By Sadie Engleken, ACSM-CEP, CCES

What We Know About Breast Cancer

• Every year, breast cancer accounts for 32% of all new cancer cases in U.S. women.
• Approximately 1 in 8 women (13%) in the United States will develop breast cancer at some point in their life.
• The incidence rate continues to rise by 1% annually, however, this is even higher (1.4%) in women younger than 50.
• Breast cancer survival rates are steadily increasing. The overall 5-year relative survival rate in the United States is about 92%. For early-stage, localized breast cancer, the survival rate tops 99%.
• The #1 non-cancer-related cause of mortality in breast cancer patients is cardiovascular disease (CVD).

What We Know About Breast Cancer and Cardiac Rehabilitation

The What

Breast cancer is increasingly prevalent in the United States, but survivors are living longer thanks to better screening tools, early detection, and more targeted treatments. However, advanced treatments for improved survival can come at a cost: quality of life, physical health, and mental health. Clinical exercise professionals know exercise is an important tool to combat these changes and support quality of life from diagnosis through survivorship. Cardiovascular rehabilitation (CR) is an innovative way to support this patient population.

Over the last 25 years, the narrative has changed. It transitioned from the question “Is exercise safe?” to the statement “Exercise should be standard of care.” This is especially true for breast cancer survivors.¹ Starting at diagnosis, exercise should be incorporated in the treatment plan to reduce treatment side effects, maintain or improve physical functioning, and support mental health.^2,3 More importantly, exercise can help lower risk of breast cancer recurrence and prolong life.^4,5 The emphasis on improved quality of life and survivorship should be a foundational discussion for breast cancer patients; however, the challenge continues to be who has these discussions and where do they get their exercise care.

The Why

CVD lifestyle risk factors, including obesity, physical inactivity, and poor diet or regular alcohol consumption and smoking do not cause breast cancer, but they can increase the risk of a breast cancer diagnosis.^6,7 CR professionals are uniquely positioned to provide patient education and support the heart health of breast cancer patients during and following cancer treatment.

Breast cancer patients also have a heightened risk of damage to their heart health because of the effects of cardiotoxic treatments included in their care. These include certain chemotherapy drugs (anthracyclines like adriamycin/doxorubicin and taxane drugs including paclitaxel/taxol), targeted therapies (herceptin/trastuzumab and enhertu), immunotherapies (keytruda/pembrolizuma), and left-sided chest radiation. These treatments are known to cause myocarditis, arrhythmias, and heart failure.^6,8,9 It is becoming more common for cardiology to be involved in these patients’ care due to the high risk of cardiotoxicity. This includes referrals for medications, labs, cardiac imaging, and if needed intervention.

The combination of heart damage from breast cancer treatments and lifestyle risk factors is one of the reasons CVD is the leading non-cancer cause of death and a major competing risk for mortality in this population.^6,10,11

The How

To support the heart health of those affected by breast cancer, cardiac rehab is a great place to start. For some, Phase 2 may be what they need because they have experienced a heart event or are in heart failure, but why not be more proactive? Having a cancer exercise program as part of cardiac rehab for prevention is a model heart health exercise experts should consider. The American College of Sports Medicine in partnership with the American Cancer Society offers a Cancer Exercise Specialist Course to prepare staff to work with this population. There are also a growing number of resources designed to assist in exercise prescription, but a great place to start is the Brown Phase Program out of the University of Northern Colorado Cancer Rehabilitation Institute that includes FITT Principle guidelines for on and after-treatment plans. If your hospital has a cardio-oncology department, connect with staff about sharing patient information and getting referrals. As the number of exercise professionals interested in offering cancer rehab services grows, finding a home for them to provide this care in cardiac rehab is a critical step toward getting patients the quality care they need.

Sadie Engelken is a clinical exercise physiologist and cancer exercise specialist. She built and runs the inpatient and outpatient cancer exercise programs as part of the Cardiopulmonary Rehabilitation Department at CommonSpirit-Memorial Hospital in Chattanooga, Tennessee. In addition to this role, Sadie also provides virtual cancer exercise coaching for PrehabRx. 

REFERENCES

1. Navarro-Martínez C, Villarejo-García DH, Becerra-Patiño BA, Pino-Ortega J. (2026). Research Trends in Physical Activity and Breast Cancer: A 25-Year Bibliometric Analysis (2000-2025). Clinical Oncology 56 104208: https://doi.org/10.1016/j.clon.2026.104208
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