Anthracyclines are among the most active agents for the treatment of
breast cancer; their use in combination regimens improves both disease-free and overall survival in patients with
breast cancer. Unfortunately, the clinical utility of
anthracycline use is limited by a cumulative dose-dependent
cardiac toxicity resulting in
congestive heart failure. As methods for detecting and treating
breast cancer improve, there has been a steady decline in
breast cancer mortality over the past 15 years. With an increasing number of long-term
breast cancer survivors, the number of patients experiencing
anthracycline-induced
cardiotoxicity may also continue to grow. Moreover, new agents used in the treatment of
breast cancer can potentiate
cardiac toxicity. Recently, studies of non-
anthracycline-containing regimens have been found to be effective in preventing recurrence of
breast cancer (as compared with
anthracycline-containing regimens) in patients with early-stage
breast cancer, with a reduced incidence of adverse cardiac outcomes. In this article, we summarize the incidence, presentation, and mechanism of
anthracycline-associated
cardiotoxicity. We also discuss risk factors for the development of
anthracycline-induced
cardiotoxicity and new
therapies, such as
trastuzumab, that may potentiate
cardiac toxicity. Finally, we review monitoring and preventive practices that may reduce the long-term risk of
anthracycline-related
cardiotoxicity.