Lung Cancer Surveillance
As in the general population, the risk of lung cancer is greater among patients who smoke after XRT than among those who refrain from smoking. Owing to the relative rarity of lung cancer in childhood cancer survivors, routine imaging surveillance is not recommended.69 Shared decision-making regarding earlier (before that recommended for population screening) CD 1530 of low-dose helical computed tomography imaging is recommended for survivors treated with chest XRT and high-risk history of smoking (minimum history of 30 pack-years).72 In addition, survivors should be counseled regarding health risks associated with tobacco use and referred to resources to facilitate success in quitting smoking.
Skin Cancer Surveillance
Owing to the excess prevalence and morbidity associated with skin cancer observed among childhood cancer survivors, annual skin examination with particular attention to skin lesions and pigmented nevi in previous radiation treatment fields is recommended as per American Cancer Society guidelines.73 In addition, survivors should be counseled about risks conferred by tanning and benefits of adhering to sun protection behaviors.