MedicalResearch.com Interview with:
David Hodgson, MD, MPH, FRCPC
University of Toronto
Toronto, ON Canada
MedicalResearch.com: What is the background for this study?
Dr. Hodgson: We know that treatment for childhood Hodgkin lymphoma can cause some side effects that arise years after treatment is finished. In particular, radiotherapy given to the chest of adolescent females increases the risk of developing breast cancer in young adult survivors. But there are very little data about whether the early initiation of breast cancer screening will prevent breast cancer deaths in these survivors, and what kinds of screening is optimal. This is important because less than half of these young survivors are undergoing breast cancer screening, and in some jurisdictions early screening is not covered by insurance.
MedicalResearch.com: What are the main findings?
Dr. Hodgson: Because there has not been, and likely never will be, a large randomized screening trial for these patients, we used all the available information about their breast cancer risk, other health issues and the effectiveness of screening, and created a mathematical model that allows us to estimate the number of breast cancer deaths prevented by starting screening at age 25 for women who had received chest RT as teenagers. We found that one would have to invite about 260 survivors to early mammographic screening to prevent one breast cancer death, which compares favorably to other accepted reasons for breast cancer screening. Using MRI for screening, approximately 80 women would have to be invited to prevent one breast cancer death, because MRI is so much more sensitive than mammography. One of the problems with MRI, however, is that a substantial number of women will have “false positive” tests – abnormal findings that are not really cancer.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Hodgson: Certainly young women who received radiation therapy to the chest as part of treatment for lymphoma should be discussing early breast cancer screening with their doctors. Clinicians should be aware that this is increasingly emerging as an accepted indication for starting MRI-based screening in women before age 30. It is also relevant to policy makers, insofar as in some jurisdictions, the early initiation of screening is not covered by insurance, and this should probably change.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Hodgson: We did not do an economic evaluation of early screening, largely because the results can be highly variable depending on the region. But this is an important consideration. From a clinical perspective, it would be ideal if the false-positive rate of MRI screening could be brought down without compromising the sensitivity of the test.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
David C. Hodgson, Cecilia Cotton, Pavel Crystal, and Paul C. Nathan
Impact of Early Breast Cancer Screening on Mortality Among Young Survivors of Childhood Hodgkin’s Lymphoma JNCI J Natl Cancer Inst (2016) 108 (7): djw010 doi:10.1093/jnci/djw010 First published online March 1, 2016 (10 pages)
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David Hodgson, MD, MPH, FRCPC (2016). Early Breast Cancer Screening Recommended For Survivors of Childhood Hodgkin’s Lymphoma