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Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer
Kevin C. Oeffinger, MD;
Jennifer S. Ford, PhD;
Chaya S. Moskowitz, PhD;
Lisa R. Diller, MD;
Melissa M. Hudson, MD;
Joanne F. Chou, MPH;
Stephanie M. Smith, MPH;
Ann C. Mertens, PhD;
Tara O. Henderson, MD;
Debra L. Friedman, MD;
Wendy M. Leisenring, ScD;
Leslie L. Robison, PhD
JAMA. 2009;301(4):404-414.
Context Women treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer at a young age and are recommended to have an annual screening mammogram starting at age 25 years or 8 years after radiation, whichever occurs last.
Objective To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening.
Design, Setting, and Participants Between June 2005 and August 2006, a 114-item questionnaire was administered to a random sample of 625 women aged 25 through 50 years who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS), a North American cohort of long-term survivors diagnosed from 1970-1986. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the CCSS siblings cohort (n = 712).
Main Outcome Measure Screening mammogram within the previous 2 years.
Results Of 1976 cancer survivors and siblings who were contacted, 87.9% participated. Among the 551 women with a history of chest radiation, 55% reported a screening mammogram in the past 2 years (ages 25-39 years, 36.5%; 95% confidence interval [CI], 31.0%-42.0%; ages 40-50 years, 76.5%; 95% CI, 71.3%-81.7%). In comparison, 40.5% of survivors without chest radiation and 37.0% of CCSS siblings reported a screening mammogram in the same time interval. Notably, among women with a history of chest radiation, 47.3% (95% CI; 41.6%-53.0%) of those younger than 40 years had never had a mammogram and only 52.6% (95% CI; 46.4%-58.8%) of women aged 40 through 50 years were being regularly screened (2 mammograms within 4 years). Screening rates were higher among women who reported a physician recommendation than those who did not (ages 25-39 years, 76.0% vs 17.6%; ages 40-50 years, 87.3% vs 58.3%). In multivariate models, the association was particularly strong for younger women (ages 25-39 years, prevalence ratio [PR], 3.0; 95% CI, 2.0-4.0; ages 40-50 years, PR, 1.3; 95% CI, 1.1-1.6).
Conclusions In this cohort of women who had childhood cancer treated with chest radiation, 63.5% of those aged 25 through 39 years and 23.5% of those aged 40 through 50 years had not had mammography screening for breast cancer within the previous 2 years despite a guideline recommendation that survivors of childhood cancer who were treated with chest radiation should undergo annual screening mammography.
Author Affiliations: Departments of Pediatrics (Drs Oeffinger and Ford), Medicine (Dr Oeffinger), Psychiatry and Behavioral Sciences (Dr Ford), and Epidemiology and Biostatistics (Dr Moskowitz and Mss Chou and Smith), Memorial Sloan-Kettering Cancer Center, New York, New York; Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (Dr Diller); Oncology (Dr Hudson) and Epidemiology and Cancer Control (Drs Hudson and Robison), St Jude Children's Research Hospital, Memphis, Tennessee; Pediatrics, Emory University, Atlanta, Georgia (Dr Mertens); Pediatrics, University of Chicago, Chicago, Illinois (Dr Henderson); Pediatrics, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (Dr Friedman); and the Clinical Research and the Public Health Sciences Divisions of the Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Leisenring).
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