Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30 years of life: A French multicentre cohort study

Supiot, S.; Oberlin, Odile; Helfre, Sylvie; Vigneron, C.; Brillaud-Meflah, Victoire; Bernier, V.; Laprie, Anne; Ducassou, A.; Claude, L.; Mahé, M.‐A.; Vathaire, Florent de

doi:10.1016/j.radonc.2017.06.028

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Nevertheless, more than mortality, we can expect an improvement regarding morbidity and quality of life because smaller cancers are diagnosed before the age of 40: < 2 cm in 34.12% without early screening versus 81.66% with sameday annual mammography and MRI; diagnosed with positive nodes: 44.15% without any early screening versus 11.73% with same-day annual mammography and MRI. This is in line with our previous study [10]. Regarding thyroid cancer screening, the international group for harmonisation of guidelines recommends that CAYACS should be counselled regarding their increased risk of STC and their options for STC surveillance [3].…”

Section: Introductionsupporting

confidence: 89%

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

Demoor-Goldschmidt¹,

Berger²,

Guichard³

et al. 2020

Clin Res Trial

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Purpose: Childhood, adolescent and young adult cancer survivors (CAYACS) who were treated by radiotherapy have a significant risk of developing subsequent malignancies, particularly breast and thyroid cancers when the field of irradiation concerned these organs. Advice regarding their increased risk of developing secondary breast (SBC) and thyroid (STC) cancer are recommended to ensure risk-stratified life-long follow-up care including appropriate screening. In France, a national program called DeNaCaPST was started to promote this care. We aimed to explore the perspectives of medical practitioners (MP) on the healthcare system factors that limited inclusion in this programme.Methods: Data of the DeNaCAPST programme regarding organisation were studied, including data from a qualitative survey done among MP.Results: Seventeen months after the DeNaCaPST programme started, 84.6% of the French regions had participating centres/hospitals, along with one overseas territory. The main barriers to screening highlighted by MP were: 1) inconvenient and under-resourced healthcare professionals to perform these consultations, (2) difficulty determining which CAYACS need SBC and/or STC screening, (3) difficulty organising the network of professionals from paediatric to adult health services.Conclusions: Despite a slow inclusion speed and a suboptimal geographical coverage, changes are underway and should allow for several improvements and interesting perspectives for this study. CAYACS lost to follow-up are difficult to invite for a consultation. The absence of real long-term follow-up care is a real barrier to promoting such screening, which must involve a transition care between the paediatric oncologists who know who are at risk and why and the adult medical professionals who have the knowledge to do the screening. The involvement and empowerment of CAYACS is necessary to promote patient-centred healthcare solutions and seems feasible.

show abstract

Section: Introductionsupporting

confidence: 89%

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

Demoor-Goldschmidt¹,

Berger²,

Guichard³

et al. 2020

Clin Res Trial

View full text Add to dashboard Cite

show abstract

“…Nevertheless, more than mortality, we can expect an improvement regarding morbidity and quality of life because smaller cancers are diagnosed before the age of 40: < 2 cm in 34.12% without early screening versus 81.66% with same-day annual mammography and MRI; diagnosed with positive nodes: 44.15% without any early screening versus 11.73% with same-day annual mammography and MRI. This is in line with our previous study [10]. Regarding thyroid cancer screening, the international group for harmonisation of guidelines recommends that CAYACS should be counselled regarding their increased risk of STC and their options for STC surveillance [3].…”

