ASCO: Childhood cancer survivors lax about surveillance

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Too few childhood cancer survivors are following surveillance guidelines for cancers of the breast, colon and skin, even though their treatments may have elevated the risk of these cancers, according to research presented Monday at the 2009 American Society of Clinical Oncology (ASCO) meeting in Orlando, Fla.

"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 the study's lead author Paul Nathan, MD, staff oncologist at the Hospital for Sick Children in Toronto. "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 was a long-term follow-up study funded by the National Cancer Institute. In the 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.

According to the authors, 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 percent of those for whom a colonoscopy was recommended had one within the last five years, 46.3 percent had a mammogram within the last two years, and 26.7 percent had ever had a complete skin exam (for skin cancer, the most common radiation-associated second cancer in survivors), the researchers said.

However, they noted that 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.

Based on their findings Nathan and colleagues concluded that childhood cancer survivors are not screened adequately for second malignant neoplasms, and surveillance is "very poor amongst those at highest risk for colon, breast, or skin cancer." They recommended that survivors and their physicians need education about the importance of surveillance.