幼年时期患有癌症或经历儿童期癌症的女性在晚年时期罹患乳腺癌的风险较高。该风险在年轻时接受高剂量放射线治疗的患者中尤为显著，但对其他治疗方法或同时接受放射线治疗的幸存者也存在。致病风险因素较为复杂。放射线治疗水平的提高仍未能完全避免二次癌症的风险，且延迟期长。化疗与乳腺癌长期风险的叠加作用可能会增加二次癌症的风险。建议在罹患初期8年或25岁之后，以胸部接受了10 Gy或更高的放射线照射的女性定期进行乳腺钼靶检查和核磁共振检查。但对高风险无放射线治疗史的女性仍缺乏指导建议。因为幸存者患乳腺癌后的死亡率高于原发性患者，而且其再次异步乳腺癌的发病率也高于普通人群，因此定期检查是至关重要的，有望改善死亡率。然而，对于这些年轻的患者，意识和连续的关注可能缺乏，其检查参与度也很低。幸存者从儿童期向成年期的过渡需要针对年龄的策略和终身的教育和风险预防措施，以改善这类患者的长期预后。©RSNA，2023。请参见本期Chikarmane的特邀评论。本文的问答题可在网络学习中心获取。

Women who survived childhood cancers or cancers at a young age are at high risk for breast cancer later in life. The accentuated risk is notable among those treated at a young age with a high radiation dose but also extends to survivors treated with therapies other than or in addition to radiation therapy. The predisposing risk factors are complex. Advances in radiation therapy continue to curtail exposure, yet the risk of a second cancer has no dose threshold and a long latency period, and concurrent use of chemotherapy may have an additive effect on long-term risk of cancer. Early screening with annual mammography and MRI is recommended for chest radiation exposure of 10 Gy or greater, beginning 8 years after treatment or at age 25 years, whichever is later. However, there is a lack of recommendations for those at high risk without a history of radiation therapy. Because mortality after breast cancer among survivors is higher than in women with de novo breast cancer, and because there is a higher incidence of a second asynchronous breast cancer in survivors than that in the general population, regular screening is essential and is expected to improve mortality. However, awareness and continuity of care may be lacking in these young patients and is reflected in their poor screening attendance. The transition of care from childhood to adulthood for survivors requires age-targeted and lifelong strategies of education and risk prevention that are needed to improve long-term outcomes for these patients. © RSNA, 2023 See the invited commentary by Chikarmane in this issue. Quiz questions for this article are available through the Online Learning Center.