Low rates of screening among childhood cancer survivors

1 Jun 2009

A new report from the Childhood Cancer Survivors Study has found that too few survivors of childhood cancer are undergoing recommended screening for cancers of the breast, colon and skin, even though the treatments they received (particularly radiation therapy) may have elevated their risk of these cancers.

"We were surprised to find that many survivors of childhood cancer are not following surveillance guidelines that may detect new cancers during their earlier, more curable stages," said Paul Nathan, MD, MSc, staff oncologist at the Hospital for Sick Children in Toronto and the study’s lead author, speaking at the American Society of Clinical Oncology annual meeting. "Many of these survivors are seen by their family physicians, who may not have full knowledge of the recommended surveillance for childhood cancer survivors. Survivors and their physicians should be aware of what cancer they had, exactly what treatments they received, their risk of second cancers and the surveillance tests they should be receiving."

The Childhood Cancer Survivor Study is a comprehensive, long-term follow-up study funded by the National Cancer Institute. In this analysis, investigators surveyed cancer screening behaviors among 8,318 survivors who were originally diagnosed between 1970 and 1986, 2,661 of their siblings, and 8,318 controls from the 2003 National Health Interview Survey.

Many survivors of childhood cancer are at increased risk for a second cancer because of their treatment and should follow Children’s Oncology Group guidelines (which vary significantly by treatment exposure, but include recommendations for increased surveillance for breast, colon, and skin cancers based on risk). Among survivors at increased risk for a second cancer who should have been following these surveillance guidelines, only 11.5 per cent of those for whom a colonoscopy was recommended had one within the last five years, 46.3 per cent had a mammogram within the last two years, and 26.7 per cent had ever had a complete skin exam (for skin cancer, the most common radiation-associated second cancer in survivors). High-risk patients were more likely to seek mammography or a skin exam if they were receiving their routine medical care at a cancer center.