For the millions of adults navigating cancer treatment, cardiovascular complications are already a leading cause of morbidity — yet a largely invisible class of environmental exposures may be quietly compounding that risk. A growing body of evidence now positions endocrine-disrupting chemicals not merely as carcinogens but as active modulators of the cardiovascular vulnerabilities that make cancer care so dangerous long-term.
This narrative review synthesizes experimental, translational, and epidemiological data on how major EDC classes — bisphenols, phthalates, PFAS, persistent organic pollutants, parabens, and pesticides — interact with the biological systems most relevant to cardio-oncology. These chemicals, encountered continuously through plastics, food packaging, and consumer products, interfere with hormonal signaling, vascular endothelial function, inflammatory cascades, and metabolic homeostasis. The review gives particular attention to breast cancer biology, adipose tissue dysfunction, and the molecular overlap between EDC-driven toxicity and cancer therapy-related cardiovascular injury, exploring how these exposures may potentiate or mimic the cardiac damage already associated with anthracyclines, targeted therapies, and radiation.
What makes this analysis analytically significant is the concept of the "exposome" — the cumulative environmental chemical burden a patient carries into treatment. Conventional cardio-oncology risk stratification focuses on hypertension, diabetes, and prior cardiac history, but ignores chronic low-level EDC exposure that may have already primed vascular inflammation or disrupted estrogen receptor signaling years before diagnosis. The limitation here is meaningful: as a narrative review, it cannot establish causation, and direct mechanistic evidence linking EDC burden to therapy-specific cardiotoxicity in human cohorts remains sparse. Most supporting data derive from animal models or population-level epidemiology not designed around oncology patients. Still, this represents a potentially paradigm-shifting reframing — one that argues cardiologists and oncologists should consider environmental chemical history as part of a complete cardiovascular risk profile, particularly for hormone-sensitive cancers.