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Breast cancer survivorship has become a major issue, particularly in the last decade, as early detection and more effective therapies have led to an ever-increasing number of those transitioning from patient to survivor. These successes present a new challenge to the medical community, which must now deal with the long-term complications of past and current treatment modalities.

Although extremely effective in curative intent, many of these therapies result in long-term side effects. Current therapies, which often include polychemotherapeutic agents, RT, and AET, can challenge the cardiovascular system. Cardiovascular disease remains the number one cause of mortality in women in the US, although breast cancer is the most feared.21,22 Bone strength is affected secondary to prolonged estrogen blockade. As younger patients are receiving a breast cancer diagnosis, the incidence of SPMs is becoming more frequently recognized. Thromboembolism risk increases after a cancer diagnosis, and some therapies increase its risk, resulting in death secondary to embolic events.

Advanced therapies call for extended administration of recently developed oral chemotherapy agents. The medical community has been challenged to enforce a five-year regimen for estrogen blockade, and recent findings suggest that doubling the therapy to ten years may decrease recurrence and increase survival. Adherence and compliance for just five years of oral therapy have been poor, and extending such recommendations to ten years appears to be the next challenge for oncologists.

Lifestyle changes, largely focused on reducing BMI, have been demonstrated to play a significant role in extending OS after breast cancer treatment. HEALER provides a tool for clinicians to evaluate the status of survivors of breast cancer. HEALER also summarizes the proactive role that patients may take to enhance their survival.

There is a well-recognized predicted shortage of oncologists by 2020.511 Therefore, the bulk of long-term care will become dependent on the primary care physician. This shift of care means that these physicians will need to be well educated in the long-term medical issues related to breast cancer treatment. Our intent is to share the present information with all those who will be charged with survivorship care in the coming years.

Disclosure Statement

The author(s) have no conflicts of interest to disclose. 


The authors wish to acknowledge the assistance of Helene Wolf in the preparation of this manuscript, the assistance of Stephen Beebe in creating the Virchow’s triad figure, and the editorial assistance and support provided by Max L McMillen, ELS.

Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.

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