Heart Health and Breast Cancer: Why It Matters

Breast cancer is the most commonly diagnosed cancer in women, while cardiovascular disease remains the leading cause of death among women in Singapore. Together, they account for a large proportion of morbidity and mortality. The important thing to note is that they are connected in many ways, especially for breast cancer patients and survivors.The strong link between heart health and cancer has led to the growth of cardio-oncology - a multidisciplinary approach dedicated to protecting the heart throughout the cancer journey and improving long-term survival for cancer survivors at higher risk of heart disease.¹Why Breast Cancer Survivors Are at Higher Heart Risk Treatment-related cardiac effects of cancer therapy play a major role. Some common breast cancer treatments can affect heart health: Anthracycline chemotherapy (e.g. doxorubicin) is linked to heart damage.² Risk increases with higher cumulative doses and in patients with pre-existing cardiovascular risk factors. Trastuzumab (Herceptin) can affect cardiac function, especially when combined with other agents that affect the heart.² Unlike anthracyclines, trastuzumab-related heart dysfunction is often reversible when detected early. Radiotherapy, especially to the left side of the chest, can unintentionally affect the heart.² Modern techniques have reduced but not eliminated this risk. These effects may not appear immediately; slow, cumulative damage can develop years after treatment.²Heart-Healthy StrategiesA. Stay Active Physical activity is one of the most powerful ways to reduce cardiovascular risk after breast cancer³: Survivors who are physically active have a significantly lower risk of cardiovascular death and all-cause mortality.³ Even adding ~2,500 extra steps per day or moderate exercise can reduce risk.³ Guideline recommendation: According to the Health Promotion Board (HPB) and World Health Organisation, aim for at least 150-300 minutes of moderate-intensity aerobic physical activity per week, or 75 minutes of vigorous activity, plus strength training on 2 days/week.³B. Eat a Heart-Healthy Diet Nutrition plays a key role in cardiovascular health: Diets similar to DASH (Dietary Approaches to Stop Hypertension) or Mediterranean patterns are associated with lower risk of heart disease in breast cancer survivors.⁴ Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats, while minimising processed foods, added sugars, and excessive salt.⁴ This supports healthy blood pressure and overall heart function.C. Monitor Key Risk Factors Regular monitoring of cardiovascular risk factors is essential: Blood pressure Blood cholesterol Blood sugar Weight Physical inactivity Smoking status These factors contribute to cancer-related heart risk and can often be improved through lifestyle changes or medication.²D. Work with Your Healthcare Team Collaborating with oncology and cardiology teams improves outcomes¹,²: Tailored cardiovascular risk assessments before, during, and after treatment - including heart imaging (such as echocardiograms) and functional evaluations when appropriate - help detect issues early.² Shared-care models that involve oncologists, cardiologists, primary care, and rehabilitation professionals achieve the best long-term results.¹E. Consider Structured Rehabilitation Some programmes, called Cardio-Oncology Rehabilitation (CORE), integrate cardiovascular and cancer survivorship care¹,³: Exercise training Nutritional counselling Psychological support Education on risk factors Smoking cessation support These programmes are similar to traditional cardiac rehabilitation programmes but adapted for cancer survivors, and can reduce long-term heart risk and support overall health.Summary Breast cancer survivors face elevated long-term risk for cardiovascular disease due to treatment effects and shared risk factors.1,2 The good news is that this risk can be managed and reduced through: Regular physical activity³ Heart-healthy eating⁴ Routine monitoring of cardiovascular risk factors² Close collaboration with healthcare providers¹ Many cancer centres and breast surgeons in Singapore now work closely with cardiologists to monitor heart health during and after treatment. With proactive care, breast cancer survivors can improve long-term heart health and overall quality of life.Article reviewed by Dr Benji Lim, Interventional Cardiologist at Novena Heart Centre.References Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, et al. Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association. Circulation. 2018;137(8):e30-e66. doi:10.1161/CIR.0000000000000556. Epub 2018 Feb 1. PMID: 29437116. https://pubmed.ncbi.nlm.nih.gov/29437116/ Bostany G, Chen Y, Francisco L, et al. Cardiac dysfunction among breast cancer survivors: role of cardiotoxic therapy and cardiovascular risk factors. J Clin Oncol. 