Breast cancer screening in childhood cancer survivors

Health behaviors and cancer screening practices in long-term survivors of hematopoietic cell transplantation (HCT): a report from the BMT Survivor Study

Patients undergoing HCT are at increased risk of chronic health conditions, including second malignant neoplasms and cardiovascular disease. Little is known about health behaviors and cancer screening practices among HCT survivors that could moderate the risk of these conditions. The BMTSS examined health behaviors and cancer screening practices in individuals who underwent HCT between 1976 and 1998, and survived 2+ years. Health behavior was deemed high-risk if an individual was a current smoker and if they reported risky alcohol intake (≥4 drinks/day [males], ≥ 3 drinks/day [females]) on days of alcohol consumption. Cancer screening assessment was per American Cancer Society recommendations. There were 1040 survivors: 42.7% underwent allogeneic HCT; 43.8% were female; median time from HCT: 7.4 years (range 2.0–27.7 years). Median age at study participation: 43.8 years (range 18.3–73.0 years). Multivariate regression analysis revealed younger age (<35 years) at study participation (Odds Ratio [OR]=4.7; p<0.01) and lower education (<college: OR=2.1; p<0.01) to be significantly associated with high-risk behavior. Survivors were significantly less likely to report high-risk behavior (OR=0.5; p<0.01), and more likely to have had a screening mammogram (OR=2.8; p=0.05) when compared to gender-matched sibling controls (N=309).

A comparison of cancer screening practices in cancer survivors and in the general population: the Korean national health and nutrition examination survey (KNHANES) 2001-2007

OBJECTIVE

This study aimed to describe cancer screening rates for second primary cancer among cancer survivors in Korea, and to compare these rates with those of two control groups: individuals without a history of cancer but with other chronic diseases, and individuals without a history of cancer and without other chronic diseases.

METHODS

The study is a cross-sectional analysis of 15,556 adults ≥ 30 years old who participated in the 2001, 2005, and 2007 Korean National Health and Nutrition Examination Surveys (KNHANES). The prevalence of breast, cervical, gastric, and colorectal cancer screening examinations according to national guidelines was assessed and compared to two control groups.

RESULTS

Screening rates among cancer survivors were 48.5, 54.7, 34.7, and 28.6% for breast, cervical, gastric, and colorectal cancer screening, respectively. Cancer survivors showed higher screening rates for all four cancer sites compared with both control groups, but breast cancer screening was only statistically significant after adjusting gender, age, marital status, education, income, working status, health insurance, smoking and drinking status, and self-reported health status.

CONCLUSIONS

Cancer survivors were more likely than individuals without a cancer history to obtain screening examinations according to recommended guidelines. Still, screening rates even among survivors were suboptimal, emphasizing the need for a more systematic approach to second primary cancer screening and prevention.

Creating the basis for a breast health program for female survivors of Hodgkin disease using a participatory research approach

PURPOSE/OBJECTIVES

To learn from female survivors of Hodgkin disease about their perceptions of their current health status and future health risks, self-care practices to prevent or diminish health risks, and what kind of breast health program could benefit them, including the most effective methods and optimal times for learning about breast health.

DESIGN

Participatory research using focus groups.

SETTING

Urban pediatric cancer center.

SAMPLE

1 African American and 19 Caucasian female survivors of Hodgkin disease aged 16-26 years, diagnosed at least two years before the start of the study, and treated with mantle radiation therapy. Participants were recruited during visits to an outpatient clinic.

METHODS

Six open-ended questions were asked during three separate focus group sessions. Transcribed data were evaluated by content analysis techniques and analyzed to identify common themes.

MAIN RESEARCH VARIABLES

Current health status and perceived health risks, current health practices, and effective methods and timing for breast health teaching.

FINDINGS

Survivors reported feeling damaged by their cancer and its treatment and perceived that they were at risk for breast cancer. Self-care and risky behaviors also were reported. Internal influences (e.g., fear) and external influences (e.g., family) motivated survivors to participate in health promotion activities. Effective methods identified for learning about breast health included having access to other survivors, being respected as an adult, and having one-on-one staff teaching and peer support. The preferred timing of teaching varied, but survivors generally supported a gradual provision of information.

CONCLUSIONS

A positive listening environment is important for developing a breast health program for survivors. An essential first step is to create an opportunity for survivors to tell about their experiences with cancer, including its impact on their lives. Information regarding breast health must be provided in multiple formats during and after treatment if good practices are to be undertaken.

IMPLICATIONS FOR NURSING

The provision of adequate information during and after therapy as well as peer counseling in a positive listening environment are important in helping survivors participate in health promotion activities.

The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

BACKGROUND

The current study characterized the self-reported cancer screening practices of adult survivors of childhood cancer.

METHODS

A cohort of 9434 long-term survivors of childhood cancer and a comparison group of 2667 siblings completed a 289-item survey that included items regarding cancer-screening practices.

RESULTS

Overall, 27.3% of female respondents reported performing breast self-examination (BSE) regularly, 78.2% reported undergoing a Papanicolaou smear within the previous 3 years, 62.4% underwent a clinical breast examination (CBE) within the last year, and 20.9% had gotten a mammogram at least once in their lifetime. Approximately 17.4% of male respondents reported performing regular testicular self-examination (TSE). Women age > or =30 years who had been exposed to chest or mantle radiation therapy were more likely to report undergoing CBE (odds ratio [OR], 1.59; 95% confidence interval [95% CI], 1.32-1.92) and mammography (OR, 1.92; 95% CI, 1.47-2.56). Compared with the sibling comparison group, survivors demonstrated an increased likelihood of performing TSE (OR, 1.52; 95% CI, 1.22-1.85) or BSE (OR, 1.30; 95% CI, 1.10-1.52), of having undergone a CBE within the last year (OR, 1.18; 95% CI, 1.02-1.35), and of ever having undergone a mammogram (OR, 1.82; 95% CI, 1.52-2.17).

CONCLUSIONS

The results of the current study demonstrate that the cancer screening practices among survivors of childhood cancer are below optimal levels. Primary care physicians who include childhood cancer survivors among their patients could benefit these individuals by informing them about future cancer risks and recommending appropriate evidence-based screening.

Late effects of childhood cancer therapy

This study reviews the common long-term sequalae of childhood cancer and its therapy. It discusses the clinical and research challenges posed by such late effects. The authors address related topics of late effects research and clinical care, methodological issues, barriers and directions for the future.

Epidemiology, prevention, and early detection of breast cancer

Decreases in the incidence of breast cancer have not been achieved, but there is a downward trend in age-adjusted breast cancer mortality rates in the United States. Recent epidemiologic investigations continue to refine our understanding of the role of established breast cancer risk factors, such as reproductive characteristics and body mass index, and in the process advance understanding of the etiology of breast cancer. Important strides are being made in the chemoprevention of breast cancer, but clarifying the potential contributions of factors such as diet, physical activity, and cigarette smoke to the breast cancer burden is a high priority because these lifestyle behaviors also have important implications for primary prevention. The role of both environmental and endogenous exposures in breast carcinogenesis will be more clearly elucidated by studies that account for genetic polymorphisms, some of which may lead to differential susceptibility to harmful agents.