Breast Cancer After Childhood, Adolescent, and Young Adult Cancer: It’s Not Just About Chest Radiation

2017 ◽  
pp. 736-745
Author(s):  
David Hodgson ◽  
Flora van Leeuwen ◽  
Andrea Ng ◽  
Lindsay Morton ◽  
Tara O. Henderson
Keyword(s):  
Breast Cancer ◽  
Young Adult ◽  
Health Care Providers ◽  
Malignant Neoplasm ◽  
Breast Cancer Diagnosis ◽  
Adolescent And Young Adult ◽  
Care Providers ◽  
Adolescent Cancer ◽  
Increased Risk ◽  
Young Adult Cancer

Women who have been treated for a childhood, adolescent, or young adult cancer are at an increased risk for developing breast cancer at a young age, and breast cancer accounts for the most common subsequent malignant neoplasm among female childhood and adolescent cancer survivors. Risk of breast cancer in these survivors appears to be a multifaceted relationship between constitutional factors, exposures to radiation therapy (RT) and chemotherapy, and genetic predisposition. Given the significant morbidities and mortality associated with a breast cancer diagnosis, it is imperative that health care providers understand the risks, biology and genetics, recommended surveillance guidelines for early detection, and potential prevention strategies for women who have survived pediatric and young adult cancer.

scholarly journals Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research

2020 ◽  
Author(s):  
Scott C Adams ◽  
Jennifer Herman ◽  
Iliana C Lega ◽  
Laura Mitchell ◽  
David Hodgson ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Adolescent And Young Adult ◽  
Future Research ◽  
Evidence Based ◽  
Pediatric Cancer Survivors ◽  
Increased Risk ◽  
Care Guidelines ◽  
Young Adult Cancer ◽  
Evidence Based Guidelines

Abstract Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related late effects that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, ON) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium’s stakeholder-identified high-priority targets for late effects screening and care, and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, while not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, support the development of evidence-based ‘late effects’ screening and care guidelines for AYAs.

scholarly journals Risk of Late Mortality and Second Malignant Neoplasms among 5-Year Survivors of Young Adult Cancer: A Report of the Childhood, Adolescent, and Young Adult Cancer Survivors Research Program

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Yang Zhang ◽  
Karen Goddard ◽  
John J. Spinelli ◽  
Carolyn Gotay ◽  
Mary L. McBride
Keyword(s):  
Young Adult ◽  
Proportional Hazards Model ◽  
Malignant Neoplasm ◽  
Cox Proportional Hazards Model ◽  
Adolescent And Young Adult ◽  
Malignant Neoplasms ◽  
Risk Of Death ◽  
Young Adult Cancer Survivors ◽  
Adult Cancer Survivors ◽  
Young Adult Cancer

We conducted a population-based retrospective study to assess the long-term risks of overall and cause-specific mortality and second malignant neoplasm (SMN) among survivors of young adult cancer compared to the risk in British Columbia (BC) population and to evaluate the effects of demographic and clinical factors on risk. 1248 5-year survivors of young adult cancer diagnosed 1970–1995 between 20 and 24 years of age were identified from the BC Cancer Registry and followed to the end of 2007. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated. The Cox proportional hazards model was used to estimate the effects of different demographic and disease-related characteristics on the risk of death and SMN. A total of 138 deaths and 62 SMNs were observed during follow-up. The overall SMR was 5.9 (95% CI 4.9–6.9) and the absolute excess risk was 5.3 per 1,000 person-years. The overall SIR was 3.0 (95% CI 2.3–3.8). Treatment with radiation resulted in increased risks of death and SMN. These observed increased risks emphasize the importance of prevention, surveillance, and treatment of late effects in survivors of young adult cancers.

scholarly journals Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

2016 ◽  
Vol 34 (28) ◽  
pp. 3440-3450 ◽  
Author(s):  
Wendy van Dorp ◽  
Renée L. Mulder ◽  
Leontien C.M. Kremer ◽  
Melissa M. Hudson ◽  
Marry M. van den Heuvel-Eibrink ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Alkylating Agents ◽  
Adolescent And Young Adult ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Female Survivors ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Young Adult Cancer

Purpose Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors’ access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. Patients and Methods The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. Results and Conclusion The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.

scholarly journals Double Discourse: Qualitative Perspectives on Breast Screening Participation among Obese Women and Their Health Care Providers

