Cardio-Oncology: Risk Stratification, Guideline Recommendations, and Exemplifications in Breast Cancer and Chronic Lymphatic Leukemia – An ad hoc Expert Opinion

Cardio-oncology is a rapidly developing subspecialty addressing the growing burden of cardiovascular disease (CVD) in cancer patients exposed to cardiotoxic therapies.Since the creation of the European Society of Cardiology (ESC) Council of Cardio-Oncology in 2018, the field has advanced significantly, with the 2022 ESC Cardio-Oncology Guidelines and the 2024 ESC Core Curriculum defining standards of care and specialist training.Multidisciplinary collaboration remains central, integrating expertise from cardiology, oncology, hematology, and radiology.Breast cancer illustrates the challenges of survivorship, as long-term outcomes are increasingly limited by CVD.Anthracyclines, human epidermal growth factor receptor (HER) 2-targeted agents, immune checkpoint inhibitors, and radiotherapy contribute to diverse cardiotoxicities, including heart failure, arrhythmias, and vascular disease.Risk stratification tools, biomarkers, and imaging enable early detection, but further validation across patient populations is required.The ESC guidelines recommend structured assessment, surveillance, and preventive strategies, yet widespread implementation is hindered by limited high-quality and sometimes conflicting evidence, scarce dedicated services, and underdeveloped training programs.Similar challenges are evident in malignant hematology, where Bruton tyrosine kinase inhibitors carry significant cardiovascular risks.Overall, cardio-oncology emphasizes balancing effective cancer therapy with cardiovascular safety.Continued research, interdisciplinary collaboration, and dedicated care models are essential to improving long-term outcomes in this complex patient population.