2025;43(1):32-45. PMID: 38833638. https://pubmed.ncbi.nlm.nih.gov/38833638/ Wilson OWA, Wojcik KM, Cohen CM, Kamil D, Butera G, Matthews CE , Dieli-Conwright CM , Jayasekera J, et al. Exercise and cardiovascular health among breast cancer survivors: a scoping review. Cardio-Oncology. 2025;11:24. PMID: 40012001. https://pubmed.ncbi.nlm.nih.gov/40012001/ Vo JB, Ramin C, Veiga LHS, Brandt C, Curtis RE, Bodelon C, Barac A, Roger VL, Feigelson HS, Buist DSM, Bowles EJA, Gierach GL, González ABE, et al. Dietary patterns and cardiovascular risk in breast cancer survivors. J Natl Cancer Inst. 2024;[Epub ahead of print]. PMID: 38718210. https://pubmed.ncbi.nlm.nih.gov/38718210/
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Demystifying the QT Scan: Comfort Can’t Replace Confidence

The Quantitative Transmission (QT) Ultrasound scan is often promoted as the next frontier in breast imaging - automated, radiation-free, and compression-free. For patients, the appeal is clear: no discomfort, no X-rays, and a sleek sense of innovation.But for clinicians, comfort isn’t the benchmark - performance is. And here, QT scanning still has much to prove. While it may one day complement established tools, current evidence does not support replacing mammography or standard ultrasound in breast cancer screening.What is the QT Scan?Unlike conventional ultrasound, QT Ultrasound transmits sound waves through the breast to measure how tissue absorbs and refracts them, creating detailed 3D maps of internal structure [1]. The procedure takes about 10–20 minutes, involves no radiation or compression, and is fully automated [2].It’s a patient-friendly innovation - but comfort alone doesn’t equal clinical validation.How Does it Compare to Standard Screening Tools?Mammography remains the only imaging method proven to reduce breast cancer deaths in large population studies [3] [4]. Conventional ultrasound is an established adjunct, particularly in women with dense breasts [5].QT scanning offers theoretical advantages — no radiation, greater comfort, and possible benefits in dense tissue [2] [6] [7]. However, these claims remain preliminary. No current evidence shows improved cancer detection, mortality reduction, or cost effectiveness compared with established tools.Why We Remain Cautious Unproven clinical outcomes: No studies yet show QT scanning improves survival or early detection [8]. False positives: High-resolution data can increase over-diagnosis and unnecessary biopsies [9]. Limited validation: Most studies are small or early-phase [1] [2]. No guideline endorsement: Major societies, including the NCCN and American Cancer Society, have not added QT scanning to screening recommendations [4] [5]. Access barriers: Availability, reimbursement, and standardization remain challenges [2]. Comfort Can’t Replace ConfidenceImproving comfort and reducing radiation are worthy goals, but accuracy must come first. A test that feels better but misses cancers - or triggers false alarms - risks harming the very patients it aims to help.Until QT scanning demonstrates outcomes equal to or better than mammography and ultrasound, it should remain an adjunct tool, used selectively and backed by ongoing clinical trials [10].For now, mammography remains the gold standard, supported by decades of evidence and proven mortality reduction. Innovation is vital - but in medicine, innovation must be validated.References[1] Medical Physics, Quantitative Transmission Ultrasound Tomography: Imaging and Performance Characteristics[2] Academic Radiology, Comparing Transmission Ultrasound to Mammography on Recall and Detection Rates for Breast Cancer Lesions[3] New England Journal of Medicine, Effect of Screening and Adjuvant Therapy on Mortality from Breast Cancer[4] JAMA (Journal of the American Medical Association), Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update from the American Cancer Society[5] JNCCN (Journal of the National Comprehensive Cancer Network), NCCN Guidelines Insights: Breast Cancer Screening and Diagnosis, Version 1.2023[6] Patient-Related Outcome Measures, Ultra-Low Frequency Transmitted Ultrasound Breast Imaging vs. Digital Breast Tomosynthesis: A Patient-Reported Outcome Study[7] Academic Radiology, Noninferiority of Quantitative Transmission (QT) Ultrasound to Digital Breast Tomosynthesis[8] Radiologic Clinics of North America, Emerging Technologies in Breast Cancer Screening[9] American College of Radiology (ACR), Practice Parameter for the Performance of Screening and Diagnostic Breast Ultrasound[10] ClinicalTrials.gov, Quantitative Transmission Imaging Evaluation With MRI as Supplemental Screening to Mammography (QTI-E)
