The early initiation—at age 25 to 30—of annual breast cancer screening with magnetic resonance imaging (MRI) with or without mammography may reduce breast cancer mortality by more than half in survivors of childhood cancer who had been previously exposed to chest radiation, according to a study by Yeh et al published in the Annals of Internal Medicine.
According to the researchers, these findings highlight the importance of MRI screening in reducing deaths from breast cancer among young women previously exposed to chest radiation and suggest identifying effective policies and interventions to reduce barriers to screening to ensure comprehensive and coordinated care for these high-risk survivors.
Although treatment advances for childhood cancers have resulted in greater survival increases, with more than 80% of children diagnosed with cancer surviving 5 years or more, these survivors face risks for treatment-related death and late effects from treatment, including secondary breast cancer. Research shows that an estimated 30% of female childhood cancer survivors who had received chest radiotherapy at doses of 20 Gy or more will develop breast cancer by age 50.
Study Methodology
The objective of the study was to compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in survivors of childhood cancers. The researchers used data from the Childhood Cancer Survivor Study and two breast cancer simulation models from the Collaborative Intervention and Surveillance Modeling Network to estimate the benefits, harms, and cost-effectiveness of breast cancer screenings in these survivors.
The target population was 20-year-old women with a history of chest radiotherapy.
KEY POINTS
- Lifetime breast cancer mortality risk without screening was 10% to 11% across models.
- Compared with no screening, starting at age 25, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62% of deaths.
- The benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged.
Study Results
The researchers found that the lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62% of deaths. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an incremental cost-effectiveness ratio threshold of less than $100,000 per quality-adjusted life-year gained, screening beginning at age 30 was preferred.
According to the results of sensitivity analysis, assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged.
The study authors concluded, “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.”
Jennifer M. Yeh, PhD, of the Division of General Pediatrics, Boston Children’s Hospital, is the corresponding author of this study.
Disclosure: Funding for this study was provided by the American Cancer Society and the National Institutes of Health. For full disclosures of the study authors, visit acpjournals.org.
