Skin cancer early detection practices among adult survivors of childhood cancer treated with radiation

Because rates of skin cancer are greater among adult survivors of childhood cancer who received radiation therapy than the general population, the National Cancer Institute recommends skin self-examinations and annual physician examination. There has been no comprehensive assessment of survivor’s adherence with skin cancer screening guidelines associated with skin self-examination (SSE) and physician whole-body skin examination (PSE).

We conducted a cross-sectional survey of radiation-treated, adult five-year survivors of childhood cancer, diagnosed between 1970-1986, in the Childhood Cancer Survivor Study (CCSS) cohort.

Multivariate multinomial logit regression investigated the association between demographic, cancer diagnosis, patient activation, cancer treatment characteristics, and skin cancer screening practice. Among 728 survivors, 13.1% reported having had performed SSE in the prior 2 months plus received PSE in the prior 12 months, while 16.4% and 11.0% reported having had only a SSE or a PSE, respectively; 59.5% of survivors reported having had neither. Participants at the highest patient activation score were most likely to report SSE+PSE compared with neither (aRRR 4.16, 95% CI 1.34-12.85). Most adult survivors of childhood cancer who underwent radiation therapy do not practice strategies that promote early detection of skin cancer.

Interventions designed to activate survivors to increase screening are needed.