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Screening
Since second cancers remain a significant threat to the health of childhood cancer survivors, vigilant screening is important for those at risk. Risk for therapy-related myelodysplasia and acute myeloid leukemia usually manifests within 10 years following exposure. Most other second cancers are associated with radiation exposure. Screening recommendations include careful annual physical examination of the skin and soft tissues in the radiation field with radiographic or other cancer screening evaluations as indicated. Since outcome after breast cancer is closely linked to stage at diagnosis, close surveillance resulting in early diagnosis should confer survival advantage.[1] Mammography, the most widely accepted screening tool for breast cancer in the general population, may not be the ideal screening tool in isolation for radiation-related breast cancers occurring in relatively young women with dense breasts, hence the recommendations by the American Cancer Society to use adjunct screening with magnetic resonance imaging (MRI).[2] Thus, specialized considerations for females who received radiation with potential impact to the breast (i.e., radiation doses of 20 Gy or higher to the mantle, mediastinal, whole lung, and axillary fields) include monthly breast self-examination beginning at puberty, annual clinical breast examinations beginning at puberty until age 25 years, and then a clinical breast examination every 6 months, with annual mammograms and MRIs beginning 8 years after radiation, or at age 25 years (whichever occurs later).[3]
References
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Diller L, Medeiros Nancarrow C, Shaffer K, et al.: Breast cancer screening in women previously treated for Hodgkin's disease: a prospective cohort study. J Clin Oncol 20 (8): 2085-91, 2002.
[PUBMED Abstract]
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Saslow D, Boetes C, Burke W, et al.: American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57 (2): 75-89, 2007 Mar-Apr.
[PUBMED Abstract]
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Bhatia S, Constine LS: Late morbidity after successful treatment of children with cancer. Cancer J 15 (3): 174-80, 2009 May-Jun.
[PUBMED Abstract]
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