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Canadian Journal of Cardiology

Cardiovascular Late Effects and Exercise Treatment in Breast Cancer: Current Evidence and Future Directions

Published:April 01, 2016DOI:https://doi.org/10.1016/j.cjca.2016.03.014

      Abstract

      Advances in detection and supportive care strategies have led to improvements in cancer-specific and overall survival after a diagnosis of early-stage breast cancer. These improvements, however, are associated with an increase in competing forms of morbidity and mortality, particularly cardiovascular disease (CVD). Indeed, in certain subpopulations of patients, CVD is the leading cause of mortality after early breast cancer, and these women also have an increased risk of CVD-specific morbidity, including an elevated incidence of coronary artery disease and heart failure compared with their sex- and age-matched counterparts. Exercise treatment is established as the cornerstone of primary and secondary prevention of CVD in multiple clinical populations. The potential benefits of exercise treatment to modulate CVD or CVD risk factors before, immediately after, or in the months/years after adjuvant therapy for early-stage breast cancer have received limited attention. We discuss the risk and extent of CVD in patients with breast cancer, review the pathogenesis of CVD, and highlight existing evidence from select clinical trials investigating the efficacy of structured exercise treatment across the CVD continuum in early breast cancer.

      Résumé

      L’évolution des stratégies de dépistage et de soins de soutien a permis d’améliorer le taux de survie spécifique au cancer et le taux de survie globale après un diagnostic de cancer du sein au stade précoce. Ces améliorations sont toutefois associées à une augmentation de diverses formes de morbidité et de mortalité, plus particulièrement les maladies cardiovasculaires (MCV). En effet, chez certaines sous-populations de patientes, les MCV constituent la principale cause de mortalité suivant un diagnostic de cancer du sein au stade précoce et ces femmes présentent également un risque accru de morbidité liée aux MCV, y compris une incidence accrue de coronaropathie et d’insuffisance cardiaque comparativement aux populations appariées selon l’âge et le sexe. L’instauration d’un programme d’exercice physique est considérée comme une des pierres angulaires de la prévention primaire et secondaire des MCV chez un nombre important de populations cliniques. Cependant, les bienfaits potentiels d’un programme d’exercice physique sur la modulation des MCV et les facteurs de risque de MCV avant, immédiatement après et au cours des mois et des années suivant un traitement adjuvant du cancer du sein au stade précoce ont jusqu’ici été très peu étudiés. Nous traitons donc du risque et de l’étendue des MCV chez les patientes atteintes d’un cancer du sein, passons en revue la pathogenèse des MCV et mettons l’accent sur les données d’études cliniques qui ont examiné l’efficacité d’un programme d’exercice physique structuré pour lutter contre les MCV tout au long de son continuum évolutif chez les patientes atteintes d’un cancer du sein au stade précoce.
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