Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Sections 137-146: cancer

Brief Summary

GUIDELINE TITLE

Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Sections 137-146: cancer and general health screening.

BIBLIOGRAPHIC SOURCE(S)

Children's Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Sections 137-146: cancer and general health screening. Bethesda (MD): Children's Oncology Group; 2006 Mar. 11 p. [45 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Children's Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Version 1.2. 2004 Mar.

BRIEF SUMMARY CONTENT

RECOMMENDATIONS
EVIDENCE SUPPORTING THE RECOMMENDATIONS
IDENTIFYING INFORMATION AND AVAILABILITY
DISCLAIMER

Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Note from the Children's Oncology Group and the National Guideline Clearinghouse (NGC): The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG LTFU) are organized according to therapeutic exposures; this guideline has been divided into individual summaries. In addition to the current summary, the following are available:

In order to accurately derive individualized screening recommendations for a specific childhood cancer survivor using this guideline, see "Using the COG LTFU Guidelines to Develop Individualized Screening Recommendations" in the original guideline document. (Note: For ease of use, a Patient-Specific Guideline Identification Tool has been developed to streamline the process and is included in Appendix I of the original guideline document.)

Guideline Organization

The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers are organized according to therapeutic exposures, arranged by column as follows:

System	Body system (e.g., auditory, musculoskeletal) most relevant to each guideline section.
Score	Score assigned by expert panel representing the strength of data from the literature linking a specific late effect with a therapeutic exposure coupled with an assessment of the appropriateness of the screening recommendation based on collective clinical experience.
Section Number	Unique identifier for each guideline section corresponding with listing in Index.
Therapeutic Agent	Therapeutic intervention for malignancy, including chemotherapy, radiation, surgery, blood/serum products, hematopoietic cell transplant, and other therapeutic modalities.
Risk Factors	Host factors (e.g., age, sex, race, genetic predisposition), treatment factors (e.g., cumulative dose of therapeutic agent, mode of administration, combinations of agents), medical conditions (e.g., pre-morbid or co-morbid conditions), and health behaviors (e.g., diet, smoking, alcohol use) that may increase risk of developing the complication.
Highest Risk Factors	Conditions (host factors, treatment factors, medical conditions and/or health behaviors) associated with the highest risk for developing the complication.
Periodic Evaluations	Recommended screening evaluations, including health history, physical examination, laboratory evaluation, imaging, and psychosocial assessment. Recommendation for minimum frequency of periodic evaluations is based on risk factors and magnitude of risk, as supported by the medical literature and/or the combined clinical experience of the reviewers and panel of experts.
Health Counseling/ Further Considerations	*Health Links: Health education materials developed specifically to accompany these guidelines. Title(s) of Health Link(s) relevant to each guideline section are referenced in this column. Health Link documents are included in Appendix II of the original guideline document. Counseling: Suggested patient counseling regarding measures to prevent/reduce risk or promote early detection of the potential treatment complication. Resources: See the original guideline document for lists of books and web sites that may provide the clinician with additional relevant information. Considerations for Further Testing and Intervention*: Recommendations for further diagnostic evaluations beyond minimum screening for individuals with positive screening tests, recommendations for consultation and/or referral, and recommendations for management of exacerbating or predisposing conditions.
References	References are listed immediately following each guideline section in the original guideline document. Included are medical citations that provide evidence for the association of the therapeutic intervention with the specific treatment complication and/or evaluation of predisposing risk factors. In addition, some general review articles have been included in the Reference section of the original guideline document for clinician convenience.

Note: See the end of the "Major Recommendations" field for explanations of abbreviations included in the summary.

Sec #	Organ	At Risk Population	Highest Risk Factors	Periodic Evaluation	Health Counseling Further Considerations
137 (Female)	Breast	Over age 40 Family history of breast cancer in first degree relative Early onset of menstruation Late onset of menopause (age 55 or older) Older than 30 at birth of first child Never pregnant Obesity Previous breast biopsy with atypical hyperplasia Hormone replacement therapy	Chest radiation with potential impact to the breast (see Section 68; see list of related summaries at the beginning of the "Major Recommendation" field), including >20 Gy to the following fields: Mantle Mini-Mantle Mediastinal Chest (thorax) Axilla BRCA1, BRCA2, ATM mutation	*PATIENTS AT STANDARD RISK (ACS Recommendation)* Physical Clinical breast exam (Every 3 years between ages 20-39, then yearly beginning at age 40) Screening Mammogram (Yearly, beginning at age 40)	Health Links See "Patient Resources" field Breast Cancer (for patients at highest risk only) Counseling For patients at highest risk, counsel to perform breast self-examination monthly, beginning at puberty. For standard risk patients, provide general guidance regarding routine screening beginning at age 40 per current ACS guidelines. Considerations for Further Testing and Intervention Surgery and/or oncology consultation as clinically indicated.
137 (Female)	Breast			*PATIENTS AT HIGHEST RISK* Physical Breast self exam (Monthly, beginning at puberty) Clinical breast exam (Yearly, beginning at puberty until age 25, then every six months) Screening Mammogram (Yearly, beginning 8 years after radiation or at age 25, whichever occurs last) Info Link: There is currently a deficiency in the literature regarding whether or not TBI is a risk factor for the development of breast cancer. Monitoring of patients who received TBI should be determined on an individual basis. Mammography is currently limited in its ability to evaluate premenopausal breasts. The role of MRI is evolving for screening of other populations at high risk for breast cancer (e.g., premenopausal known or likely carriers of gene mutation of known penetrance).