The ‘Know Your Heart’ Challenge for Breast Cancer Survivors

Breast cancer survivors need to think about heart health and so do the providers working with them. The average person loses 10% of their VO2 max (measure of the amount of oxygen the body consumes per unit of time) every 10 years, but a breast cancer patient’s VO2 max is equal to 2-3 decades of aging! (1) Chemo & hormone therapy, radiation, surgical intervention, tumors and the emotional stress associated with breast cancer treatment can all have an adverse impact on the heart, but I believe with screening, early intervention and proper training there is no glass-ceiling for the physical abilities of breast cancer patients!

By Following these 5 steps in the ‘Know Your Heart’ Challenge will help breast cancer survivors towards achieving their physical goals safely.

  1. Understand Risks

It is important for oncologists and rehabilitation practitioners to understand the cardiac risks of various medical interventions as well as their side effects. Cardiotoxicity is a general term pertaining to cardiovascular deficits associated with cancer treatment. As we know, many patients receive multiple treatment interventions that can increase their cardiotoxicity risk profile. Click here to get access to my screening form ‘Heart Health for Breast Cancer Survivors’ that I use in my clinic.

Let’s say for example, Martha undergoes a mastectomy, receives the chemotherapeutic drug Doxyrubicin (adriamyacin), has radiation to the left side of her chest wall involving the sternum, and is placed on long-term Tamoxifen. Incidence rates for cardiotoxicity with an anthracycline agent are about 25%, the patient may be at risk for coronary artery disease due to radiation of the chest wall, and Tamoxifen can also lead to arteriosclerosis and higher rates of DVT and stroke. Did I tell you that Martha also has a history of high-cholesterol and her mother passed away due to a heart attack at age 56?

This is NOT meant to scare anyone. There are many other factors that go into weighing out someone’s risk profile such as the dose of anthracycline and the rate of infusion or, when it comes to radiation, considering the depth of radiation beams, involvement of the heart and use of contemporary equipment. My goal here is to get medical and rehabilitation practitioners thinking about a holistic approach to treatment and long-term follow-up.

2. Know the baseline

Once your risk profile has been assessed it is important breast cancer patients receive a referral to a rehabilitation practitioner who can assess someone’s baseline cardiorespiratory fitness and help implement a safe training plan.

3. Monitor Signs & Symptoms

I believe in early intervention, and if the referral happens for prevention, the patient will likely not require an intensive plan of care. It is important that our patients are taught how to assess their own vitals and track their activity as well as phsyiological responses to exercise over time.

4. Communicate abnormal findings to a physician

Many signs of abnormal cardiac function are latent (undiscovered) until they are paired with symptoms and a patient goes to the doctor. Exercise (although good for us) can stress the heart, therefor rehabilitation practitioners are in an ideal position to monitor abnormal changes in vitals such as irregular heart rhythms or abnormal blood pressure responses to exercise and report them to the physician immediately. This form of screening, even a decade or two after breast cancer treatment ends, can mean earlier medical intervention and prolonged life for survivors.

5. Believe in the body’s ability to adapt

The body is INCREDIBLY adaptable. Breast cancer does not have to mean a downward spiral in perceived or actual physical health. Cardio-respiratory training can even occur DURING treatment and help alleviate other side effects of breast cancer treatment such as fatigue and joint pain. There are breast cancer survivors who have run their first marathon after treatment or report being more in tune with their body during treatment. Every cancer survivors story is unique and may benefit from a comprehensive risk assessment and education in cardio-vascular training.

If you are a breast cancer survivor or medical practitioner who has a SUCCESS STORY or TEACHING POINT please post it below! Inspiration and education will propel us forward on this journey towards achieving comprehensive care for breast cancer patients!


  1. Jones, L. W., Courneya, K. S., Mackey, J. R., Muss, H. B., Pituskin, E. N., Scott, J. M., Hornsby, W. E., Coan, A. D., Herndon, J. E., Douglas, P. S., … Haykowsky, M. (2012). Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. Journal of clinical oncology : official journal of the American Society of Clinical Oncology30(20), 2530-7.

Susannah Haarmann is a physical therapist in Asheville, North Carolina and advocate of comprehensive rehabilitation for breast cancer patients. She teaches practitioners around the world about comprehensive treatment for breast cancer patients. She is currently writing ‘The Breast Book’ which is a collection of patient education handouts on prevention, self-treatment and training during and after breast cancer treatment.