2019 ◽  
Vol 16 (4) ◽  
pp. 534
Author(s):  
Kate McBride ◽  
Catharine Fleming ◽  
Emma George ◽  
Genevieve Steiner ◽  
Freya MacMillan
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Health Care Providers ◽  
Breast Screening ◽  
Health Concern ◽  
Obese Women ◽  
Health Providers ◽  
Care Providers ◽  
Screening Participation ◽  
Increased Risk

Obesity in Australia is rising rapidly, and is a major public health concern. Obesity increases the risk of breast cancer and worsens associated outcomes, yet breast screening participation rates in Australia are suboptimal and can be lower in higher risk, obese women. This study qualitatively explored barriers to breast screening participation in obese women in Australia. In-depth interviews (n = 29), were conducted with obese women (body mass index ≥ 30) and key health providers. A disconnect between providers’ and women’s perceptions was found. For women, low knowledge around a heightened need to screen existed, they also reported limited desire to prioritize personal health needs, reluctance to screen due to poor body image and prior negative mammographic experiences due to issues with weight. Providers perceived few issues in screening obese women beyond equipment limitations, and health and safety issues. Overall, weight was a taboo topic among our interviewees, indicating that a lack of discourse around this issue may be putting obese women at increased risk of breast cancer morbidity and mortality. Consideration of breast screening policy in obese women is warranted. Targeted health promotion on increased breast cancer risk in obese women is required as is a need to address body image issues and encourage screening participation.

Mammography use in women age 80 and older with breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9039-9039
Author(s):  
S. H. Giordano ◽  
B. Badgwell ◽  
Z. Duan ◽  
I. Bedrosian ◽  
G. Hortobagyi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Health Care Providers ◽  
Tumor Size ◽  
Age Groups ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Stage Ii ◽  
Care Providers ◽  
Mammography Use

9039 Background: The guidelines for screening mammography use in patients age 80 years and older are not clear. The purpose of this study was to determine the effect of mammography use on stage and tumor size at breast cancer diagnosis. Methods: The study is a retrospective cohort using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. We evaluated 14,976 women aged 80 and older diagnosed with breast cancer between 1996–2002. Patients were divided into three cohorts based on screening mammography use in the 60 months prior to diagnosis: nonusers, non-regular users (1–2 mammograms), and regular users (3+). The effects of screening on tumor stage (0-I vs. II-IV) and size were determined by logistic regression and multivariate analysis of variance. Results: Regular mammography use for the age groups 80–84, 85–89, and >= 90 was 29%, 19%, and 9%, respectively. Among regular users of mammography, 26% presented with stage II or greater cancer while 64% of non-users presented with stage II or greater disease. On multivariate analysis, non-users were 4.7 (95% CI 4.26–5.14) times more likely to present with high-stage cancer. Non-users, non-regular users, and regular users had an adjusted mean tumor size of 5.08 (4.44–5.72), 3.26 (2.57–3.95), and 2.77 (2.02–3.51), respectively. Conclusions: Regular screening mammography among women aged 80 years and older is associated with earlier stage at presentation and smaller tumor size compared to mammography nonusers. Health care providers should consider discussing potential benefits of screening mammography with their older patients particularly for those without significant comorbidity. No significant financial relationships to disclose.

Preserving fertility for adolescent and young adult cancer survivors: A community model.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 109-109
Author(s):  
Stephanie L. Lawrence ◽  
Karen H. Albritton ◽  
Emily Berry ◽  
Aurelio Rodriguez ◽  
Keith Edward Argenbright
Keyword(s):  
Young Adult ◽  
Cancer Survivors ◽  
Fertility Preservation ◽  
Care Coordination ◽  
Adolescent And Young Adult ◽  
Care Providers ◽  
Young Adult Cancer Survivors ◽  
Number Of Patients ◽  
Adult Cancer Survivors ◽  
Young Adult Cancer

