Paul Craig Nathan, MD, MSc; Kirsten Kimberlie Ness, PT, PhD; Martin Christopher Mahoney, MD, PhD; Zhenghong Li, MSc; Melissa Maria Hudson, MD; Jennifer Sylene Ford, PhD; Wendy Landier, RN, MSN, CPNP; Marilyn Stovall, PhD; Gregory Thomas Armstrong, MD, MSCE; Tara Olive Henderson, MD, MPH; Leslie L. Robison, PhD; Kevin Charles Oeffinger, MD
Acknowledgment: The CCSS is a collaborative, multi-institutional project, funded as a resource by the National Cancer Institute. The cohort was assembled through the efforts of 26 participating clinical research centers in the United States and Canada. Information on how to access and use the CCSS resource is available at http://ccss.stjude.org.
Grant Support: By the National Cancer Institute, National Institutes of Health (grant U24-CA-55727) to Dr. Robison and by the American Lebanese Syrian Associated Charities.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0953.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Nathan (e-mail, email@example.com). Data set: Available from Dr. Nathan. See www.stjude.org/ccss for description of data utilization procedures.
Requests for Single Reprints: Paul Craig Nathan, MD, MSc, The Hospital for Sick Children, Division of Haematology/Oncology, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Nathan: The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Drs. Ness, Hudson, Armstrong, and Robison and Mr. Li: St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105.
Dr. Mahoney: Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263.
Drs. Ford and Oeffinger: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
Ms. Landier: City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010.
Dr. Stovall: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
Dr. Henderson: Comer Children's Hospital at the University of Chicago, 5721 South Maryland Avenue, Chicago, IL 60637.
Author Contributions: Conception and design: P.C. Nathan, K.K. Ness, M.M. Hudson, W. Landier, G.T. Armstrong, L.L. Robison, K.C. Oeffinger.
Analysis and interpretation of the data: P.C. Nathan, K.K. Ness, M.C. Mahoney, Z. Li, J.S. Ford, W. Landier, M. Stovall, T.O. Henderson, L.L. Robison, K.C. Oeffinger.
Drafting of the article: P.C. Nathan, K.K. Ness, J.S. Ford, M. Stovall, G.T. Armstrong, T.O. Henderson, L.L. Robison, K.C. Oeffinger.
Critical revision of the article for important intellectual content: P.C. Nathan, K.K. Ness, M.C. Mahoney, M.M. Hudson, J.S. Ford, W. Landier, T.O. Henderson, L.L. Robison, K.C. Oeffinger.
Final approval of the article: P.C. Nathan, K.K. Ness, M.C. Mahoney, M.M. Hudson, J.S. Ford, W. Landier, M. Stovall, G.T. Armstrong, T.O. Henderson, L.L. Robison, K.C. Oeffinger.
Provision of study materials or patients: M.M. Hudson, G.T. Armstrong, L.L. Robison.
Statistical expertise: K.K. Ness, Z. Li, M. Stovall, L.L. Robison.
Obtaining of funding: L.L. Robison.
Administrative, technical, or logistic support: L.L. Robison.
Collection and assembly of data: M. Stovall, G.T. Armstrong, T.O. Henderson, L.L. Robison.
Nathan PC, Ness KK, Mahoney MC, Li Z, Hudson MM, Ford JS, et al. Screening and Surveillance for Second Malignant Neoplasms in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. Ann Intern Med. 2010;153:442-451. doi: 10.7326/0003-4819-153-7-201010050-00007
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Published: Ann Intern Med. 2010;153(7):442-451.
Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance.
To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm.
Retrospective cohort study.
The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986.
4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer.
Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy.
In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively.
Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer.
Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance.
The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.
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Hematology/Oncology, Cancer Survivorship, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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