A French national breast and thyroid cancer screening programme for survivors of childhood, adolescent and young adult (CAYA) cancers - DeNaCaPST programme

Abstract

BackgroundSurvival of childhood, adolescent and young adult (CAYA) cancers has increased with progress in the management of the treatments and has reached more than 80% at 5 years. Nevertheless, these survivors are at great risk of second cancers and non-malignant co-morbidities in later life. DeNaCaPST is a non-interventional study whose aim is to organize a national screening for thyroid cancer and breast cancer in survivors of CAYA cancers. It will study the compliance with international recommendations, with the aim, regarding a breast screening programme, of offering for every woman living in France, at equal risk, an equal screening.MethodDeNaCaPST trial is coordinated by the INSERM 1018 unit in cooperation with the LEA (French Childhood Cancer Survivor Study for Leukaemia) study’s coordinators, the long term follow up committee and the paediatric radiation committee of the SFCE (French Society of Childhood Cancers).A total of 35 centres spread across metropolitan France and la Reunion will participate. FCCSS (French Childhood Cancer Survivor Study), LEA and central registry will be interrogated to identify eligible patients. To participate, centers agreed to perform a complete “long-term follow-up consultations” according to good clinical practice and the guidelines of the SFCE (French Society of Children Cancers).DiscussionAs survival has greatly improved in childhood cancers, detection of therapy-related malignancies has become a priority even if new radiation techniques will lead to better protection for organs at risk. International guidelines have been put in place because of the evidence for increased lifetime risk of breast and thyroid cancer. DeNaCaPST is based on these international recommendations but it is important to recognize that they are based on expert consensus opinion and are supported by neither nonrandomized observational studies nor prospective randomized trials in this specific population. Over-diagnosis is a phenomenon inherent in any screening program and therefore such programs must be evaluated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3318-1) contains supplementary material, which is available to authorized users.

A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility

“…Participation in various studies was also collected, including the maintenance of a tumor bank. In the framework of certain studies (local or national), self-questionnaires (on, e.g., experience with the screening of second tumors in the framework of the DeNaCaPST study [ 16 ]) are given to the patient, which can be answered directly in the software via a dedicated interface for the patient, or in the near future (as in the case of the follow-up of patients after hematological pathologies, LEA study [ 17 ]).…”

Review of risk factors of secondary cancers among cancer survivors

“…26,27 In the CCSS cohort, among the 1230 female survivors exposed to chest radiotherapy, the cumulative incidence of breast cancer was 30% by age 50, or a cumulative incidence of 35% among the survivors of HL, which is comparable to that of BRCA mutation carriers in the general population. [28][29][30][31][32] The risk of developing secondary sarcoma increases with the dose received by the organ, and the risk is 30-fold higher after 44 Gy than 14 Gy. [33][34][35][36] In the CCSS case-control study, radiotherapy is a risk factor for secondary sarcoma with an OR of 15.6 (95% CI, 4.5-53.9) for 10-29.9 Gy, which increases to 114.1 (95% CI, 13.5-964.8) for doses >50 Gy.…”

“…84 Some national programmes are ongoing to help follow these recommendations. 30 For the thyroid, the exact screening is discussed bec'ause of the small speed of development. Most of the recommendations agree with ultrasound screening every 2 to 5 years.…”

Healthcare system barriers of breast and thyroid screening for childhood and young adulthood cancer survivors in France: A qualitative study of the DeNaCaPST programme at one year

“…Breast cancer screening for childhood, adolescent and young adult cancer survivors (CAYACS) is the subject of numerous articles. Many institutions, including the COG (Children's Oncology Group), UK CCSG (Children's Cancer and Leukaemia Group), NCI (National Cancer Institute), ACS (American Cancer Society), HAS (French High Authority of Health) and SFCE (French Society of Childhood Cancer) recommend breast screening for women at a high and early risk; this was resumed in the harmonisation of international guidelines [1,5]. Hodgson, et al.…”