Childhood cancer survivors often have a higher risk for getting a second cancer later in life. Early screening can help, but not enough survivors are getting the screenings recommended by the Children’s Oncology Group (COG). One researcher is trying to change that by gathering better evidence on the effectiveness of early breast cancer screening for women who received radiation to the chest as children.
These women have an increased risk of breast cancer similar to that of women with BRCA1 gene mutations. The COG recommends they start breast cancer screening at age 25 or 8 years after receiving radiation, which is much earlier than women with an average risk. But, studies show too few women follow through on these recommendations. One reason may be that their doctors are often not familiar with the recommendations.
“Uncertainty about the benefits of early screening may explain in part the low adherence rates to current guidelines by survivors and their doctors,” said Jennifer Yeh, PhD, an assistant professor at Harvard Medical School and Boston Children’s Hospital.
That’s why she wants to gather better evidence about the effectiveness of screening this population. She hopes having that information and making it available to doctors will increase the number of them who talk with childhood cancer survivors about the benefits of early screening. Her work has been supported with grants from the American Cancer Society (ACS).
Her ultimate goal is to improve the health and quality of life of young survivors at risk for a second cancer.
The Childhood Oncology Group's current guidelines for early breast cancer screening may reduce breast cancer deaths by half in women who had cancer as a child and received radiation to the chest."
“Randomized controlled clinical trials are often seen as the gold standard for medical studies,” said Yeh, but they are aren’t always the best way to study cancer screening, especially for a group of people who have a less common risk, like certain survivors of childhood cancers.
So instead of a clinical trial, Yeh’s taking a different approach. She’s using math.
As a decision scientist, Yeh’s using ACS funding to put computer-simulated models to work. “Simulation can provide valuable insights when testing in the real world is infeasible, impractical, or unethical,” Yeh said.
She’s using data from the NCI-sponsored Childhood Cancer Survivor Study, which follows a group of almost 36,000 childhood cancer survivors diagnosed between 1970 and 1999. She’s evaluating the benefits and risks of the COG’s breast cancer screening guidelines for female survivors of childhood cancers after chest radiation.
As part of this work, she’s collaborating with the NCI-funded Cancer Intervention and Surveillance Modeling Network (CISNET) and using their breast cancer models, which helped inform screening guidelines for women with an average risk for breast cancer.
Yeh’s team estimates that current COG guidelines may reduce breast cancer deaths by half in women who had cancer as a child and received radiation to the chest, and that MRI is an important component of screening for these high-risk women.
The findings, she hopes, will help increase the screening rates of childhood cancer survivors and motivate them to continue regular screening.