Selected exposure-based screening recommendations.(Screening recommendations available in their entirety at www.survivorshipguidelines.org)
| Category . | Therapeutic Exposure . | Potential Late Effect . | Recommended Screening . |
|---|---|---|---|
| Neurocognitive | Radiation involving the brain Intrathecal methotrexate Intermediate/high dose IV methotrexate or cytarabine | Neurocognitive deficit | Baseline neuropsychological assessment, repeated as clinically indicated and at key educational transition points Yearly assessment of vocational/educational progress |
| Cardiac | Anthracycline chemotherapy | Cardiomyopathy Subclinical left ventricular dysfunction | |
| Chest radiation | Cardiomyopathy Subclinical left ventricular dysfunction Early-onset atherosclerotic heart disease Valvular disease Pericardial complications | Yearly history and physical exam Baseline electrocardiogram Periodic echocardiogram as indicated based on dose and age at exposure Fasting glucose and lipid profile every 3 to 5 years (every 2 years in obese patients) Cardiac stress testing as indicated based on exposure | |
| Pulmonary | Carmustine Lomustine Busulfan Bleomycin | Pulmonary fibrosis | Yearly history and physical exam Baseline measure of pulmonary function, including DLCO and spirometry Baseline chest x-ray |
| Bleomycin | Pulmonary fibrosis Interstitial pneumonitis Acute respiratory distress syndrome | Repeat evaluations prior to general anesthesia and as clinically indicated | |
| Radiation impacting the lungs | Pulmonary fibrosis Delayed interstitial pneumonitis Restrictive/obstructive lung disease | ||
| Endocrine | Radiation impacting the thyroid Radiation impacting the hypothalamic-pituitary axis | Hypothyroidism (primary or central) Hyperthyroidism Growth hormone deficiency Central adrenal insufficiency Hyperprolactinemia | Yearly history and physical exam Yearly thyroid function test (free T4, thyroid-stimulating hormone [TSH]) 8am serum cortisol if radiation to HP axis >30 Gy— test yearly for at least 15 years Prolactin level if positive history for galactorrhea, amenorrhea (females) or decreased libido (males) |
| Gonadal Function | Alkylating chemotherapy Surgical removal of both gonads Radiation involving the gonads | Hypogonadism Gonadal failure Infertility Premature menopause (females) | Yearly history and physical exam including evaluation of secondary sexual characteristics and sexual function Baseline (females–age 13; males–age 14) and periodic assessment of gonadal function (luteinizing hormone [LH], follicle-stimulating hormone [FSH], estradiol or testosterone) Additional evaluations as indicated (e.g., semen analysis) |
| Second Malignancies | Etoposide Teniposide | Acute myeloid leukemia | CBC, platelet, differential yearly for 10 years following exposure |
| Anthracyclines Alkylating chemotherapy | Acute myeloid leukemia/myelodysplasia | ||
| Radiation (any field) | Second malignant neoplasm (SMN) in radiation field (skin, bone, soft tissue) | Yearly history and physical exam with inspection and palpation of tissues in radiation field | |
| Radiation impacting the thyroid | Thyroid cancer | Yearly thyroid exam | |
| Radiation impacting the breast | Breast cancer | Monthly breast self-exam Clinician breast exam yearly until age 25, then every 6 months Mammogram yearly beginning 8 years after radiation or at age 25, whichever comes last | |
| Radiation impacting the colon | Colorectal cancer | Colonoscopy every 10 years beginning 10 years following radiation or at age 35, whichever comes last |
| Category . | Therapeutic Exposure . | Potential Late Effect . | Recommended Screening . |
|---|---|---|---|
| Neurocognitive | Radiation involving the brain Intrathecal methotrexate Intermediate/high dose IV methotrexate or cytarabine | Neurocognitive deficit | Baseline neuropsychological assessment, repeated as clinically indicated and at key educational transition points Yearly assessment of vocational/educational progress |
| Cardiac | Anthracycline chemotherapy | Cardiomyopathy Subclinical left ventricular dysfunction | |
| Chest radiation | Cardiomyopathy Subclinical left ventricular dysfunction Early-onset atherosclerotic heart disease Valvular disease Pericardial complications | Yearly history and physical exam Baseline electrocardiogram Periodic echocardiogram as indicated based on dose and age at exposure Fasting glucose and lipid profile every 3 to 5 years (every 2 years in obese patients) Cardiac stress testing as indicated based on exposure | |
| Pulmonary | Carmustine Lomustine Busulfan Bleomycin | Pulmonary fibrosis | Yearly history and physical exam Baseline measure of pulmonary function, including DLCO and spirometry Baseline chest x-ray |
| Bleomycin | Pulmonary fibrosis Interstitial pneumonitis Acute respiratory distress syndrome | Repeat evaluations prior to general anesthesia and as clinically indicated | |
| Radiation impacting the lungs | Pulmonary fibrosis Delayed interstitial pneumonitis Restrictive/obstructive lung disease | ||
| Endocrine | Radiation impacting the thyroid Radiation impacting the hypothalamic-pituitary axis | Hypothyroidism (primary or central) Hyperthyroidism Growth hormone deficiency Central adrenal insufficiency Hyperprolactinemia | Yearly history and physical exam Yearly thyroid function test (free T4, thyroid-stimulating hormone [TSH]) 8am serum cortisol if radiation to HP axis >30 Gy— test yearly for at least 15 years Prolactin level if positive history for galactorrhea, amenorrhea (females) or decreased libido (males) |
| Gonadal Function | Alkylating chemotherapy Surgical removal of both gonads Radiation involving the gonads | Hypogonadism Gonadal failure Infertility Premature menopause (females) | Yearly history and physical exam including evaluation of secondary sexual characteristics and sexual function Baseline (females–age 13; males–age 14) and periodic assessment of gonadal function (luteinizing hormone [LH], follicle-stimulating hormone [FSH], estradiol or testosterone) Additional evaluations as indicated (e.g., semen analysis) |
| Second Malignancies | Etoposide Teniposide | Acute myeloid leukemia | CBC, platelet, differential yearly for 10 years following exposure |
| Anthracyclines Alkylating chemotherapy | Acute myeloid leukemia/myelodysplasia | ||
| Radiation (any field) | Second malignant neoplasm (SMN) in radiation field (skin, bone, soft tissue) | Yearly history and physical exam with inspection and palpation of tissues in radiation field | |
| Radiation impacting the thyroid | Thyroid cancer | Yearly thyroid exam | |
| Radiation impacting the breast | Breast cancer | Monthly breast self-exam Clinician breast exam yearly until age 25, then every 6 months Mammogram yearly beginning 8 years after radiation or at age 25, whichever comes last | |
| Radiation impacting the colon | Colorectal cancer | Colonoscopy every 10 years beginning 10 years following radiation or at age 35, whichever comes last |