Understanding Heart Health and Cancer
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Understanding Heart Health and Cancer
Prevention and monitoring
Before treatment
Your heart health may be checked before you start cancer treatment. It’s important that your treatment team knows about any existing heart problems or risk factors (e.g. high blood pressure, high cholesterol, diabetes) so they can recommend the safest and most effective cancer treatment for you.
The doctor may ask you about your risk factors for developing heart problems and any previous heart issues or cancers you’ve had. They may also suggest changes you can make to improve your heart health.
To work out your overall risk of heart problems, your doctors will consider:
- your heart health before treatment
- any risk factors you have
- if the cancer treatments could affect your heart.
If you don’t have heart concerns and your treatment plan does not include treatments that might affect your heart, you may not need to have any heart tests.
If you have risk factors for cardiovascular disease or are receiving cancer treatment that may affect your cardiovascular system, then you may need some tests. You may have these before cancer treatment starts (called baseline tests). Any further tests can then be compared with the results of baseline tests to check for any changes in your heart during and after treatment.
Cardiovascular tests you may have before treatment
Depending on the type of cancer you have and your cardiovascular risk factors, you may have one or more of the following tests before starting cancer treatment.
Blood tests
What does it check for? If your heart has existing damage or is under strain, the cells may release particular proteins (called biomarkers) into the blood.
How it is done – A sample of your blood will be collected with a needle from a vein in your arm. It will be sent to a laboratory where a pathologist will check your blood for certain biomarkers.
Electrocardiogram (ECG)
What does it check for? This shows how fast or slow your heart is beating and checks for irregular heartbeats (called arrhythmias). It can also show if you have had a heart attack.
How it is done – Several leads (electrodes) will be stuck to your chest; any hair on your chest may need to be shaved so the electrodes stick properly. The electrodes are connected to a computer that records your heart beating.
Echocardiogram (echo scan)
What does it check for? This looks at how well your heart muscle and heart valves are working.
How it is done – This is a type of ultrasound scan. The person doing the ultrasound (sonographer) will spread gel on your chest and then move a small device (transducer) over the chest. The transducer sends soundwaves to a computer to create pictures of your heart.
Cardiac magnetic resonance imaging (CMRI)
What does it check for? This scan may be done if an echo scan suggests a more serious cardiovascular problem. A CMRI shows how well the heart is pumping and if the valves are working properly. Most people will not need this test.
How it is done – This scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of your heart. During the scan, you may be injected with a dye (called contrast) to help make the pictures clearer. You will lie on a table inside a large metal tube that is open at both ends. The scan is noisy but painless.
Computerised tomography (CT) coronary angiogram
What does it check for? This scan checks for any blockages or damage in your heart and surrounding blood vessels. It may be called a CTCA.
How it is done – A small tube (cannula) will be put into a vein in your arm. You will lie on a table that slides into the CT machine. Dye (called contrast) will be injected into the cannula to help show if there is any narrowing or blockage in your heart arteries. You will be asked to hold your breath for about 10 seconds and stay still while the images are taken.
Coronary angiogram
What does it check for? This test is used to check if the arteries around your heart (coronary arteries) have narrowed or are blocked. Most people will not need this test.
How it is done – A thin, flexible tube (catheter) is inserted into the largest artery in your body (the aorta) through your wrist or the groin. It is then threaded up into the coronary arteries. A dye (called contrast) is injected into the catheter, and x-rays are taken to show up any blockages.
Exercise stress test
What does it check for? This measures how well your heart and lungs are working during exercise.
How it is done – Your heart rhythm and lung function will be monitored while you walk on a treadmill or ride a stationary bike. The appointment may take about 90 minutes, but you will only be exercising for 5–15 minutes. An echo scan might be done before and after the stress test. You will be given instructions on what you can eat or drink the day before the test.
During and after cancer treatment
After having some of the tests listed above, your risk of developing heart problems will be assessed as low, moderate, or high and very high. This helps your doctors work out a treatment plan, and how closely to monitor your heart during and after your treatment.
Your heart risk may change over time. It’s important to tell your GP or cancer treatment team if you notice any symptoms that could be related to your heart. When found early, heart problems can usually be managed and are less likely to become serious.
Ways heart problems are managed
When planning the cancer treatment, your doctor will consider your risk for heart problems, the type of cancer treatment you need and the results from any heart tests.
If there are concerns about your heart health, your doctor may:
- change the type of cancer treatment to reduce the impact on the heart
- reduce the dose of the cardiotoxic drug so it works well against the cancer but is less likely to cause heart damage
- change how the drug is given. For example, chemotherapy given through a vein in your arm (intravenously) may be delivered more slowly
- prescribe heart medicines to be taken during, and sometimes after, cancer treatment. These can be to treat existing heart problems or to prevent them from developing. Research in this area is ongoing and new drugs may become available. Your doctor will talk to you about the best heart medicine for you.
Heart protection during radiation therapy
Radiation therapy has improved over time. Lower doses of radiation are now used to effectively treat the cancer while reducing the risk to other organs, including the heart.
If you need radiation therapy to the chest (e.g. for breast or lung cancer), the heart can be protected. Shielding in the radiation machine (called a linear accelerator) may be used to block radiation reaching the heart.
A special breathing technique is sometimes suggested. This is called a deep inspiration breath hold (DIBH). You will be asked to take a deep breath and hold it for about 20 seconds while the radiation is given. This technique helps move your heart away from the treatment area, protecting it from the radiation beams.
Even if many years have passed since the cancer treatment, always tell your health professional that you have had cancer and any treatments you had. Cancer will always be part of your medical history.
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This information is reviewed by
This information was last reviewed June 2025 by the following panel: Prof Bogda Koczwara, Director, Australian Research Centre for Cancer Survivorship, UNSW, NSW; Prof Aaron Sverdlov, Cardiologist and Co-Director, Newcastle Centre of Excellence in Cardio-Oncology, Hunter New England Health and The University of Newcastle, NSW; Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre, NSW; Tamara Casey, Clinical Nurse Consultant, Breast Assessment Unit, Fiona Stanley Hospital, WA; Dr Daniel Chen, Cardiologist and Specialist in Cardio-Oncology, Prince of Wales and St George Hospitals, NSW; A/Prof Eng-Siew Koh, Radiation Oncologist, Liverpool Cancer Therapy Centre, Liverpool Hospital and University of NSW, NSW; Cynthia Leigh, Consumer; Dr David Mizrahi, Senior Research Fellow and Accredited Exercise Physiologist, The Daffodil Centre at Cancer Council NSW and The University of Sydney, NSW; Prof Doan Ngo, Co-Director, Newcastle Centre of Excellence in Cardio-Oncology, The University of Newcastle, Hunter Medical Research Institute, NSW; Peter O’Hearn, Consumer; Prof Nick Pavlakis, Medical Oncologist, Royal North Shore Hospital and Professor of Medicine, The University of Sydney, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Dr Lorcan Ruane, Cardiologist, The Prince Charles Hospital, QLD; Margaret Ryan, Nurse Practitioner, Cardio-Oncology Clinic, Prince of Wales Hospital, NSW; Dr Elysia Thornton-Benko, Specialist GP/Primary Care and Cancer Survivorship Physician, NSW; Helen Wardman, Consumer; Dr Trent Williams, Clinical Nurse Consultant, Cardiology, John Hunter Hospital, NSW; Dr Janice Yeh, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Megan Yong, Consumer.