Survivors of childhood cancer previously treated with chest radiation are at high risk of developing secondary breast cancer. Similar to BRCA1 mutation carriers, an estimated 30% of these survivors will develop breast cancer by age 50. Current guidelines recommend early initiation of screening at age 25 in these women, but the benefits and harms are uncertain. Jennifer Yeh and colleagues at Boston Children’s Hospital used simulation modelling to assess the clinical benefits, harms and cost-effectiveness of breast cancer screening in these high-risk survivors.
The researchers adapted two Cancer Intervention and Surveillance Modelling Network (CISNET) breast cancer simulation models by using data from the Childhood Cancer Survivor Study (CCSS) and evaluated annual screening with mammography with breast MRI starting at ages 25 (current recommendation), 30 and 35, as well as annual MRI screening starting at ages 25, 30, and 35. Compared with no screening, all screening strategies prevented more than half of breast cancer deaths. Screening with mammography with MRI starting at age 25 prevented the greatest number of deaths (56 to 71 percent). However, when both costs and quality of life were considered, initiating screening at age 30 was preferable to age 25. Early screening was still favorable even if the elevated risk of breast cancer was 50% lower due to changes in radiation dose and delivery among survivors diagnosed more recently.
These findings underscore the importance of early initiation of screening for high-risk survivors and highlight how increasing the awareness of screening guidelines and ensuring access to screening can improve the long-term health of survivors.
Learn more: Read about Childrens Hospital Monitoring for Breast Cancer After Childhood Chest Radiation
Learn more: Read the full Annals of Internal Medicine article
Learn more: Read about Models and Tools
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