Mammography rates low among childhood cancer survivors who underwent chest radiation

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