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Early MRI Screening Improves Breast Cancer Survival Rates in Women With Childhood Hodgkin Lymphoma

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Women who had radiation to the chest as children to treat a cancer other than breast cancer, such as Hodgkin lymphoma (cancer of the immune system), have a higher risk of breast cancer.

A study strongly suggests that starting screening for breast cancer early with MRI (magnetic resonance imaging) can boost breast cancer survival rates in survivors of childhood Hodgkin lymphoma.

The study was published in the March 1, 2016 issue of the Journal of the National Cancer Institute. Read the abstract of “Impact of Early Breast Cancer Screening on Mortality Among Young Survivors of Childhood Hodgkin’s Lymphoma.”

In recent decades, some of the most important medical discoveries have been in treating childhood cancer. Still, some childhood cancer patients develop a second cancer or another serious medical condition later in life that's believed to be related to treatment for the childhood cancer. Doctors don’t completely understand why childhood cancer survivors are more likely to be diagnosed with a different cancer later in life. For some, it could be genetics that make them more likely to develop cancer. For others, the higher cancer risk is probably related to the childhood cancer treatment. For example, radiation used to treat childhood cancer also can affect normal cells that are exposed to the radiation, causing a new, different cancer -- such as breast cancer -- to develop decades later.

To do this study, the researchers developed a mathematical model to compare the effects of starting breast cancer screening early, at age 25, to screening that started at age 40 in women who had been treated for Hodgkin lymphoma as children.

With mammography screening, the researchers found that about 260 women who had Hodgkin lymphoma as children would have to be invited to be screened at age 25 to prevent one breast cancer death. To compare, studies have shown that 300 to 1,300 average-risk women age 50 or older need to be screened to prevent one breast cancer death.

So starting breast cancer screening at age 25 with mammography for women who had Hodgkin lymphoma as children is about the same as starting mammography screening at age 50 for average-risk women.

With MRI screening, the researchers found that fewer than 80 women who had Hodgkin lymphoma as children would have to be invited to be screened at age 25 to prevent one breast cancer death. So far fewer women needed to be screened with MRI to save a life.

It’s important to know that the researchers estimated that about one-third of the women would have what’s called a false positive MRI result. This is when the MRI finds an area that looks like cancer but turns out to be normal. Besides worrying about being diagnosed with breast cancer, a false positive means more tests and follow-up visits, which can be stressful and scary. Still, other research has found that while false positive results do cause anxiety and stress, the anxiety is short-term and doesn’t affect a woman’s overall health and well-being.

“If you are a young woman who was treated with radiation therapy to your chest as a teenager or child for Hodgkin lymphoma, or chest radiation therapy for any reason, you should be having a conversation with your family doctor or your oncologist about whether to start breast cancer screening earlier than most women would,” said Dr. David Hodgson, professor of radiation oncology at the University of Toronto and the lead author of the study.

This study strongly suggests that childhood cancer survivors need a screening plan that’s tailored to their unique needs and risks.

Other research has shown that childhood cancer survivors are at much higher risk for a number of health problems in adulthood, including cancer. Because of these risks, people who have been treated for childhood cancer should take aggressive steps to minimize their risk of another cancer. These people also should have regular screenings for any complications of earlier treatment, including heart and lung disease as well as cancer.

If you've been treated in the past for cancer, it's important to regularly see a doctor who:

  • is familiar with your past medical history
  • understands your special risks
  • can give you the necessary counseling, monitoring, and screening for possible complications of your earlier treatment

If your childhood cancer treatment included radiation therapy to the chest area, your risk of breast cancer is most likely higher than average. You and your doctor should consider a more aggressive breast cancer screening plan. This plan will likely include more frequent mammograms starting at an earlier age and possibly using different screening techniques, such as breast MRI.

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