, 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.

Investigators from the Childhood Cancer Survivor Study (CCSS) examined adherence to recommended screening practices in adult survivors of childhood cancers. The CCSS cohort includes individuals who were diagnosed with cancer prior to their 21st birthday at 1 of 26 centers in the United States and Canada from 1970 to 1986 and who were alive at least 5 years from their original diagnosis. In female childhood cancer survivors at average risk for cervical and breast cancer, recommended screening was based on United States Preventative Services Task Force (USPSTF) guidelines.1 In female survivors who were at high risk for breast cancer, and male and female survivors at high risk for colorectal cancer, malignant melanoma, or nonmelanoma skin cancer, the Childen’s Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers were used.2 

Eligible participants in this study included 8,347 individuals who completed a questionnaire that addressed cancer screening and surveillance practices and who had not developed a new neoplasm. The mean age at cancer diagnosis in study participants was 8.1 years in men and 7.6 years in women. The mean age at time of questionnaire completion was 31.5 years in men and 30.8 years in women. In women who were at average risk of developing cervical or breast cancer, 81% and 67% reported receiving a Papanicolaou smear and mammography, respectively, within the recommended time period. Among women who were at increased risk for breast cancer, 42.6% reported receiving mammography within the recommended time period. Only 11.5% of the study participants who were at high risk for colon cancer reported undergoing colonoscopy within the recommended time period. For individuals who were at risk for skin cancer, 26.6% reported ever having a complete skin examination of all irradiated areas. Older age was associated with an increased likelihood of receiving mammography and colonoscopy. Individuals with a copy of their cancer treatment summary had an increased likelihood of receiving colonoscopy and skin examination, while those receiving medical care at a cancer center in the past two years were more likely to receive a skin examination.

The authors conclude that female childhood cancer survivors who are not at an increased risk of a second neoplasm have reasonable adherence to recommended screening for breast and cervical cancer. However, childhood cancer survivors at high risk of developing a second neoplasm of the breast, colon, or skin have poor adherence to recommended screening practices.

Dr Geskey has disclosed no financial relationship relevant to this commentary; he is on the Speakers’ Bureau for Glaxo-Smith Kline. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Adult preventive cancer screening in the primary care setting for childhood cancer survivors...

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