Surveillance and screening for new neoplasms in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 18, 2009

Title: Surveillance and screening for new neoplasms in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)
Reviewer: Christine Hill-Kayser, MD
Presenter: Paul Nathan, MD, MSc
Affiliation: The Hospital for Sick Children, Toronto, Canada

Due to numerous clinical trials in pediatric oncology, the overall survival rates after a diagnosis of childhood cancer approach 80%. Currently, over 325,000 childhood cancer survivors are living in the United States, and this number is expected to grow as survival rates after childhood cancer continue to increase. Currently, one in 640 adults aged 20-39 years in the US is a childhood cancer survivor.

Unfortunately, prior studies have demonstrated that approximately 60% of adult survivors of childhood cancer report having a chronic health condition, and 28% report having a severe or life-threatening medical condition. Among severe health problems encountered by survivors of childhood cancer are second cancers (unrelated to the first cancer). The Childhood Cancer Survivor Study (CCSS) follows cancer survivors who have survived at least 5 years; 26 institutions in the U.S. and Canada participated. This study evaluated how well these survivors adhere to guidelines for cancer screening compared with a similar-aged control group. Survivor guidelines recommend starting breast, colorectal and breast cancer screening earlier than the general population for those who had received radiation to those areas.

A total of 8,318 survivors participated in the study, which was done by a telephone interview. In the groups recommended for earlier screening, only 11.5% were compliant with colorectal screening, 46.3% with breast screening, and 26.7% with skin screening. Being followed at a dedicated cancer center led to better compliance.

Among the survivors with no elevated risk (recommended to have same screening as general population), they were more likely to undergo breast and cervical cancer screening than the general population (66.8% vs. 58.1%, p=0.0001 and 82.3% vs. 69.6%, p<0.001, respectively). There was no difference in colorectal cancer screening among the survivor and control groups.

These rates of screening, particularly in the at-risk group, are terribly low. This underscores the need for survivorship care plans, and education about the need for such screening among survivors and primary care physicians.

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