Early breast cancer screening lowers mortality risk among childhood cancer survivors

Female childhood cancer survivors aged 25 to 35 years who underwent annual breast cancer screening via MRI with or without mammography lowered their risk for breast cancer mortality, according to results from a comparative modeling study.

Jennifer M. Yeh, PhD, assistant professor of pediatrics at Harvard Medical School and Associate Scientific Researcher in the division of general pediatrics at Boston Children's Hospital, and colleagues wrote in Annals of Internal Medicine that several medical societies — including the American Cancer Society — recommend female childhood cancer survivors begin breast cancer screening earlier than their healthier peers.

However, “fewer than 50% of at-risk survivors undergo recommended screening, and clinicians who care for adult survivors are often unfamiliar with surveillance guidelines,” the researchers said.

Yeh and colleagues built different models to estimate the clinical benefits and harms of breast cancer screening in childhood cancer survivors, using data from the Childhood Cancer Survivor Study and the Cancer Intervention and Surveillance Modeling Network.

They found that among women who did not get screened, the lifetime breast cancer mortality risk among survivors who were diagnosed with childhood cancer between 1970 and 1986 and treated with radiation was 10% to 11% across the different models. Compared with no screening, starting at age 25 years, annual mammography with MRI prevented 56% to 71% of deaths, while annual MRI without mammography prevented 56% to 62% of deaths. Also, per 1,000 women who underwent screening, life-years gained increased by 1,317 to 2,544 years.

“Our findings highlight the importance of MRI in reducing deaths from breast cancer among young women previously exposed to chest radiation,” Yeh and colleagues concluded. “Identifying effective policies and interventions to reduce barriers to screening should be a priority for policymakers to ensure comprehensive and coordinated care for these high-risk survivors.”