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Improvements in detecting and treating breast cancer have resulted in substantial reductions in breast-cancer mortality. However, many therapies used in early breast cancer — including anthracycline-containing chemotherapy regimens, radiation therapy, and newer agents such as trastuzumab (Herceptin) — can have detrimental cardiac effects. This state-of-the-art paper reviews the risks associated with these therapies.
For example, anthracyclines have been associated with a 0% to 1.6% incidence of clinical heart failure, but recent data suggest that as many as 10% to 50% of patients experience a greater than 10% decline in ejection fraction. Although modern techniques reduce radiation exposure, such therapy still is associated with increased ri…