Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer

A report from the childhood cancer survivor study

Paul Craig Nathan, Kirsten Kimberlie Ness, Martin Christopher Mahoney, Zhenghong Li, Melissa Maria Hudson, Jennifer Sylene Ford, Wendy Landier, Marilyn Stovall, Gregory Armstrong, Tara Olive Henderson, Leslie L. Robison, Kevin Charles Oeffinger

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. Objective: To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm. Design: Retrospective cohort study. Setting: The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986. Patients: 4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer. Measurements: Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy. Results: In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively. Limitations: Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer. Conclusion: Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance. Primary Funding Source: The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.

Original languageEnglish (US)
Pages (from-to)442-451
Number of pages10
JournalAnnals of internal medicine
Volume153
Issue number7
DOIs
StatePublished - Oct 5 2010

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Second Primary Neoplasms
Survivors
Neoplasms
Mammography
Guidelines
Breast Neoplasms
Papanicolaou Test
Skin Neoplasms
Colonoscopy
Uterine Cervical Neoplasms
Charities
Skin
National Cancer Institute (U.S.)
National Institutes of Health (U.S.)
Advisory Committees

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer : A report from the childhood cancer survivor study. / Nathan, Paul Craig; Ness, Kirsten Kimberlie; Mahoney, Martin Christopher; Li, Zhenghong; Hudson, Melissa Maria; Ford, Jennifer Sylene; Landier, Wendy; Stovall, Marilyn; Armstrong, Gregory; Henderson, Tara Olive; Robison, Leslie L.; Oeffinger, Kevin Charles.

In: Annals of internal medicine, Vol. 153, No. 7, 05.10.2010, p. 442-451.

Research output: Contribution to journalArticle

Nathan, PC, Ness, KK, Mahoney, MC, Li, Z, Hudson, MM, Ford, JS, Landier, W, Stovall, M, Armstrong, G, Henderson, TO, Robison, LL & Oeffinger, KC 2010, 'Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: A report from the childhood cancer survivor study', Annals of internal medicine, vol. 153, no. 7, pp. 442-451. https://doi.org/10.7326/0003-4819-153-7-201010050-00007
Nathan, Paul Craig ; Ness, Kirsten Kimberlie ; Mahoney, Martin Christopher ; Li, Zhenghong ; Hudson, Melissa Maria ; Ford, Jennifer Sylene ; Landier, Wendy ; Stovall, Marilyn ; Armstrong, Gregory ; Henderson, Tara Olive ; Robison, Leslie L. ; Oeffinger, Kevin Charles. / Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer : A report from the childhood cancer survivor study. In: Annals of internal medicine. 2010 ; Vol. 153, No. 7. pp. 442-451.
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abstract = "Background: Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. Objective: To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm. Design: Retrospective cohort study. Setting: The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986. Patients: 4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer. Measurements: Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy. Results: In average-risk female survivors, 2743 of 3392 (80.9{\%}) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0{\%}) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2{\%}) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5{\%}) and 1290 of 4850 (26.6{\%}), respectively. Limitations: Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer. Conclusion: Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance. Primary Funding Source: The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.",
author = "Nathan, {Paul Craig} and Ness, {Kirsten Kimberlie} and Mahoney, {Martin Christopher} and Zhenghong Li and Hudson, {Melissa Maria} and Ford, {Jennifer Sylene} and Wendy Landier and Marilyn Stovall and Gregory Armstrong and Henderson, {Tara Olive} and Robison, {Leslie L.} and Oeffinger, {Kevin Charles}",
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AU - Nathan, Paul Craig

AU - Ness, Kirsten Kimberlie

AU - Mahoney, Martin Christopher

AU - Li, Zhenghong

AU - Hudson, Melissa Maria

AU - Ford, Jennifer Sylene

AU - Landier, Wendy

AU - Stovall, Marilyn

AU - Armstrong, Gregory

AU - Henderson, Tara Olive

AU - Robison, Leslie L.

AU - Oeffinger, Kevin Charles

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N2 - Background: Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. Objective: To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm. Design: Retrospective cohort study. Setting: The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986. Patients: 4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer. Measurements: Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy. Results: In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively. Limitations: Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer. Conclusion: Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance. Primary Funding Source: The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.

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