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Curing Childhood Cancer Carries A Price Later In Life

Perhaps the greatest victory in cancer treatment is the success doctor have had with kids.

Four of 5 children and teenagers who get cancer can expect to be alive and well five years later. That's the usual definition of a cancer cure.

But this happy story has a darker side.

A analysis just published in the Annals of Internal Medicine predicts survivors of childhood cancers will live from four to 18 fewer years than people their age who haven't battled cancer.

There are about 300,000 of these childhood cancer survivors in the U.S., and 10,000 more children and adolescents are diagnosed with cancer every year, most of whom will survive.

About 1 in 4 of these survivors will die of cancer recurrence or new cancers, years after they were declared "cured," or from damage to their heart, lungs or other organs caused by the potent chemicals and radiation used to achieve those cures.

"Childhood cancer survivors face considerable mortality during adulthood, with excess risks reducing life expectancy by as much as 28 percent," Jennifer Yeh of the Harvard School of Public Health and her colleagues conclude.

Their prognosis is based on a mathematical model that draws on decades of data from the Childhood Cancer Survivors Study.

A separate study in the same issue of Annals zeroes in on a particular hazard of childhood cancer treatment —- the long-term impact of radiation therapy to the chest among female cancer victims. About 55,000 US women have had chest radiation to treat Hodgkin disease, other lymphomas, leukemia and other cancers.

These women have a substantially increased risk of breast cancer at a young age, report a national group of cancer specialists. By age 45, their risk of breast cancer is as high as 20 percent. And the risk doesn't level off with age.

The researchers recommend young women with a history of chest radiotherapy be monitored carefully for breast cancer beginning at age 25.

However, younger women have denser breast tissue that makes small breast tumors more difficult to detect with mammography. Study authors say perhaps magnetic resonance imaging (MRI) should be combined with mammography for these women — but acknowledge this might produce more false alarms — detection of lumps that are not cancer.

Some worry about the small extra dose of radiation that women would get from extra mammography exams. The authors say the extra cancers induced by this additional radiation would be greatly offset by the early breast cancers detected.

The overall message from both of these studies is that survivors of childhood and adolescent cancer —- and their doctors —- need to be much more aware of their risk of later malignancies and other health problems.

"Most adult survivors of childhood cancer do not receive regular medical care focused on their long-term risks," Yeh and her coauthors say. Many of them don't even have a record of their cancer treatment to help guide their doctors.

One of their most significant problems may be relieved, though. The nation's new health law will eventually require insurers to cover people with preexisting health conditions such as cancer. That's something many of these survivors have to keep battling.



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