Despite recommendations to undergo annual mammography,
many female survivors of childhood cancer who received chest radiation do not
undergo the screening. Of women aged 25 to 39 years, 63.5% had not had a
mammogram in the previous two years, according to data from a recent analysis.
Researchers used data from the Childhood Cancer Survivor
Study to identify 625 women aged between 25 and 50 years who survived a
childhood cancer and were treated with chest radiation. Researchers compared
this group with with a cohort of 639 survivors who did not receive chest
radiation and 712 patients from the CCSS sibling cohort. The primary endpoint
was screening mammogram within the past two years.
The study included 87.9% of survivors and siblings
contacted. Fifty-five percent of women with a history of chest mammogram
received a mammogram in the past two years, compared with 37% of siblings and
40.5% of survivors without chest radiation.
Age was a strong predictor for mammography; 47.3% of
women aged younger than 40 years with a history of chest radiation never had a
mammogram. Only 52.6% of those aged between 40 and 50 years were undergoing
regular screening. However, the researchers reported a nearly twofold increase
in the likelihood of reporting mammography with each five-year increase in age.
Among women aged between 25 and 39 years, the strongest
predictor of mammography was physician recommendation; 76% of those who
received a recommendation underwent screening compared with 17.6% who did not.
Similarly among women aged between 40 and 50 years, 87.3% of those who received
a physician recommendation underwent screening compared with 58.3% who did not
receive a recommendation. – by Stacey L. Adams
JAMA. 2009;301:404-414.
This study has highlighted the low uptake of screening mammography in a
young adult population of female childhood cancer survivors who are at an
increased risk of breast cancer due to treatment that included relatively
high-dose chest irradiation in childhood. The high doses of chest irradiation
used in the past to treat some types of childhood cancer are no longer used
today. Screening mammography can detect breast cancer at a relatively early
stage when treatment can be very effective. Therefore, it is important for
these childhood cancer survivors to attend breast screening programs to enable
early diagnosis and treatment of breast cancer.
In addition, this study has shown that clinician recommendation can
improve the uptake of screening mammography. It is also important to continue
to educate survivors and clinicians through well-designed education programs to
increase attendance rates. Further studies are needed to determine other ways
of improving uptake; however, it is also important to explore whether screening
uptake rates could be improved if survivors were provided with screening at no
extra cost.
– Aliki J. Taylor, MD, MPH, PhD
University of Birmingham, United Kingdom