Cancer surveillance in survivors of adolescent and young adult (AYA)-onset breast and colon cancers from the VOICE study.

Abstract

646 Background: The population of AYA-onset cancer survivors is growing rapidly. Breast and colon cancers are among the most common cancers and the leading causes of cancer-related death in this age group. These patients require surveillance for cancer recurrence, progression, and development of second cancers as recommended by the National Comprehensive Cancer Network (NCCN). However, concordance with surveillance recommendations for this population is largely unknown. Methods: Breast (stage 0-III) and colon (stage I-II) cancer survivors diagnosed at ages 15–39 years between 2012–2020 and who survived ≥1 year post-diagnosis were identified from two regions of an integrated healthcare system, Kaiser Permanente Northern and Southern California (KPNC/KPSC). Concordance with NCCN recommendations was assessed for annual breast imaging (mammography, magnetic resonance imaging (MRI)) for breast cancer survivors; for colon cancer survivors, recommended computed tomography (CT) and laboratory testing (labs) were assessed for patients with stage II/III disease and colonoscopy within one year post-surgery (all stages). Data on utilization was obtained from state and local cancer registries and electronic medical records. Follow-up was through five years post-treatment, death, loss to follow-up, or second primary cancer. Results: Overall, 2,852 cancer survivors were included: 2,373 breast and 479 colon. Most patients were female (>90%); racial/ethnic composition varied across sites with proportions of Asian, Black, and Hispanic patients of 14%, 10%, and 44% at KPSC versus 25%, 8%, and 23% at KPNC. Across the cohort, 54% of breast cancer survivors were screened in all years; among colon cancer survivors, 40% received labs in all years, 57% received CT in all years, and 80% underwent colonoscopy within first 15 months post-surgery. There was a decreasing trend over time for imaging and labs by surveillance year (Table 1). Among breast cancer survivors, screening by surveillance year ranged from 89% in Year 1 (Y1) to 71% in Year 5 (Y5); for colon cancer, labs ranged from 80% Y1 to 46% Y5 and CT scans ranged from 85% Y1to 56% Y5. Conclusions: Concordance with recommended surveillance testing declined over time, highlighting the need for continued outreach to AYA survivors as they move further from diagnosis. Given the increasing incidence of breast and colon cancers at younger ages, it is critical to develop and test multilevel interventions to increase participation in surveillance recommendations among this population. Breast KPSC N=1,200 KPNC N=1,173 Year (Y) Y1 Y2 Y3 Y4 Y5 Y1 Y2 Y3 Y4 Y5 Mammography/MRI (min. 1/y), % 87 82 78 74 71 89 85 81 78 73 Screened in all years, % 54 54 Colon KPSC N=251 KPNC N=228 Year (Y) Y1 Y2 Y3 Y4 Y5 Y1 Y2 Y3 Y4 Y5 CEA labs (min. 2/y), % 80 73 56 58 62 72 71 71 53 46 CT scan (min. 1/y), % 77 69 64 64 56 85 79 77 70 70 Received labs all years, % 54 28 Received CT scan all years, % 50 60