Breast Cancer Screening for Childhood Cancer Survivors With a History of Chest Radiotherapy
Posted: Wednesday, August 12, 2020
Although surveillance with annual mammography and breast MRI is indicated for female survivors of childhood cancer who have received chest radiotherapy, it remains unclear whether it is an effective strategy with more benefits than harms. In a comparative modeling study published in the Annals of Internal Medicine, Jennifer M. Yeh, PhD, of the Division of General Pediatrics at Boston Children’s Hospital, and colleagues attempted to clarify the best way to detect breast cancers early in this patient population.
“Our findings based on modeling suggest that even if breast cancer risk is cut in half with more recent changes in radiation dose and delivery, early initiation of screening still remains favorable for these high-risk survivors,” commented Dr. Yeh in a news item from Boston Children’s Hospital.
Dr. Yeh and colleagues used two breast cancer simulation models, which were from the Cancer Interventional and Surveillance Modeling Network, adapting them for survivors of childhood and adolescent cancers (diagnosed between 1970 and 1986). The target population was women 20 years of age with a history of chest radiotherapy. The annual screening strategies assessed via the models included no screening; digital mammography plus breast MRI starting at age 25, 30, or 35; and MRI alone starting at age 25, 30, or 35.
Based on analysis across the models, the investigators reported a 10% to 11% lifetime breast cancer mortality risk without screening. Beginning with age 25, annual mammography with MRI averted the most deaths (56%–71%), followed by annual MRI without mammography (56%–62%), compared with no screening at all.
The study authors offered the following closing thoughts: “Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer.”
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
