Adult Survivors of Childhood Cancer Have Lower Bone Mineral Density
Men who survived childhood leukemia treatment into adulthood were more likely to have low bone mineral density than other
adults their age, putting them at risk of bone fractures and osteoporosis, a bone disorder common in older adults, according
to a new study.
Researchers led by James G. Gurney, Ph.D., of the University of Michigan Comprehensive Cancer Center, found that 24 percent
of the 74 survivors studied had abnormally low bone mineral density, a measure of bone strength. The average age of the survivors
was 30, and they had been treated an average of 24 years ago for the most common type of childhood cancer, acute lymphoblastic
According to the World Health Organization, in the general population, 11 percent of 30-year-old men and 19 percent of
30-year-old women on average have low bone mineral density, a condition known as osteopenia. In this study, published in the
journal Cancer, 36 percent of men and 16 percent of women had low bone mineral density.
"Studies such as this one stress the importance of monitoring for bone health in these survivors, particularly since there
may be some simple interventions, such as vitamin D and calcium, that may be beneficial," said study lead author Inas Thomas,
M.D., a U-M Medical School fellow.
The researchers also looked at levels of growth hormones, which are affected by leukemia treatment. Low growth hormone levels
can contribute to poor bone health. The researchers believe the disease itself or the treatments, such as radiation-particularly
to the brain-and chemotherapy may affect bone growth.
"We would argue that all adult survivors should be screened," Thomas said. "The disease, chemotherapy and cranial radiation --
even if they do not lead to growth hormone deficiency-may play a role in the development of osteopenia or osteoporosis."
Costs block survivors from follow-up care, study finds
As many as 2 million American cancer survivors may be going without health care because of its expense, according to a recent
National Cancer Institute study.
Based on the National Health Interview Survey that collected data between 2003 and 2006 from 40,000 households, the NCI examined
health-seeking behaviors of 6,602 adult cancer survivors as compared with 104,000 adults without a cancer history.
Survivors younger than 65 were almost twice as likely to go without medical care as were people in the same age group who had
never had cancer.
Douglas Blayney, M.D., medical director for the University of Michigan Comprehensive Cancer Center, said it's critical for
cancer survivors to seek regular medical care.
"We know that some people who have one cancer are at high risk for getting a second cancer, either from innate susceptibility
or as a side effect of treatment. Part of survivorship care is targeting those who are most at risk so that we catch cancers early
when they're more likely to be treatable," said Dr. Blayney, who was not involved in the NCI study. "If it's important for the
general population to be screened to catch cancers early, then it's even more important for cancer survivors because of their
increased risk for developing second cancers."
The NCI study found that almost 8 percent of the cancer survivors went without medical care because of cost. Nearly 11 percent
went without dental care, 3 percent went without mental health care and 10 percent failed to fill prescriptions for the same reason.
African-American and Hispanic cancer survivors appeared to be disproportionately affected by cost: Hispanic survivors were twice
as likely as white survivors to go without prescriptions, while African-Americans were 87 percent more likely than whites to do that.
"There are certainly a lot of things we don't know about survivorship care. This study points out that cost is one barrier to
care, but there may be others we don't understand," Blayney said. "One of the ways we can address this within the medical community
is to be more directed in our testing so that we can target those people we know are at risk. That way, we can be more efficient in
our use of health-care dollars."
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