Non-coding (nc) RNAs and breast cancer treatment related sequelae: Current evidence and perspectives

Breast cancer (BC) is the most common malignancy among women worldwide. Advances in multimodal treatments—including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted therapies—have significantly improved survival rates. However, these improvements are often offset by long-term side effects such as neuropathy, cardiotoxicity, and fibrosis, which greatly diminish survivors’ quality of life. Recent discoveries in non-coding RNA (ncRNA) biology have transformed our understanding of the molecular mechanisms behind both treatment effectiveness and associated toxicities. Non-coding RNAs—including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs)—regulate vital processes like apoptosis, oxidative stress, inflammation, and extracellular matrix remodeling, thereby influencing the development and progression of these complications. In this review, we provide an update on the main side effects of traditional BC treatments and compile current evidence linking ncRNAs to the molecular and cellular processes that drive these treatment-related issues, emphasizing their potential as diagnostic, prognostic, and therapeutic tools to improve survivorship and personalized cancer care.