Regular oncology follow-up missed most second malignancies in testicular cancer survivors

Buchler T. Cancer. 2011;117:4212-4218 .

Most second cancers diagnosed in survivors of testicular cancer are missed during routine oncology follow-up, according to a retrospective study. Instead, data indicated that in more than half of cases, second cancers were diagnosed as a result of patients making an appointment due to symptoms.

In the study, researchers looked at data from 1,057 patients who were long-term survivors of testicular germ cell tumors treated or followed up at Thomayer University Hospital in Prague. Lifelong clinical oncology follow-up visits were recommended to this group of patients. Data showed that 26 contralateral testicular cancers and 37 nontesticular cancers were diagnosed in 57 patients. The median time to diagnosis of second cancer was 9.9 years.

Twenty-seven percent of the second cancers were found due to imaging, clinical examination or laboratory tests done during a scheduled follow-up visit with an oncologist. Nineteen percent were detected by a non-oncologist physician during a preplanned visit or a visit for an unrelated condition.

However, 54% of second cancers were detected during a visit prompted by patient symptoms. Few tumors were diagnosed on CT scan ordered as part of the routine follow-up.

In addition, in 93% of cases, the patient had seen an oncology for a follow-up appointment within the prior 12 months to the diagnosis of second cancer.

“Routine imaging of even a high-risk population cannot be assumed to be beneficial, and skepticism is warranted regarding recommendations for prolonged radiologic surveillance,” Timothy Gilligan, MD, of the Taussig Cancer Institute at the Cleveland Clinic, wrote in an accompanying editorial. “If screening for second cancers in cancer survivors is going to be recommended, then the recommendation needs to be based on data indicating that such screening improves mortality or quality of life.”

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