New Risk Prediction Tool Identifies Breast Cancer Survivors Most Likely to Develop Heart Failure Within 10 Years

A newly developed risk prediction tool may help identify which breast cancer (search)Search disease survivors are most likely to develop heart failure (search)Search disease or cardiomyopathy (search)Search disease within a decade of completing treatment, according to a study published in JAMA Oncology. The research, involving more than 26,000 women with early-stage breast cancer in California, addresses a growing concern in oncology: the cardiovascular toll of life-saving cancer therapies.

The tool assigns women to low, medium, or high risk categories based on a constellation of clinical factors, and was found to correctly classify patients in nearly 80% of cases during validation testing.

"Anyone who has a high risk and people with a medium risk who are in the younger category [diagnosed before age 54] should consider seeing a cardiovascular specialist," said Ana Barac, MD, a cardio-oncologist at Inova (search)Search term and co-author of the study.

Key Risk Factors Identified

The researchers identified several factors that elevate a woman's chances of developing heart failure (search)Search disease following breast cancer (search)Search disease treatment: diagnosis at age 65 or older, high blood pressure, pre-existing heart conditions, diabetes, obesity, history of smoking, treatment with chemotherapy (particularly anthracyclines (search)Search drug), and treatment with anti-HER2 (search)Search target therapies.

Importantly, receiving chemotherapy or anti-HER2 (search)Search target therapies does not automatically place a patient in a higher risk category. "You have to look at the whole picture to know your risk," the researchers emphasized.

Guiding Treatment Decisions

The model is designed not only to stratify risk after treatment but also to inform upfront therapeutic decision-making. For a woman younger than 54 without additional risk factors such as hypertension or diabetes, a physician may have fewer concerns about using anthracycline chemotherapy, which remains one of the most effective agents against breast cancer (search)Search disease. In such cases, the survival benefits would likely outweigh the cardiac risks.

Even when a treatment would push a patient into the high-risk category, it may still represent the best option for her overall health. "The point of this score is to facilitate that decision-making," Barac said.

The tool is intended for use by healthcare professionals. Barac recommends that patients share the study with their oncologist, cardiologist, or primary care provider to discuss their risk category and whether any changes to heart health management are warranted.

Modifiable Risk Factors and Monitoring

One of the study's most actionable findings concerns modifiable risk factors. Patients with high blood pressure, for instance, can take steps to manage it through medication, weight loss, and dietary changes. For those identified as high risk, Barac advises against panic: "Take this as a sign that you should see a cardiologist." Specialists can employ blood tests or imaging to monitor cardiac function and help patients reduce their risk of heart failure (search)Search disease.

Emerging Role of Blood Biomarkers

Complementing the risk prediction tool, a separate small study—not yet peer-reviewed—suggests that routine blood tests and electrocardiograms (ECGs) could detect cardiac stress earlier during breast cancer (search)Search disease treatment. Researchers followed 50 women with stage 1 to 3 breast cancer through six cycles of chemotherapy, measuring cardiac troponin I (search)Search target, a protein released into the bloodstream when heart muscle cells are injured.

Troponin levels rose during treatment, and ECG abnormalities became more common, including prolonged QT intervals, which can increase the risk of dangerous irregular heartbeats. While larger studies are needed to confirm these findings, the research adds to evidence that signs of heart stress can sometimes be detected before a patient develops symptoms such as breathlessness, fatigue, or palpitations.

A 2004 report first identified troponins as promising biomarkers in this setting, and a later clinical study found that persistently elevated troponin levels during high-dose chemotherapy predicted a decline in left ventricular ejection fraction, the heart's main pumping capacity.

A More Personalized Monitoring Approach

Established cardiac monitoring methods remain essential. Left ventricular ejection fraction, typically assessed via echocardiogram, is a cornerstone of heart surveillance during cancer treatment. However, LVEF can remain normal while subtler changes develop. Global longitudinal strain, which examines how well the heart muscle squeezes and relaxes, may reveal changes before they appear in ejection fraction measurements.

Blood tests and ECGs provide additional diagnostic pieces. An ECG is quick, painless, and widely available, and may help identify patients who need closer observation, particularly given that some chemotherapy drugs can disrupt electrical activity in heart cells.

The emerging field of cardio-oncology increasingly tailors monitoring to each patient's individual risk profile, considering existing heart health, age, blood pressure, diabetes risk, and prior exposure to potentially cardiotoxic treatments. If rising troponin levels or ECG changes are detected, clinicians may increase testing frequency, refer to a cardiac specialist with cancer care expertise, or consider cardioprotective treatments—all while aiming to continue effective cancer therapy whenever possible.

As breast cancer (search)Search disease survival rates continue to improve, protecting long-term heart health has become an increasingly urgent priority. The goal, as experts in the field articulate it, is no longer simply surviving cancer—it is maintaining heart health long after treatment has ended.