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Early MRI may lower breast cancer mortality among Hodgkin lymphoma survivors
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Early MRI–based screening decreased breast cancer mortality among women survivors of Hodgkin lymphoma who underwent mediastinal radiotherapy during adolescence, according to results of a mathematical model.
Despite the considerable rate of false-positive results associated with MRI, the benefit far outweighs those described for other accepted screening indications, according to the researchers.
David Hodgson
Previous research has shown radiotherapy for Hodgkin lymphoma significantly increases the risk for breast cancer in women later in life. Consensus guidelines recommend early initiation of breast cancer screening in this population.
Yet, no data exists measuring the potential benefit of early screening and its ability to decrease breast cancer mortality in this population.
David Hodgson, MD, MPH, associate professor of radiation oncology at University of Toronto and researcher in the cancer clinical research unit at Princess Margaret Cancer Center, and colleagues sought to assess the potential benefit of screening for breast cancer at age 25 years compared with traditional screening initiated at 40 years among a simulated cohort of 100,000 women treated with mediastinal radiotherapy for Hodgkin lymphoma during adolescence.
Specifically, researchers developed the following screening protocols:
Average-risk screening with annual mammography between ages 40 and 74 years;
Early mammography annually between ages 25 and 74 years;
Early MRI annually between ages 25 and 39 years, plus annual mammography and MRI between ages 40 and 74 years;
Early same-day mammography and MRI annually between ages 25 and 74 years; or
Early alternating annual mammography and annual MRI every 6 months between ages 25 and 74 years.
By age 75 years, the researchers hypothesized the absolute risk for mortality from breast cancer among women treated with radiotherapy at age 15 years would be 16.65% with no screening. However, the risk would decrease to 16.28% with annual mammography, to 15.4% with annual MRI, to 15.38% with same-day annual mammography plus MRI, and to 15.37% among women alternating between mammography and MRI every 6 months.
To prevent one breast cancer mortality, nearly 80 women would need to be referred to early MRI screening based on moderate compliance. In other words, 12.48 breast cancer deaths would be averted in every 1,000 women invited for early screening.
Results of sensitivity analyses indicated the number of women that needed to be referred to MRI to prevent one breast cancer mortality ranged between 71 and 333 women.
However, researchers predicted 99.52 false-positive results would occur per 1,000 screenings with an MRI plus mammography combination conducted between the age of 25 and 39 years.
Researchers acknowledged the lack of cost considerations as a limitation of this analysis.
“One of the most appealing methods of reducing the morbidity of late-onset treatment toxicity is to detect asymptomatic disease before it causes clinical problems,” the researchers wrote. “MRI screening is more effective in reducing breast cancer mortality than mammography in these patients, but increases the rate of false-positive results.” – by Jennifer Southall
Disclosure: The researchers report no relevant financial disclosures.
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