Childhood Cancer Survivors Show Inadequate Screening for Breast Cancer

Although women treated with chest radiation for childhood cancers constitute one of the highest risk populations for breast cancer, they are far less likely to begin receiving early mammograms when they should, say investigators at St. Jude Children's Research Hospital.

Researchers emphasize the importance of educating such at-risk women and their physicians about the need for early screening and recommend that these women begin breast cancer screenings at age 25. By catching the disease at an early stage, successful treatment is far more likely.

A survey conducted of 551 women, ages 25 to 50, who had been treated for childhood cancers with chest radiation found that only 55 percent had undergone a screening mammogram in the previous two years. Although low, this percentage was higher than comparison groups of participants’ healthy siblings and of women with childhood cancers who had not received chest radiation.

The screening level was particularly low among women ages 25 to 39, with only 36.5 percent reporting having mammograms in the previous two years. By contrast, 76.5 percent of the women ages 40 to 50 reported having mammograms. All of the women surveyed were participants in the Childhood Cancer Survivor Study (CCSS), a consortium of centers in the United States and Canada. St. Jude is the central coordinating institution.

“These statistics document a serious problem—that a large proportion of women who should be screened at a very young age are not being tested,” said Les Robison, Ph.D., chair of the Epidemiology and Cancer Control department at St. Jude and the senior author of a paper about these findings, which was published earlier this year.

Researchers said physician recommendations were most likely to influence the women to have mammograms. Women who had a positive view of screening mammography were also more likely to have mammograms.

Thus, Robison said, besides continuing to monitor the mammogram frequency among the at-risk women, the CCSS consortium will develop educational programs for these women and health care providers. “We would hope that these programs could achieve the ultimate goal of bringing the screening rate of this at-risk population to 100 percent,” he said.

Endeavors such as these are helping St. Jude improve the quality of life of adults who received treatment for pediatric cancer. The hospital is actively pursuing areas of study to understand what other effects childhood cancer treatments may have on this population.

Through the hospital’s After Completion of Therapy Clinic, patients who have been in remission for five years are evaluated yearly until age 18 or 10 years after diagnosis, whichever comes later. Additionally, in one of the most significant undertakings in survivorship research, the St. Jude Life study is inviting more than 4,000 of its childhood cancer survivors—many who are in their fourth, fifth and sixth decades of life—to return to the hospital for evaluation. St. Jude is the first institution in the world to commit to this type of long-term research, which provides a uniform clinical assessment for a large group of childhood cancer survivors.