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Early Breast Cancer Screening in Childhood Cancer Survivors

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Childhood cancer survivors may benefit from early MRI breast cancer screening.

Early MRI-based breast cancer screening of females treated with radiation therapy for childhood cancer can reduce breast cancer mortality in this patient group, according to a study published in the Journal of the National Cancer Institute.

Researchers from Canada sought to determine the benefit of early breast cancer screening of female childhood cancer survivors who had undergone thoracic radiation therapy (RT). The researchers searched through published studies that reviewed the risk of breast cancer in survivors of childhood lymphoma, and used a mathematical model of breast cancer development to quantify the effectiveness of screening starting at age 25 among women who had undergone chest RT as children.

The results showed that overall, survivors who were 15 years old when they received RT had an absolute risk of 16.65 percent of BC mortality by age 75 years. However, this risk decreased with regular screening:

Exam
Absolute Risk of BC Mortality by Age 75
Annual mammography
16.28%
Annual MRI
15.40%
Same-day annual mammography and MRI
15.38%
Alternating mammography and MRI every six months
15.37%

“Approximately 80 patients would need to be invited to MRI-based screening to prevent one BC death,” the authors wrote. Combining MRI and mammography would likely produce 99.52 false positives per 1,000 screenings of women between 25 and 39 years.

"If you are a young woman who was treated with radiation therapy to your chest as a teenager or child for [Hodgkin’s lymphoma], or for that matter chest radiation therapy for any reason, you should be having a conversation with your family doctor or your oncologist about whether to start breast cancer screening earlier than most women would," principal investigator David Hodgson, MD, professor in the department of radiation oncology, faculty of medicine, University of Toronto, said in a release.

Because of the increased risk of false positives in this age group, Hodgson said in the release: This is important for patients to know and for physicians to counsel patients about because it's stressful for a patient to be called back about suspicious findings.

The researchers concluded that early breast cancer screening with MRI for women who received RT for childhood cancers is beneficial and will reduce breast cancer mortality.

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