Breast Cancer Screening with MRI for Childhood Cancer Survivors

Survey results published in Internal medicine annual report It has been suggested that starting an annual breast cancer screening with MRI at age 25 to 30 with or without mammography may reduce breast cancer mortality in breast cancer survivors by more than 50%.

Previously chest radiation using data from the Childhood Cancer Survivor Study (CCSS) and 2 Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models. The model evaluated three strategies starting from age 25, without screening, digital mammography with MRI screening (current pediatric oncology group). [COG] Recommended), 30 or 35 years to 74 years, MRI begins at 25, 30, or 35 years and continues to 74 years.

Overall, the unscreened lifetime risk of breast cancer mortality was found to be 10% to 11% across models. Beginning at age 25, annual mammography with MRI prevented most deaths (56% to 71%) and annual MRI (without mammography) prevented 56% to 62% compared to no screening. In addition, both screening strategies had the most screening tests, false positive screening results, and benign biopsy results.

In an interview with Cancer Network®Dr. Jennifer M. Ye, an associate professor at Harvard Medical School and associate scholar in pediatrics at Boston Children’s Hospital, further discussed the study and its impact on breast cancer patients.

Cancer Network®: First of all, could you describe your recent study of breast cancer screening in childhood cancer survivors who received chest radiation?

Yup: Childhood cancer survivors who have previously received high-dose chest radiation are at increased risk of secondary breast cancer. The Children’s Oncology Group and several other organizations have established guidelines to manage this increased risk, focusing on early initiation of breast cancer screening in these high-risk survivors. Compliance rates are lower than we want, which may be due in part to the uncertain benefits and harms associated with screening.

To address this gap in our understanding, we used simulation modeling to estimate the clinical outcomes associated with the screening of these high-risk survivors. Data from the Childhood Cancer Survivor Study, a cohort study of approximately 25,000 survivors diagnosed between 1970 and 1999, were used to fit two CISNET breast models and to develop several screening strategies. Evaluated This includes MRI screening starting at age 25-current COG recommendations-30 and 35 yearly mammography and annual screening with MRI starting only at ages 25, 30 and 35.

What do you think the overall impact of these findings is?

Our study estimated that early initiation of screening with breast MRI, with or without mammography, could prevent more than half of the breast cancer deaths in these high-risk women. These findings underscore the importance of ensuring that these young women are informed of the increased risk of breast cancer and the benefits of regular screening.

Are there any next steps planned for the study?

Recent studies suggest that survivors who have been treated with chemotherapy but not chest radiation may also be at increased risk of secondary breast cancer. We would like to extend these analyzes to explore the potential benefits of screening these survivors at a younger age.

What do you think is the most important thing to know about research in the practice of oncologists?

Survivors who have previously received chest radiation are at increased risk of secondary breast cancer. Our study estimates that screening can avoid more than half of the expected breast cancer deaths in these women. An oncologist’s practice should discuss the importance and potential benefits of screening with patients.

From the findings, what do you think needs to be changed or implemented, whether at the facility level or the government level?

Our study found that MRI was an important component of screening and accounted for the majority of screening benefits in terms of avoided death in these high-risk women. These findings suggest that screening guidelines should emphasize the importance of MRI in screening with and without mammography. Moreover, because many survivors do not have access to or coverage of MRI screening, making access to MRI screening a priority for survivors is a priority for improving their long-term health. Must be a matter.

reference:

The clinical benefits, harms, and cost-effectiveness of breast cancer screening for survivors of childhood cancers undergoing chest radiation therapy, such as Yeh JM, Lowry KP, and Schechter CB. Internal medicine annual report.. Doi: 10.7326 / M19-3481.