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From Burden to Confidence: Combining Breast Cancer Surgery with a Breast Reduction or Breast Lift

For women with excessively large or heavy breasts (macromastia), symptoms like back, neck and shoulder pain can be a daily reality. It’s not just uncomfortable—it can cause skin irritation, strain posture, and lead to self-consciousness or even embarrassment [1].If they’re diagnosed with breast cancer and need surgery, some women choose to have a breast reduction or lift at the same time. This can help reduce discomfort and improve how their breasts look and feel.While a breast cancer diagnosis can be overwhelming, surgery can also be a chance not just to treat the disease, but to improve their overall comfort, confidence, and quality of life.What Affects Your Surgical Options?Each woman’s relationship with her body – and her journey through cancer – is deeply personal. That’s why there’s no one-size-fits-all approach – only what feels right for you.Studies show that fears of cancer returning and concerns about body image and sexuality can also play a big role in these decisions [4] [5]. Many women worry about losing their breasts or how their body may change, which can bring feelings of grief, shame, embarrassment and low self-esteem [6].The decisions you make should support both your medical needs and emotional well-being. Ultimately, the goal of breast cancer surgery is to remove the tumour while maintaining a satisfying post-operative appearance.Combining Cancer Surgery with Macromastia ReliefFortunately, for women living with large or sagging (ptotic) breasts, procedures like breast reduction (reduction mammoplasty) or breast lift (mastopexy) can be safely combined with cancer surgery [1] [7] – offering both medical treatment and meaningful relief. Do note that this is subject to eligibility and surgeon recommendation.Reduction mammoplasty removes excess breast tissue, fat and skin, creating a breast appearance that’s more balanced with the rest of the body [1]. Mastopexy lifts, reshapes and tightens the breasts for a more youthful appearance [8].While these may seem like cosmetic procedures on the surface, they can carry deeper meaning. For many women, addressing both breast cancer and macromastia in a single session can bring lasting physical relief and emotional healing, with positive outcomes well into recovery [1] [9].Breast reduction can improve physical function, alleviate pain, reduce skin complications and enhance their body image and mental health [1]. The breast lift can help restore confidence, offer a renewed sense of control and help women feel whole again [7].For women navigating breast cancer alongside macromastia, combining surgery can be a powerful way to reclaim comfort, health and self-confidence – all in one procedure.“But no matter what treatment path you take, always remember:You are brave. You are bold. You are beautiful.And you are making the choices that are right for you.”Care That Sees the Whole YouAt Solis, care doesn’t end in the operating theatre. The experienced and dedicated breast surgeons understand that healing is both physical and emotional, supporting each woman through her unique journey.Specialising in advanced surgical techniques such as oncoplastic surgery – a method that combines cancer removal with plastic surgery techniques to reshape the breast – they collaborate closely with Luma Women’s Medical Centre, where an in-house pathologist examines surgical specimens in real time to ensure complete cancer removal and reduce the need for a second surgery.This integrated approach allows for compassionate and reassuring breast care that respects your body, your choices and your well-being every step of the way.If you’re exploring your options, we’re here to help. Contact us to schedule a consultation or speak with our team about how we can support your journey.Article contributed and reviewed by Dr Lim Sue Zann, Senior Consultant & Breast Surgeon at Solis Breast Care & Surgery Centre.References:[1] National Library of Medicine, Breast Reduction[2] Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery[3] Cancer Research UK, Types of Breast Cancer Surgery[4] The Emotional Status, Attitudes in Decision-Making Process, and Their Impact on Surgical Choices in Korean Breast Cancer Patients[5] Factors influencing surgical treatment decisions for breast cancer: a qualitative exploration of surgeon and patient perspectives[6] Decision-making process for breast-conserving therapy from the perspective of women with breast cancer: A grounded theory study[7] Mayo Clinic, Breast Lift[8] Aesthetic breast surgery: putting in context—a narrative review[9] Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes
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