Miranda Fidler-Benaoudia, PhD, calls for tailored surveillance in AYA cancer survivors

In a recent interview with Contemporary Pediatrics, Miranda Fidler-Benaoudia, PhD, highlighted the complexities of long-term surveillance for survivors of adolescent and young adult (AYA) cancers, particularly as they transition from pediatric to adult care systems.

While it is well established that childhood cancer survivors face an elevated risk of subsequent primary neoplasms, clear, evidence-based screening guidelines for AYA survivors remain limited. Existing pediatric protocols recommend earlier and more intensive screening based on treatment exposures—for example, initiating breast cancer screening at aged 30 years or 8 years after chest irradiation—but comparable guidance for AYA populations has yet to be defined.

Fidler-Benaoudia emphasized that current findings primarily serve to prompt further investigation rather than provide definitive clinical direction. A key gap lies in understanding how specific treatment exposures influence long-term cancer risk in AYA survivors. Radiation therapy is identified as the most significant contributor, given its well-documented carcinogenic effects.

For instance, chest irradiation is associated with increased risks of breast and lung cancers, while pelvic irradiation elevates the likelihood of colorectal cancer. Additional contributors include certain chemotherapeutic agents and hormone therapies, which may further heighten the risk of secondary malignancies.

Optimizing risk-based screening protocols for high-risk groups—such as survivors of Hodgkin lymphoma, breast cancer, or head and neck cancers—requires more granular data. According to Fidler-Benaoudia, future research must move beyond broad diagnostic categories to analyze individual treatment regimens.

This approach would allow clinicians and policy makers to better weigh the benefits of earlier detection against potential harms, such as false positives, unnecessary interventions, and psychological distress. Ultimately, such evidence is essential for developing targeted, efficient screening strategies that do not overburden patients or health care systems.

In the absence of definitive guidelines, communication and education are critical. AYA survivors should engage in ongoing discussions with both oncologists and primary care providers to ensure appropriate surveillance.

Equally important is the role of modifiable lifestyle factors in mitigating cancer risk. Avoiding tobacco, limiting alcohol consumption, maintaining a healthy weight, and practicing sun protection are universally recommended strategies that remain highly relevant for this population.

Finally, Fidler-Benaoudia underscored the importance of robust survivorship care models. Systems that support lifelong follow-up, comprehensive documentation, and shared electronic medical records can help ensure continuity of care, particularly for a highly mobile young population. Strengthening these frameworks will be essential to bridging current gaps in surveillance and improving long-term outcomes for AYA cancer survivors.

No relevant disclosures.

References

1. Alam AU, Tchir D, McKillop S, et al. Subsequent primary neoplasm risk among survivors of cancer in adolescence and young adulthood: a population-based study from Alberta, Canada. CMAJ. 2026;198(14):E535-E549. doi:10.1503/cmaj.251381
2. Survivors of adolescent, young adult cancers at double the risk of future cancers. News release. Canadian Medical Association Journal. April 13, 2026. Accessed April 14, 2026. https://www.eurekalert.org/news-releases/1123172