TY - JOUR T1 - Cardiotoxicity: precision medicine with imprecise definitions JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2018-000774 VL - 5 IS - 2 SP - e000774 AU - Robin Chung AU - Arjun Kumar Ghosh AU - Amitava Banerjee Y1 - 2018/07/01 UR - http://openheart.bmj.com/content/5/2/e000774.abstract N2 - Cardiovascular diseases (CVD) and cancer are the two leading disease burdens worldwide. Epidemiological and demographic transitions, improved survival and better screening at health system level are among the factors leading to increasing overlap between these separate conditions, both in terms of aetiology and outcome. The number of cancer survivors will rise to 19 million in the USA by 20241 and four million in the UK by 2040.2 New immune, biological and small-molecule therapies as well as existing chemotherapies alike have increased the proportion of cancer survivors for whom morbidity and mortality from CVD (‘cardiotoxicity’) supersedes that arising from cancer. A new medical specialty has evolved, involving multidisciplinary teams from both oncology and cardiology. Cardio-oncology recognises that today’s cancer patient is tomorrow’s cardiac patient and aims to prevent, diagnose and treat cardiotoxicity.‘Cardiotoxicity’ was first coined to describe the cardiac toxicity from local anaesthetics, mercurial diuretics and digitalis in 1946. In the 1970s, the term was also used to describe the cardiac complications associated with anthracyclines (daunorubicin and doxorubicin), combination therapy (doxorubicin and radiotherapy) and for 5-fluorouracil. Early reports of ‘cardiotoxicity’ were predicated on the clinical syndrome of heart failure (HF), and later led to the development of a lifetime cumulative limit for anthracycline dose, although adverse cardiac effects can arise at lower doses.There are already targeted, immune-mediated, biologically active small molecule, and monoclonal antibody therapies for over 200 recognised cancers,3 and ‘precision medicine’ (which uses information about a person’s genes, proteins and environment to prevent, diagnose and treat disease4) promises further advances. Unfortunately, the same precision is currently lacking in the prediction, prognosis and treatment of cardiotoxicity and in the very definition of ‘cardiotoxicity’ itself. Cardio-oncology is a useful lens to study … ER -