When I was diagnosed with cancer I felt I could cope and was very positive, but when they said my heart was failing as well, this was too much to bear.

At the First International Meeting on Cancer and the Heart in Houston in 2010, there were numerous excellent scientific presentations in the field of cardio-oncology,1 but the simple, yet extremely poignant words of a patient, describing her own story of chemotherapy-induced cardiomyopathy, were the ones that made the greatest impression on this author. They were also a call to arms to practitioners to build up a new interdisciplinary specialism—cardio-oncology—in which excellence in a broader concept of clinical care would be established on deep foundations of basic science. The clinical care would be broader, because cardiologists and oncologists have quite different styles of clinical care, and the depth of the basic science greater because of the contrasting perspectives of molecular and cellular scientists in these specialties.

By now, cardio-oncology has come of age with several excellent recent reviews2–6 and some formal international guidelines.7 Among the most intensively studied cancers is breast cancer. The latter is common and there has been a more than twofold rise in incidence over the last 20 years, a combination of a true absolute increase, as well as detection at earlier stages, aided by mass screening. Treatments have become significantly more effective and mortality has fallen by 50% over the last 30 years,8 but this has required more aggressive treatment regimens.

Anthracyclines

Anthracyclines (eg, doxorubicin or epirubicin) have been the mainstay of chemotherapy for breast cancer since their discovery in the 1960s. The therapeutic action of anthracyclines is thought to be mediated through their intercalation within the DNA of replicating cells. In addition, anthracyclines …