Breast Cancer Screening in Childhood Cancer Survivors – an Article Review

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Breast cancer is a recognized complication of chest irradiation for childhood cancer.  The article by Dr Kevin C. Oeffinger and colleagues (first reference below) was recently published in JAMA.  Their stated objective was:

To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening.

To do this, they used a 114-item questionnaire which was given to a random sample of 625 women (551 participated in the study, response rate, 88.2%).  This was done between June 2005 and August 2006, and included women aged 25 – 50 years of age who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS).  CCSS is a North American cohort of long-term survivors diagnosed from 1970-1986.   They then compared these women to 639 similarly aged pediatric cancer survivors who had not been treated with chest radiation (561 participated, response rate 87.8%)  and 712 siblings of the  CCSS cohort (622 participated, response rate, 87.4%).

Breast cancer surveillance practices, including screening and diagnostic mammograms, were characterized using 25 questions adapted from the National Health Interview Survey 2000 Cancer Control Module .

Childhood Oncology Group (COG) guidelines currently recommend 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 effectiveness of the standard mammogram in detecting pre-invasive and invasive breast cancer is known to be relatively poor in young women due to the density of breast tissue in this age group.  This  increases the importance of MRI in the detection and diagnosis of breast cancer in younger women with dense breast tissue.

Results from the survey showed
Among women aged 25-39 years with chest RT

• only 36.5%  reported a screening mammogram within the past 2 years
• 47.3% of  had never had a mammogram
• only 23.3%  of had a screening or diagnostic mammogram within the previous year

Among women aged 40 through 50 years with chest RT

• 76.5%  reporting a screening mammogram within the past 2 years
• only 52.6% engaged in regular screening (at least 2 mammograms within 4 years)

Key characteristics -- predictor of screening mammography

• Age was an important predictor of screening mammography. For each 5-year incremental increase in age, the likelihood of reporting a mammogram increased nearly 2-fold.
• The strongest predictor of mammography in women aged 25 through 39 years was having a physician recommend the test.

Barriers to having screening mammogram

The 2 most important barriers ranked by women in this age group who did not have a mammogram in the previous 2 years were "put it off" or "didn't get around to it" (27%) and "too expensive" or "no insurance/cost" (17%).

This article is an important reminder of the ongoing health issues of childhood cancer survivors. 

REFERENCES
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


Related Blog Posts:
Breast Self-Exam (BSE)
Mammograms