UPDATED RECOMMENDATIONS FOR BREAST CANCER SURVEILLANCE IN YOUNG FEMALE CANCER SURVIVORS
Updated Recommendations for Breast Cancer Surveillance in Young Female Cancer Survivors
William J. Gradishar, MD reviewing Mulder RL et al. J Clin Oncol 2020 Dec 10
Surveillance is now strongly recommended for survivors treated with ≥10 Gy chest radiation — a change from ≥20 Gy.
In 2013 the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) published evidence-based recommendations for surveillance of female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with radiation to fields that potentially involved breast tissue on the chest wall. Based on new evidence, IGHG has updated its breast cancer surveillance recommendations.
Modified recommendations include the following:
Mammography and breast MRI should be performed at least annually up to age 60 for survivors treated with ≥10 Gy chest radiation (strong recommendation) and for those treated with upper abdominal radiation that exposed breast tissue at a young age (moderate recommendation). No specific recommendation could be made for survivors who received anthracyclines without chest irradiation, as the evidence was inconsistent.
2. Testing for genetic cancer predisposition syndromes, such as Li-Fraumeni syndrome, can be considered for survivors of leukemia, central nervous system tumor, and non-Ewing sarcoma who have been treated with high-dose anthracyclines (≥250 mg/m2) to determine if the breast cancer risk is additionally increased. In such situations, the decision to initiate breast cancer surveillance is made following discussion with the physician and patient.
3. Breast cancer surveillance should be initiated at age 25 years or ≥8 years after radiation for survivors treated with upper abdominal radiation that exposed breast tissue at a young age (strong recommendation)
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