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Cancer Screening Among Adults Who Have Survived Childhood Cancer FREE

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The summary below is from the full report titled “Screening and Surveillance for Second Malignant Neoplasms in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.” It is in the 5 October 2010 issue of Annals of Internal Medicine (volume 153, pages 442-451). The authors are P.C. Nathan, K.K. Ness, M.C. Mahoney, Z. Li, M.M. Hudson, J.S. Ford, W. Landier, M. Stovall, G.T. Armstrong, T.O. Henderson, L.L. Robison, and K.C. Oeffinger.


Ann Intern Med. 2010;153(7):I-42. doi:10.7326/0003-4819-153-7-201010050-00003
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What is the problem and what is known about it so far?

Treatments for childhood cancer have become more effective over recent decades. As a result, there are more adult survivors of childhood cancer. Unfortunately, these people are at risk for a second occurrence of cancer. Sometimes, the second occurrence is the result of the cancer treatments that these survivors received as children. For example, some women who survived childhood or adolescent Hodgkin disease (cancer of the lymph nodes) have a higher risk for breast cancer than does the general population of women.

Because of this increased risk, the Children's Oncology Group recommends earlier or more frequent cancer screening for adults who have survived after some types of treatments for childhood cancer. Women whose childhood cancer treatment involved receiving 20 Gy or more of radiation therapy to the chest are at high risk for breast cancer. The Children's Oncology Group recommends that these women get annual mammography beginning 8 years after treatment or at age 25 years, whichever occurs later. People whose childhood cancer treatment involved getting 30 Gy or more of radiation therapy to the abdomen, pelvis, or spine are at high risk for colorectal cancer. Colonoscopy every 5 years, beginning at age 35 years, is recommended. People whose treatment involved any radiation therapy are at high risk for skin cancer at the site of radiation. Annual skin examination is recommended. Information about whether cancer screening in childhood cancer survivors follows these recommendations is limited.

Why did the researchers do this particular study?

To find out whether cancer screening in survivors of childhood cancer follows the Children's Oncology Group recommendations.

Who was studied?

4329 men and 4018 women who survived childhood cancer. These men and women were participating in the Childhood Cancer Survivor Study, which follows people from 26 medical centers who had childhood cancer diagnosed from 1970 to 1986 and survived at least 5 years after diagnosis.

How was the study done?

The researchers gathered information about each patient's childhood cancer, treatment, and medical history to see who was at average or increased risk for breast, colorectal, or skin cancer because of the type of cancer treatment the patient had. They surveyed participants about the timing of their most recent mammography, colonoscopy, or skin examination.

What did the researchers find?

Among high-risk survivors, 46.2% of those eligible for earlier annual mammography reported having received mammography within the past 2 years. Among survivors eligible for early colonoscopy every 5 years, only 11.5% reported having received colonoscopy within the past 5 years. Among those eligible for annual skin examination, only 26.6% reported ever having received such an examination.

What were the limitations of the study?

Screening patterns were based on patient self-report, not on data from medical records.

What are the implications of the study?

Receipt of recommended cancer screening is poor among people whose childhood cancer treatment has put them at high risk for a second occurrence of cancer. Childhood cancer survivors and the doctors who care for them as adults must be educated about the Children's Oncology Group recommendations.

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