Checking for Breast Cancer in Childhood Cancer Survivors
Breast cancer is a recognized complication of chest irradiation for childhood cancer. A study looking at how frequently women who had survived childhood cancer were having breast cancer screening was published in the January 28 issue of the Journal of the American Medical Association.
Those at highest risk of breast cancer are women who survived Hodgkin lymphoma through treatment with high-dose radiation. However, anyone who received radiation to the chest for cancer treatment as a child is at increased risk. This risk of developing breast cancer begins as early as 8 years after radiation treatment ends.
Because of this increased risk, the Childhood Oncology Group (COG) guidelines currently recommends surveillance for breast cancer in this group of women include:
* yearly clinical breast examination from the age of puberty until age 25 years, and then every 6 months if the survivor was treated with irradiation of at least 20 Gy to mantle, minimantle, mediastinal, chest (thoracic), or axillary fields
* annual mammography and an adjunct breast magnetic resonance imaging (MRI) starting at age 25 years or 8 years after radiation, whichever is last
The study found that almost half of female childhood cancer survivors under the age of 40 who had received chest radiation as part of their treatment are not following the recommended advice.
It is important to remember that the majority of women who've had chest radiation will never have breast cancer. Equally, important is the fact that between 12 and 20 percent will have breast cancer by age 45. The recommendations for screening is to catch any breast cancer in the early stages.
The study found that screening rates were higher among women whose physicians recommended the test. Barriers to screening are similar to any woman’s barriers – lack of insurance, time, forgot to schedule.
It is important that these young women tell their adult practitioner about their pediatric diagnosis and treatment when they transfer from pediatrician to adult practitioner. These young women need to be aware that having this radiation does put them at an increased risk of breast cancer. If she has any family history of breast cancer, it's even more important to get screened.
Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer; JAMA. 2009;301(4):404-414.; Kevin C. Oeffinger, Jennifer S. Ford, Chaya S. Moskowitz, Lisa R. Diller, Melissa M. Hudson, Joanne F. Chou, Stephanie M. Smith, Ann C. Mertens, Tara O. Henderson, Debra L. Friedman, Wendy M. Leisenring, and Leslie L. Robison
Surveillance for Breast Cancer After Childhood Cancer (editorial); JAMA. 2009;301(4):435-436; Aliki J. Taylor, MD, MPH, PhD; Roger E. Taylor, MD, MA