Research Takeaway: I received heart-damaging treatment. How often do I need an echocardiogram?

Research summary

Recent research underscores the importance of monitoring heart health before and after chemotherapy, especially for patients undergoing heart-damaging (cardiotoxic) treatments such as anthracyclinesa class of drugs used in cancer chemotherapy extracted from certain types of Streptomyces bacteria. Anthracyclines damage the DNA in cancer cells, causing them to die. Daunorubicin, doxorubicin, idarubicin, and epirubicin are anthracyclines. or trastuzumaba type of targeted cancer drug called a monoclonal antibody, used alone or with other drugs to treat certain types of breast cancer, stomach cancer, and gastroesophageal junction cancer. Brands include Herceptin, Hercessi, and Herzuma.. A 2025 study followed over 800 breast cancer survivors for an average of eight years. The researchers found that cardiac dysfunction increased over time, from 1.8% at two years after treatment to 15.3% at 15 years. Several risk factors increased the likelihood of heart damage, including pre-existing high blood pressure, race, and the use of both anthracyclines and trastuzumab.¹Bostany G, Chen Y et al. Cardiac dysfunction among breast cancer survivors: role of cardiotoxic therapy and cardiovascular risk factors. Journal of Clinical Oncology. 2025 Jan;43(1):32-45.

While current guidelines are specific about when to recommend echocardiograms before treatment, the guidelines for after treatment aren’t as clear. This study suggests that heart damage can occur before symptoms are noticeable, and risk continues for years for the highest-risk patients. The researchers emphasize the importance of early screening and extended surveillance, particularly for those with risk factors such as heart disease or genetic predisposition for heart disease.

This study calls for a shift in practice: moving from reactive monitoring (after symptoms develop) to proactive screening. They recommend echocardiograms for a period of time after treatment ends, as well as proactively lessening risks.²Minerd J. Smita Bhatia, MD, on cardiac dysfunction in breast cancer survivors—call for better surveillance. MedPage Today. September 17, 2024. Viewed January 14, 2025.

Based on this research we recommend that you have a discussion with your oncologist about your personal risk and need (if any) for cardiac monitoring.

Action you can take

If you are about to start chemotherapy, especially with drugs known to affect the heart, you can take steps to protect yourself by discussing echocardiogram screening with your oncologist. 

Here are a few ways to initiate this conversation:

1. Understand your risk factors.
   Before meeting with your doctor, make a list of any personal or family history of heart disease, hypertension, diabetes, or other cardiovascular risk factors. Even if you do not have these risk factors, cardiotoxic chemotherapy and other treatments such as radiation therapy to the chest can still affect the heart. Understanding the treatment you will be receiving is important.
2. Advocate for regular monitoring.
   Mention the findings of the 2025 study to your oncologist; these findings support the use of echocardiograms even if you don’t have pre-existing heart problems. Once you start heart-damaging treatment and after it’s completed, advocate for ongoing monitoring of your heart health. An echocardiogram is a non-invasive test that can detect early signs of damage. Discuss scheduling periodic follow-ups during and after treatment to catch any potential issues early.
3. Be aware of elevated risk if you are Black.
   The study also found that Black patients were 2.15 times more likely to develop cardiac dysfunction after chemotherapy, compared to other racial groups. If you are Black or belong to another high-risk group, be sure to emphasize this increased risk when discussing screening with your doctor.³Minerd J. Smita Bhatia, MD, on cardiac dysfunction in breast cancer survivors—call for better surveillance. MedPage Today. September 17, 2024. Viewed January 14, 2025.
4. Prepare for pushback.
   Since guidelines do not call for routine echocardiograms after treatment, your oncologist may be hesitant. Be ready to present the research and express that proactive screening can reduce long-term risks of heart disease. You can also ask for a referral to a cardiologist who specializes in oncology, known as a cardio-oncologist, for a second opinion.
5. Take steps to protect your heart.
   Download our “Protecting Your Heart” brochure ›

Being informed and advocating for your health can help prevent long-term complications from chemotherapy. An echocardiogram before you begin treatment could be an essential step in protecting your heart.

References

• Bostany G, Chen Y et al. Cardiac dysfunction among breast cancer survivors: role of cardiotoxic therapy and cardiovascular risk factors. Journal of Clinical Oncology. 2025 Jan;43(1):32-45.
• Minerd J. Smita Bhatia, MD, on cardiac dysfunction in breast cancer survivors—call for better surveillance. MedPage Today. September 17, 2024. Viewed January 14, 2025.