Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Breast Cancer: Are You at Risk?
The risk of cancer increases for everyone as they age. Depending on the specific treatment you received for childhood
cancer, you may be at increased risk for developing breast cancer. It is important to understand that risk, so that you
can take steps to protect your health.
What are the risk factors?
Several studies have shown that women treated with radiation to the chest for cancer during childhood,adolescence, or young adulthood have an increased risk of developing breast cancer as they get older, compared towomen their same age in the general population. The risk of secondary breast cancer is related to the location anddose of radiation. People treated with higher doses of radiation have the highest risk. Researchers are studying thisproblem to better understand the risk factors and find ways to prevent secondary breast cancer.
When is breast cancer likely to occur?
The risk of secondary breast cancer begins to increase at about ten years following radiation therapy and continues torise thereafter. This means that if a woman develops breast cancer following chest radiation for childhood/adolescentcancer, it usually happens at a much younger age (usually 30 to 40 years old) than in women who develop primarybreast cancer (usually age 50 or older).
What can I do to protect my health?
Most women who received radiation therapy to the chest during childhood, adolescence, or young adulthood will notdevelop breast cancer. However, if you received radiation to the chest, it is important to understand that the risk ishigher for you than it is for women your age who never received radiation. So, the best way for you to protect yourhealth is by taking steps to closely monitor your breasts. That way, if a cancer develops, it will be detected in its
earliest stages, when treatment is most effective. It is also important to tell your healthcare provider about your cancer
treatment history, including the dose of chest radiation that you received. You should ask your treating oncologist or
cancer center for a written summary of your cancer treatment (see related Health Link: Introduction to Long-Term
Follow-Up).
What monitoring is recommended?
If you received radiation therapy to the chest, underarm (axilla), or total body irradiation (TBI) during childhood,adolescence, or young adulthood, you should:
1. Have a clinical breast exam performed by your healthcare provider—at least once a year until you reach age
25—then every 6 months thereafter.
2. Have a yearly mammogram and breast MRI (magnetic resonance imaging test) starting at age 25, or 8 years
after you received radiation (whichever comes last).
If your healthcare provider is not familiar with these monitoring recommendations for women who have received chest
radiation during childhood, adolescence, or young adulthood, we encourage you to share this Health Link with them,and tell them that additional information is also available at www.survivorshipguidelines.org.
Is there anything else I can do to minimize the risk?
The following lifestyle changes may help reduce the risk of developing breast cancer, and will also help you to stay as
healthy as possible:•Eat more fruits and vegetables (at least 5 servings a day are recommended).

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Breast Cancer I Version 6.0 I October 2023 I Page 1 of 2

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer•

Exercise at least 30 minutes per day on most days of the week.

•

Maintain a healthy body weight.

•

Limit your intake of alcohol to no more than one drink per day.

•Avoid smoking or vaping.

•If you have a baby, try to breastfeed for at least four months.

•If you need hormone replacement therapy or birth control pills, discuss the risks and benefits with yourhealthcare professional.

If you have questions regarding your risk of developing breast cancer, and how you can best protect your health, besure to discuss this with your healthcare provider.
Written by Melissa M. Hudson, MD, St. Jude Children’s Research Hospital, Memphis, TN; and Wendy Landier, PhD, CPNP, Children’s
Hospital of Alabama, Birmingham, AL. Portions adapted from CCSS Newsletter Winter 2001, used with permission.
Reviewed by Amelia DeRosa, RN, BSN, CPON; Kayla L. Foster, MD, MPH; and Christine Yun MSN, PNP, CPON®.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
Children’s Oncology Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.
No endorsement of any specific tests, products, or procedures is made by Informational Content, the Children’s Oncology Group, or affiliated party or member of the Children’s Oncology Group.
No Claim to Accuracy or Completeness: While the Children’s Oncology Group has made every attempt to assure that the Informational Content is accurate and complete as of the date of publication, nowarranty or representation, express or implied, is made as to the accuracy, reliability, completeness, relevance, or timeliness of such Informational Content.
No Liability on Part of Children’s Oncology Group and Related Parties/Agreement to Indemnify and Hold Harmless the Children’s Oncology Group and Related Parties: No liability is assumed
by the Children’s Oncology Group or any affiliated party or member thereof for damage resulting from the use, review, or access of the Informational Content. You agree to the following terms ofindemnification: (i) “Indemnified Parties” include authors and contributors to the Informational Content, all officers, directors, representatives, employees, agents, and members of the Children’s Oncology
Group and affiliated organizations; (ii) by using, reviewing, or accessing the Informational Content, you agree, at your own expense, to indemnify, defend and hold harmless Indemnified Parties from any
and all losses, liabilities, or damages (including attorneys’ fees and costs) resulting from any and all claims, causes of action, suits, proceedings, or demands related to or arising out of use, review oraccess of the Informational Content.
Proprietary Rights: The Informational Content is subject to protection under the copyright law and other intellectual property law in the United States and worldwide. The Children’s Oncology Groupretains excursive copyright and other right, title, and interest to the Informational Content and claims all intellectual property rights available under law. You hereby agree to help the Children’s Oncology
Group secure all copyright and intellectual property rights for the benefit of the Children’s Oncology Group by taking additional action at a later time, action which could include signing consents and legal
documents and limiting dissemination or reproduction of Informational Content.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Breast Cancer I Version 6.0 I October 2023 I Page 2 of 2