International Guideline Harmonization Group Recommendations for Breast Cancer Surveillance in Childhood, Adolescent, and Young Adult Cancer Survivors After Anthracyclines.
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PURPOSE: With new evidence emerging about breast cancer risk following anthracycline chemotherapy, the International Late Effects of Childhood Cancer Guideline Harmonization Group updated the evidence and breast cancer surveillance recommendations for female childhood, adolescent, and young adult (CAYA) cancer survivors. METHODS: The Grading of Recommendations Assessment, Development, and Evaluation methodology was used to incorporate new knowledge and refine breast cancer surveillance recommendations. The guideline panel updated the systematic literature review and revised recommendations based on new evidence, clinical judgment, and assessments of benefits and harms of surveillance, ensuring adaptability across various health care systems. RESULTS: The literature update revealed new findings on the effects of anthracyclines on breast cancer risk in female CAYA cancer survivors. Moderate-quality evidence shows no significant association between doxorubicin doses <100 mg/m2 and breast cancer risk. High-quality evidence indicates a statistically significant but weak association between breast cancer risk and 100-199 mg/m2 doxorubicin (relative risk, <2) and a moderate breast cancer risk (relative risk, 2-4) for those treated with ≥200 mg/m2 in the absence of radiotherapy exposing breast tissue (chest radiation). Routine breast cancer surveillance after ≥200 mg/m2 doxorubicin in the absence of chest radiation is reasonable from age 30 years onward or ≥8 years from exposure (whichever occurs last). Due to inconclusive evidence, no recommendation could be formulated for routine breast cancer surveillance after daunorubicin, epirubicin, or idarubicin, in the absence of chest radiation. CONCLUSION: The newly identified evidence on breast cancer risk after anthracyclines supports changes in the 2019 recommendations regarding breast cancer surveillance for survivors treated with ≥200 mg/m2 doxorubicin without chest radiation.