Tailored screening for second cancers in survivors with known high-risk exposures
Survivors who had chest radiotherapy as young women, or certain chemotherapies, have much higher risks of specific second cancers. They should be screened like people with inherited risk, and today most are not.
Women treated with chest radiotherapy before 30 have breast cancer risks comparable to BRCA carriers and are recommended annual MRI; survivors of Hodgkin lymphoma have elevated lung and gastrointestinal cancer risks; alkylating agents raise leukaemia risk. Uptake of recommended surveillance is low because survivors and their doctors do not know the exposures. Registry-driven identification and invitation to tailored screening, as is done for hereditary syndromes, would apply existing evidence.
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.
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