Dr. Nadine Norton: Predicting Risk to Protect the Heart During Cancer Treatment

Cancer treatments save lives—and researchers are working to make survivorship healthier, too. Dr. Nadine Norton, a researcher at Mayo Clinic who studies cancer and genetics, is asking an important question: how can we figure out who might develop heart problems from cancer treatment before those problems start?

Dr. Norton leads the Biomarkers to Predict Cancer Therapy‑related Cardiotoxicity study. Cardiotoxicity is heart damage caused by cancer treatment. This project tries to understand why people getting the same cancer treatment sometimes have very different results—and how spotting risks early could help keep their hearts healthy without affecting their cancer care. By using genetics, genomics (the study of the complete set of DNA in person or other organism), and teamwork between oncology and cardiology doctors, Dr. Norton wants to stop heart damage before it begins, instead of just treating it after it happens.

In this interview, Dr. Norton talks about what inspires her work, how predicting risks sooner could improve a patient’s cancer experience, and why it’s so important to involve the community, build trust, and be clear when using people’s health data and samples in research.

If you had to explain your research in one sentence to a non-scientist, what would you say—and why should they care?

Beating cancer shouldn’t mean facing heart disease later, so my research focuses on identifying who is at risk for treatment-related heart damage and stopping it before it starts. People should care because surviving cancer is only part of the journey; living well afterward matters just as much.

Tell us about the "Biomarkers to Predict Cancer Therapy-related Cardiotoxicity." What motivates you personally to focus on cancer therapy–related cardiotoxicity?

I have always been fascinated by genetics and the question of why individuals with the same disease and receiving the same treatment can experience vastly different outcomes. Whether those differences arise from genetic variation, the environment, or an interplay between the two, understanding them is both scientifically compelling and clinically essential.

The project Biomarkers to Predict Cancer Therapy-related Cardiotoxicity allows me to integrate my expertise in genetics, genomics, and genome modulation (the process of temporarily turning specific genes "on" or "off," or turning up/down their activity, without changing the underlying DNA sequence itself) while collaborating with outstanding colleagues in oncology and cardiology, including Pooja P. Advani, M.B.B.S., M.D., medical oncologist, J. Christopher Ray, M.D, cardiologist, Chadi Ayoub, M.B.B.S., Ph.D., cardiologist, Amanda Arnold, senior program coordinator, and Alyssa D. McPherson, APRN, D.N.P., nurse practitioner, among many others. Together, we aim to develop a predictive tool for cardiotoxicity that can meaningfully improve patient care.

I am continually inspired by my colleagues in the Department of Cancer Biology, who have deepened my understanding of disease mechanisms (the specific ways a disease starts, develops, and causes damage to the body's cells and systems) and biology. I especially value our Monday morning lab meetings, where a dedicated and hardworking team drives this project forward with shared purpose and enthusiasm.

As we identify new biomarkers (measurable indicators in the body—like blood pressure, proteins, or DNA—that show normal processes, disease presence, or responses to treatment) of cancer therapy-related cardiotoxicity, I am equally motivated to uncover the underlying biological mechanisms. By doing so, we hope not only to predict risk but also to implement early, precision-based interventions. Ultimately, our goal is to ensure that patients can complete their cancer treatment without the burden of preventable cardiac complications and enjoy a high quality of life long after therapy ends.

How might earlier risk prediction change a patient’s cancer journey without compromising cancer outcomes?

Earlier risk prediction allows us to identify patients who are more likely to develop cancer therapy–related cardiotoxicity before heart damage occurs, rather than reacting after symptoms appear. That changes the cancer journey in several important ways—without compromising cancer outcomes.

First, it enables proactive monitoring. Patients at higher risk can receive closer cardiac surveillance during treatment, so any early signs of dysfunction are detected and managed immediately.

Second, it opens the door to preventive strategies. Cardioprotective medications and lifestyle interventions can be introduced early to reduce cardiac risk while patients continue receiving the most effective cancer therapy.

Third, it supports truly personalized care. Instead of applying a one-size-fits-all approach, oncologists and cardiologists can work together to balance efficacy and safety for each individual patient.

