Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Abstract

Summary Female childhood, adolescent and young adult (CAYA) cancer survivors treated with radiation to fields that include breast tissue (chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these survivors receive optimum care, and thereby reduce the detrimental consequences of cancer treatment. However, surveillance recommendations vary among the existing long-term follow-up guidelines. This guideline provides international harmonized breast cancer surveillance recommendations for female CAYA cancer survivors treated with chest radiation prior to age 30 years. We applied evidence-based methods to develop the international harmonized recommendations. The recommendations were formulated by an international multidisciplinary guideline panel and categorized according to a 4-level colour grading schema adapted from existing level of evidence criteria. The harmonized breast cancer surveillance recommendations are based on a transparent process and are intended to be scientifically rigorous, positively influence health outcomes, and facilitate care for CAYA cancer survivors.

Comparison of primary and secondary breast cancers in adolescents and young adults

“…This is in contrast to the general AYA population, which tends to present at later cancer stages and experience a delay in diagnosis for primary malignancies. 1,23,24 This may represent the increased surveillance many of these patients are undergoing as a result of their prior malignancy compared with the general population, even though the absolute rate of surveillance in these survivors may be low. 25,26 This statement would definitely apply to patients who received chest radiation as treatment for their primary malignancy, although unfortunately this information is not available in the NCDB data set.…”

“…Stage was classified based on the AJCC clinical and pathological staging systems for breast cancer. 21 Treatment variables included extent of surgery (no surgery, total or radical mastectomy [SEER codes , and less than total mastectomy, which includes nipple-sparing mastectomy [SEER codes [19][20][21][22][23][24][25][26][27][28][29][30]), any lymph nodes examined, and receipt of adjuvant therapy including chemotherapy, hormone, or immune therapy, or radiation (RT). 22 Last date of contact was used for the amount of follow-up time; those with 0 months or missing follow-up data were excluded from the survival analyses.…”

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

“…In the recent report from the International Late Effects of Childhood Cancer Guideline Harmonization Group, which graded the recommendations according to the strength of the underlying evidence, a strong recommendation was made for annual mammography, breast MRI, or both in women who had received chest irradiation to doses of 20 Gy or higher, starting at age 25 or 8 years after treatment, whichever occurs last. 50 Both the NCCN and COG guidelines discussed consideration of chest imaging for lung cancer screening in high-risk patients or as clinically indicated. The type of chest imaging, timing, and frequency were not detailed, again likely due to the paucity of data on the efficacy of lung cancer screening in the HL population.…”

Screening for Subsequent Pancreatic Cancer in Childhood Cancer Survivors is Needed. A Case Report

“…Even pancreatic duct did not appear dilated on CT. At autopsy an area of 10 cm in diameter in pancreatic head and body was finely granulated and a nodular area of 2.5 cm inside that was found. There are very precise guidelines for the screening of some SPN in CCS, for example breast cancer and colon cancer (COG) [17], but to our knowledge, no guidelines exist for the screening of pancreatic cancer in this vulnerable population of patients. It would be reasonable to introduce the same guidelines for screening as proposed for patients with increased risk for familial pancreatic cancer.…”