Understanding health risks for childhood cancer survivors

Survivors of childhood cancer have every reason to celebrate after having lived through harrowing diagnoses and difficult treatments during their most formative years.

But research shows that even if they are cured, survivors aren’t out of the woods: Chemotherapy and radiation treatments can leave survivors at risk for a host of later-in-life complications, including cardiac disease and secondary cancers.

Female childhood cancer survivors — even if they did not receive radiation treatments to their chest — are at least six times more likely than the general population to be diagnosed with breast cancer. For those who did receive chest radiation, that chance increases exponentially and is on par with those who have the BRCA1 or BRCA2 genetic mutations, which increase the risk of breast cancer.

Researchers at the Childhood Cancer Survivors Center set out to discover whether survivors diagnosed with breast cancer had the same mortality rate as breast cancer patients who had previously been cancer-free as children.

We studied the cases of 274 female cancer survivors who had been diagnosed with cancer between 1970 and 1986 (before they were 21) and were subsequently diagnosed with breast cancer as adults. We then compared their cases to a group of more than 1,000 breast cancer patients who hadn’t been diagnosed with cancer previously.

Our study found that childhood cancer survivors had only a slightly higher chance of dying from breast cancer compared to the control group. While that was good news, there was a catch. Results showed that childhood cancer survivors were five times more likely to die as a result of other diseases, including other subsequent cancers and heart and lung diseases.

We know that for children who receive cancer treatments, any developing organ can be impacted by chemotherapy and radiation. That puts them at risk for developing heart failure and lung disease, along with secondary cancers. This study showed how pervasive those problems are.

That means that survivors need specialized care as they age. To help with that, our researchers worked to develop a breast cancer risk prediction model for survivors.

Also, at the University of Chicago Medicine Comer Children’s Hospital, we see survivors of both childhood andyoung adult cancers from 2 years off therapy through the lifespan, providing them with ongoing surveillance and interventions to ensure any new problems are caught early.

Importantly, that includes having open communication with cancer survivors’ primary care doctors, who are often unaware of the ongoing risks in this population.

 

We want survivors to stay engaged throughout their lifetimes and know that once they are cured, they still need to know their risks.

 

The ultimate goal is to minimize the health effects and identify diseases like breast cancer early. Since outcomes in this population are similar to breast cancer outcomes in the general population, diagnosing breast cancer when it is stage 1 often leads to a 90 percent cure rate.

We want survivors to stay engaged throughout their lifetimes and know that once they are cured, they still need to know their risks. That doesn’t necessarily mean they will have issues, but we want them to be empowered with information and not get lost in follow-up.