109 Background: Loss of fertility is a significant late effect of cancer treatment for those patients diagnosed during their reproductive years. This loss is a source of considerable distress for patients who have not yet started or completed building their families. Fertility preservation counseling to discuss reproductive concerns regardless of treatment phase can ease this burden. However, due to access- and health-related barriers, approximately half of oncologists report having never referred a patient for a fertility consultation, and as many as 60% of cancer survivors do not recall receiving this information from their healthcare team at time of diagnosis. Methods: The Moncrief Cancer Institute (MCI) Fertility Preservation Program synchronizes services between oncology care providers and fertility specialists. This model is designed to remove discomfort associated with discussing options while enhancing access to care by arranging physician and patient education opportunities specific to fertility preservation and the treatment options available, patient care coordination for fertility preservation treatment, and financial assistance for fertility preservation treatment for underinsured and uninsured adolescent and young adult cancer patients. Results: Referrals for fertility counseling have been provided from 5 institutions through an established referral network comprised of non-profit organizations, local hospitals, and private practice providers. MCI partners with 2 reproductive specialty care groups who offer treatment at reduced rates, which MCI further subsidizes based on financial need. No patients are turned away for inability to pay. The institutions that MCI has targeted for education and partnerships support an environment that meet the distinct needs of adolescent and young adult patients with cancer. Conclusions: Program impact is evaluated by the number of patients and providers receiving education, and the number of patients receiving care coordination and/or financial support for fertility preservation treatment. In the fight against cancer, MCI is assisting patients to protect their future families through fertility preservation education and care coordination.

scholarly journals Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1058
Author(s):  
Laura Reinman ◽  
Helen L. Coons ◽  
Jenna Sopfe ◽  
Robert Casey
Keyword(s):  
Health Care ◽  
Young Adult ◽  
Sexual Health ◽  
Health Care Providers ◽  
Adolescent And Young Adult ◽  
Medical Team ◽  
Care Providers ◽  
Medical Needs ◽  
Contextual Framework ◽  
Open Discussion

Adolescent and young adult (AYA) survivors of cancer have diverse psychosocial and medical needs, including those related to fertility and sexual health. Much of the focus of care around issues such as fertility and sexual health tends to be filtered through a biomedical lens. However, it is essential that health care providers assess and support AYA survivors using a biopsychosocial and contextual framework to ensure the most comprehensive and accurate understanding of AYA survivor needs, especially those related to psychosexual health. A trusting relationship between the multi-disciplinary medical team and the AYA survivor that allows for open discussion about the physical and psychosocial components of sexual health is key to providing best care and outcomes.

scholarly journals Clinical profile and management of breast cancer in women in a rural based tertiary care hospital our experience

2017 ◽  
Vol 4 (2) ◽  
pp. 697
Author(s):  
Ambikavathy Mohan ◽  
Chandan Kumar
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Carcinoma ◽  
Health Care Providers ◽  
Diagnostic Methods ◽  
Care Hospital ◽  
Care Providers ◽  
Increased Risk ◽  
The Impact ◽  
Women In India

Background: Breast cancer is the second most common cancer among women in India and accounts for 7% of global burden of breast cancer and one-fifth of all cancers among women in India. The risk factors are related to lifestyle, early menarche, nulli parity, prolonged use of oral contraceptive pills, hormone replacement therapy, not breast‑feeding, alcohol, obesity, lack of exercise, and induced abortion. A woman who attains menopause after fifty five years of age has an increased risk of ovarian, breast, and uterine cancers. The risk is greater if a woman also began menstruating before twelve years of age. A longer exposure to estrogen increases a woman’s risk of breast cancers.Methods: This is a prospective observational study, conducted in the department of surgery, between December 2013 and June 2015(2 years). Patients diagnosed as breast carcinoma and admitted in surgical wards were included, Data pertaining to demography, clinical and pathological tumor profile, and treatment details were collected prospectively for each patient based on patient interviews and medical records. To analyse the Prevalence of breast cancer, clinical presentation, risk factors, diagnostic methods, treatment protocols, difference between pre and post‑menopausal breast cancer women regarding risk factors, assess the impact of treatment given and women’s knowledge about breast cancer.Results: A total number of 25 cases of breast carcinoma based on detailed history, clinical examination, Trucut biopsy, ultrasonography breast and axilla, ultrasound abdomen, mammogram and chest x-ray were analysed. All of them received three cycles of anterior chemotherapy consisting of 5- Fluorouracil 500 mg/m2,Adriamycin 50 mg/m2 Cyclophosphamide 80 mg/m2 (FAC regimen) administered intravenously followed by modified radical mastectomy. There were no recurrences seen on follow up till date.Conclusions: Late stage at presentation of breast cancer is a challenge to the health care providers. Cancer awareness programmes, multidisciplinary approach and evidence‑based strategies for early detection and effective management of the disease can go a long way in prevention.

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