by David Podeszwa, MD (father to Alex, stage IV neuroblastoma)
The ultimate goal of every parent of a child diagnosed with neuroblastoma is long-term survival of their child. Fortunately, our understanding of the disease and successful research endeavors are allowing more and more kids to live long and happy lives.
As adults, all survivors of neuroblastoma, like all survivors of a childhood cancer, face many long term effects, including the risk of a secondary malignancy. Adult women who received chest radiation as part of their childhood treatment (as part of total body irradiation or localized tumor control) are at a significantly increased risk of breast cancer. The chest can be considered any area above the diaphragm or the area surrounded by the rib cage. Local radiation of the typical abdominal tumor bed does not include the chest.
Why are we talking about breast cancer? In the January 28, 2009 edition of the Journal of the American Medical Association, Oeffinger et al. published ?Breast Cancer Surveillance Practices Among Women Previously Treated with Chest Radiation for a Childhood Cancer?. After surveying 551 women with a history of chest radiation (including 32 women treated for neuroblastoma), they found that 63.5% of those aged 25-39 years had not had mammography screening in the last 2 years. This lack of follow-up is very alarming given the high risk of secondary breast cancer.
The increased risk can begin as early as 8 years after radiation and the median age of breast cancer diagnosis is between 32 and 35 years. By 45 years old, as many as 20% of women treated with moderate- to high-dose chest radiation will be diagnosed with breast cancer.
The Children?s Oncology Group (COG), as part of the Long-Term Follow-up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancer, now recommends a yearly clinical exam until the age of 25 then every 6 months after, annual screening mammography and breast magnetic resonance imaging (MRI) for any woman exposed to moderate- to high-dose chest radiation (=20 Gy), starting at 25 years old or 8 years after radiation, whichever occurs last.
Currently, a child being treated for high-risk neuroblastoma can receive more than 20 Gy (2000 cGy) of radiation for local control of the tumor. If you are unsure of the dose of radiation you/your daughter received, contact your oncologist.
If you or your daughter was treated for neuroblastoma with chest radiation, it would be prudent to follow the COG guidelines. Breast cancer outcomes for childhood cancer survivors are strongly associated with stage at diagnosis. Please be diligent in your breast screening!
To read more about this topic, please refer to the following:
Oeffinger KC, et al. Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer. JAMA. 2009; 301(4):404-414.
Kennedy LB, et al. Breast cancer after childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Intern Med. 2004; 141(8):590-597.
Children?s Oncology Group. Long-term Follow-up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancer. http://www.survivorshipguidelines.org.