BACKGROUND: We did a retrospective medical record and echocardiogram review of patients with history of anthracyclines and/or radiation seen in a long-term survivor clinic from 2000-2007. OBSERVATIONS: Three hundred eight out of three hundred seventy (83.2%) patients had received at least 1 screening echocardiogram, and 24/308 (7.8%) patients had an abnormal echocardiogram. Observed risk factors for a future abnormal echocardiogram included anthracycline dose > or =250 mg/m2 and underweight status (BMI <5th%) at follow-up. Age, gender, radiation, anthracycline type, history of relapse, and history of stem cell transplant were not risk factors. CONCLUSIONS: Our results confirm the dose-dependent risk of anthracyclines, and describe a novel association with underweight status.