Summary

Women who received chest radiation to treat a childhood cancer ought to have an annual mammogram, because they are at increased risk of breast cancer. A new study shows that this does not happen, particularly among younger women. The need for ongoing monitoring therefore should be made more clear so that childhood cancer survivors do not put themselves at risk.

Introduction

Women who are treated with radiation to the chest to deal with a childhood cancer like Hodgkin's disease face an increased risk of breast cancer. This starts as early eight years after treatment ends. By age 45, between 12-20 percent of women in this group will be diagnosed with breast cancer. As with other high risk groups, regular mammograms can help spot early breast cancers and are recommended. But we do not really know how good the take up is and whether women are putting themselves at risk of a second cancer by not attending for regular mammograms.

What was done

A group of 625 women aged 25 to 50 participating in the Childhood Cancer Survivor Study were recruited by researchers at Memorial Sloan-Kettering Cancer Center. They had all received chest radiation as part of treatment for a childhood cancer. They were given a questionnaire about their mammography history and compared with a group of childhood cancer survivors who had not had chest radiation and also a group of siblings who had not had cancer.

What was found

Among those aged 25 to 39 who had received chest radiation, 36 percent had had a mammogram in the last two years, 47 percent had never had one and only 23 percent had had one, as recommended, in the previous year. Women aged 40 to 50 were more likely to have had mammograms, with 76 percent reporting having had one in the previous two years, compared with 70 percent in the survivors not having radiation and 67 percent in the sibling group. But only just over half in the chest radiation group had had regular mammograms. This is not significantly higher than in the other two, lower risk, groups.

What this study means

Women at risk of breast cancer from chest radiation given for childhood cancer are not being appropriately screened. The reasons are not clear but doctors must make sure this patient group is aware of the risk and discover why younger women, in particular, are not attending for mammograms as often as they should.

Source

Oeffinger KC, Ford JS et al Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer