good source of calcium, which is important for bone health.
There’s also a lot of publicity about alternative diets for treating cancer, but there’s no evidence that they increase a person’s chance of survival. Some of these diets may lack important nutrients or be unbalanced in other ways and may even be harmful.
Doctors and specialist nurses recommend a healthy, well-balanced diet and one that you enjoy.
Our section on eating well has more helpful advice on nutrition.
Cut down on alcohol
Too much alcohol can cause heart problems and it’s also high in calories. There’s some evidence that drinking small amounts of alcohol might help to reduce the risk of heart disease, at least in middle-aged people. Stick to sensible drinking. Current guidelines recommend that men drink less than 3 units of alcohol per day, or 21 per week, and women drink less than 2 units per day, or 14 per week.
Give up smoking
If you smoke, stopping is the healthiest decision you can make. It’s one of the major risk factors for heart disease. Stopping smoking also reduces your risk of developing lung disease, bone thinning (osteoporosis) and smoking-related cancers. You’ll also feel and look better.
Giving up smoking isn’t easy but you can increase your chance of success by preparing for possible problems in advance, and making sure that you have support in place to help you overcome them. Using a treatment to reduce cravings can double your chances of success. There’s a range of treatments available on prescription. Your GP can tell you about them and help you choose the one that’s best for you.
Our section on giving up smoking has more advice and tips to help you succeed.