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Information for Survivors of Childhood, Adolescent, and Young Adult Cancers
When Ashley, 28, had her last mammogram, it revealed a suspicious-looking spot.
It required additional images with an ultrasound and magnetic resonance imaging (MRI) of her breasts. Breast MRI is a routine part of Ashley’s annual breast screening appointments.
After a closer look, radiologists didn’t find anything to indicate cancer.
“It was nerve-wracking,” Ashley said. “I’ve already been through cancer once. It’s scary to think I could go through it again.”
But Ashley wants to stay informed about her health, so she can take action if needed. In general, cancer is most treatable when found early.
When Ashley was 19, she was diagnosed with myelodysplastic syndrome (MDS). MDS is a blood disorder than sometimes develops into acute myeloid leukemia. Ashley was diagnosed with leukemia about a month after her original diagnosis.
Ashley had a hematopoietic cell transplant (commonly known as bone marrow transplant or stem cell transplant) to cure her disease. That involved getting radiation treatment throughout her body. It wiped out her immune system, a necessary step in preparing her body to receive blood cell-forming (hematopoietic) cells from a donor.
Because of the treatment she received, Ashley has a higher risk of developing breast cancer than other women her age.
Studies show that females who receive radiation to the chest have an increased risk of developing breast cancer later in life. Their risk is comparable to women with BRCA gene mutations in the general population.
“Since I had total body irradiation that means I had radiation to my chest,” Ashley said.
Ashley was 26 when she had her first mammogram and MRI. In general, most women don’t have their first mammogram until they’re 50 or older.
All women, including survivors of childhood/ adolescent cancers, are at increased risk of developing breast cancer as they age. Childhood cancer survivors who received certain treatments are at increased risk for developing additional cancers later in life. Breast cancer is the most common of these in female childhood cancer survivors.
Most women who have survived childhood/ adolescent cancer will not develop breast cancer. But some treatments do put them at higher than average risk.
Take a copy of your Survivorship Care Plan to each health care visit. This plan has your treatment history and recommended health screenings.
Discuss your unique health care needs with your primary health care provider.
It is recommended that survivors in high-risk groups begin breast cancer screening much earlier than other women.
Childhood/adolescent cancer survivors who received chest-directed radiation typically develop breast cancer at a younger age than women in general and cancer survivors who were not exposed to radiation.
Subsequent breast cancer typically occurs in survivors between the ages of 30 and 40. In the general population, women usually develop primary breast cancer at age 50 or older.
Studies have shown that the risk for breast cancer in childhood cancer survivors begins to increase at about 8 years from chest radiation exposure or age 25, whichever occurs later. This risk continues to rise as patients get older.
The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Cancers recommend:
In childhood cancer survivors, studies have shown that having both a mammogram and MRI at each screening visit is the most effective strategy for identifying breast cancers in earlier stages.
The recommendation for these women to receive both a mammogram and MRI in their 20s and 30s is different than the recommendation other women may have received. Screening in the general population does not begin until women are in their 40s to 50s.
But childhood cancer survivors are at risk in their 20s to 30s. Younger women have denser breast tissue that makes it more difficult to notice abnormalities with a mammogram alone. An MRI increases the ability to identify some of these subtle changes.
Information gained from the mammogram is still very important. Studies have shown mammography is better than MRI for detecting ductal carcinoma in situ (DCIS), a specific type of breast cancer. In younger women, DCIS is associated with a much higher rate of recurrence and death than among older women.
Mammograms do expose patients to small amounts of radiation to create images of breast tissue. The dose of radiation received from a mammogram is a fraction of that used to treat childhood cancer. Cancer survivorship experts agree that the benefits of mammography far outweigh the risk of added radiation exposure. But women are encouraged to discuss these risks and benefits with their care team.
Making healthy choices will improve your overall health and may reduce your breast cancer risk.
If you have questions about your breast cancer risk or healthy lifestyle decisions, please discuss them with your care provider.
Reviewed: October 2020