Most importantly, earlier risk prediction shifts the mindset from damage control to prevention—allowing patients to complete lifesaving cancer treatment with greater confidence and a better chance of long-term heart health.

When you think about “community voice” in research, what does that look like in your work — and why does it matter for studies that aim to predict side effects from cancer therapy?

Community voice means bringing patients and survivors to the table from day one, not just as study participants, but as partners who shape our research questions and methods. When we're trying to predict cancer therapy side effects, this matters enormously. Patients know which side effects truly impact quality of life versus what researchers might assume matters most. They can tell us if a prediction model is actually useful in real-world decision-making, or if we're solving the wrong problem. Without their input, we risk building elegant algorithms that miss the mark on what patients actually need to navigate their treatment journey.

How do you build trust and clarity when research involves biospecimens (a sample of material, such as urine, blood or tissue) and health information?

Building trust and clarity in research involving biospecimens and health information begins with transparency. Participants should clearly understand what is being collected, how it will be used, how their privacy will be protected, and whether their data or samples may be shared in the future.

Using plain language—not technical jargon—during consent, providing opportunities for questions, and maintaining ongoing communication about study goals and findings all reinforce respect and partnership. I draw on the many resources available at Mayo Clinic to do this well, including the Breast Research Unit, the Mayo Clinic Community Advisory Board in Florida, and my colleagues in the Mayo Clinic Comprehensive Cancer Center specialty group in Cancer Prevention, Control, and Survivorship (CPCS), led by Janice Krieger, Ph.D, professor of clinical translational science at Mayo Clinic in Florida. By partnering with these teams, we ensure that community perspectives are integrated into our research and that participants feel respected, informed, and valued throughout the process.

Research discoveries don’t happen overnight. What keeps you motivated through the long journey from question to impact?

Research discoveries don’t happen overnight, and I learned that lesson early from working with leaders in complex genetics like Professor Sir Michael J. Owen. As a lab technician, graduate student, and postdoctoral researcher in his lab, I experienced the full arc of scientific discovery—careful study design, negative results, failed attempts at replication, technical barriers, and long stretches of uncertainty.

Years later, several key elements came together to enable a breakthrough. Large sample sizes became available, along with high-quality phenotyping, which involves closely observing and recording people’s physical traits and experiences. Advances in genome-wide association technology provided tools to look across a person’s entire DNA to find genetic differences linked to disease. Additionally, collaboration across ten institutes played an essential role. With all these factors aligned, researchers identified the first gene linked to a higher risk of schizophrenia. Seeing that breakthrough after so many setbacks shaped how I approach science today.

I remind myself that progress takes time, that negative results are part of the process, and that perseverance through the “gray zone” of big data and unanswered questions is essential to finding the truth.

When I moved to the University of Miami, I was mentored by Ray Hershberger, M.D., in familial dilated cardiomyopathy, a genetic heart muscle disease where the heart’s main pumping chamber (the left ventricle) becomes stretched, thin, and enlarged. There, I was able to use my background in psychiatric genetics to study a completely different disease. Instead of focusing only on single nucleotide variants (small changes in a person’s DNA), I took a new approach by using genome‑wide copy number analysis, which looks for larger sections of DNA that are missing or duplicated. This was done using a new, high‑resolution microarray, a lab tool that allows scientists to examine many genetic changes at once.

The technology was new, the budget was limited, and there were technical hurdles to overcome. Thanks to careful study design and excellent clinical records from Dr. Hershberger’s two decades of work, we discovered a missing section of the BAG3 gene in a family with dilated cardiomyopathy that had affected three generations and previously had no known cause. That discovery reinforced for me that innovation, patience, and strong clinical partnerships can uncover answers that truly change lives.

I draw on these experiences in my current work on cardiotoxicity. They remind me that meaningful science requires time, resilience, and team science—and that the impact, when it comes, makes every setback worthwhile.

As this research continues to evolve, its potential impact is clear: helping patients complete lifesaving cancer treatment while protecting heart health and supporting life well beyond therapy. Through persistence, teamwork, and a commitment to prevention, Dr. Norton’s work is helping shape a future where surviving cancer does not come at the cost of long‑term well‑being.

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