Section: Introductionsupporting

confidence: 89%

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

Berger¹,

Guichard²,

Supiot³

et al. 2019

Preprint

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Purpose Childhood, adolescent and young adult cancer survivors (CAYACS) who were treated by radiotherapy have a significant risk of developing subsequent malignancies, particularly breast and thyroid cancers when the field of irradiation concerned these organs. Advice regarding their increased risk of developing secondary breast (SBC) and thyroid (STC) cancer are recommended to ensure risk-stratified life-long follow-up care including appropriate screening. In France, a national program called DeNaCaPST was started to promote this care. We aimed to explore the perspectives of medical practitioners (MP) on the healthcare system factors that limited inclusion in this programme. Methods Data of the DeNaCAPST programme regarding organisation were studied, including data from a qualitative survey done among MP. Results Seventeen months after the DeNaCaPST programme started, 84.6% of the French regions had participating centres/hospitals, along with one overseas territory. The main barriers to screening highlighted by MP were: 1) inconvenient and under-resourced healthcare professionals to perform these consultations, (2) difficulty determining which CAYACS need SBC and/or STC screening, (3) difficulty organising the network of professionals from paediatric to adult health services. Conclusions Despite a slow inclusion speed and a suboptimal geographical coverage, changes are underway and should allow for several improvements and interesting perspectives for this study. CAYACS lost to follow-up are difficult to invite for a consultation. The absence of real long-term follow-up care is a real barrier to promoting such screening, which must involve a transition care between the paediatric oncologists who know who are at risk and why and the adult medical professionals who have the knowledge to do the screening. The involvement and empowerment of CAYACS is necessary to promote patient-centred healthcare solutions and seems feasible.

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“…On the contrary, Horst reported that SBCs arising in previously irradiated breast tissue were more likely to be triple negative (i.e., estrogen and progesterone negative, HER2 negative) compared with age-matched sporadic invasive cancers (39% vs. 14%) and less likely to be HR positive ( 36 ). Similarly, the principal finding in the study of Demoor and coworkers was that invasive SBCs developing in previously irradiated breast tissue are frequently (29%) triple negative and very rarely HER2 positive ( 22 ). Interestingly, Castiglioni et al in their case– control study reported a rate of 52% of triple negative SBCs if chest RT had been given 4 years or more after the menarche, vs. 6% if given before ( 37 ).…”

Section: Discussionmentioning

confidence: 85%

“…To our knowledge, this is the first population based report on results of breast cancer screening in childhood HL survivors with more than 90% females at high-risk for SBC having regular breast cancer screening with long-term follow-up. Moreover, there are many reports on the benefit associated with early detection of SBC with screening in long-term cancer survivors after chest RT, but they are mostly hospital or multi institutional based with only part of patients being regularly screened for SBC ( 16 , 18 , 22 – 29 ). Furthermore, follow-up in some of these reports were short ( 25 – 27 ).…”

Section: Discussionmentioning

confidence: 99%

Excellent results of screening for subsequent breast cancers in long-term survivors of childhood Hodgkin's lymphoma—Results of a population-based study

et al. 2023

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IntroductionSubsequent breast cancer (SBC) represents a major complication in childhood cancer survivors and screening for SBC in survivors after incidental irradiation of breasts is recommended. In this article, we report the results and discuss benefits of SBC screening in female pts treated for Hodgkin's lymphoma (HL) in Slovenia in a period of 45 years.MethodsBetween 1966 and 2010, 117 females were treated for HL under the age of 19 in Slovenia. One hundred five of them survived for 5 years and were included in our study. They were 3–18 (med. 15) years old at diagnosis and followed for 6–52 (med. 28) years. Eighty-three percent of them had chest RT with a median dose of 30 Gy. Ninety-seven (92%) of 105 pts were regularly followed according to the international guidelines including yearly screening mammography/breast MRI in those who received chest RT.ResultsWe diagnosed 10 SBCs in eight pts 14–39 (med. 24) years after diagnosis at the age of 28–52 (med. 42) years. At 40 years of follow-up, cumulative incidence of SBCs in females who got chest RT was 15.2%. Seven of eight patients (with 9 SBCs) got chest RT with 24–80 (med. 36) Gy at the age of 12 to 18 (median 17) years. Two patients in this group got bilateral SBC. One patient got invasive SBC after being treated with ChT containing high-dose of anthracyclines without chest RT at the age of 13. All eight invasive SBCs were invasive ductal cancers, HER2 receptors negative, all but one with positive hormonal receptors. Six invasive cancers were of stage T1N0, one T1N1mi, only one, diagnosed before era of screening, was of T2N1. None of 8 pts died of SBC.ConclusionAfter introduction of regular breast screening in our female patients, who received chest RT in childhood, all SBCs were of early stage and no patients died of SBC. Survivors of pediatric HL should be informed about the risk of late sequelae of treatment for HL, including SBC. Regular follow-up with breast cancer screening and breast self-examination is of vital importance in those treated with chest RT.

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Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30 years of life: A French multicentre cohort study

Cited by 10 publications

References 34 publications

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

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

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

Excellent results of screening for subsequent breast cancers in long-term survivors of childhood Hodgkin's lymphoma—Results of a population-based study

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