Survivorship Issues Can't Be Ignored

Q: Why should I be concerned about the long-term and late effects of cancer treatment?

A: It is often said that cancer survivorship is a journey that begins the day of diagnosis and continues, hopefully, through years of recovery. But we still have a long way to go to understand what it means to be a cancer survivor. And we haven’t done a particularly good job of sharing the problems associated with survivorship with patients, their families and caregivers, and the healthcare professionals who care for them longer term.

A recent article in the Journal of Clinical Oncology makes clear what we have known for some time: Women who were treated during childhood for cancers that required radiation to the chest have an increased risk of developing breast cancer (for several years, the American Cancer Society’s guidelines for the early detection of breast cancer have pointed out that this is a group at high risk that should be screened with magnetic resonance imaging in addition to routine mammograms). The new research demonstrates how much the risk increases for women who received chest radiation before they were 21: For the entire group, 30 percent had received a breast cancer diagnosis by age 50. Thirty-five percent who were treated for Hodgkin lymphoma developed breast cancer by age 50. Women who had whole lung radiation had a risk of breast cancer almost 44 times greater than expected. Women who had mantle radiation (to the center of the chest and the top of the chest) were 24 times more likely to develop breast cancer than women at average risk. These are astounding numbers that cannot be ignored.

This example of the long-term impact of cancer treatment leads to another point: Cancer survivors should learn about their cancer, understand their treatment and know how to look out for problems that could occur in the long term. Surviving cancer is a journey, but the impact of the disease and its treatment doesn’t end once a patient leaves the oncologist’s office. Survivors must be their own best advocates.

—Len Lichtenfeld, MD, is deputy chief medical officer of the American Cancer Society. Send House Call questions to editor@curemagazine.com.