MRI Identifies Early Breast Cancer in At-Risk Survivors of Childhood Hodgkin Lymphoma

Magnetic-resonance imaging (MRI) has been shown to identify invasive breast tumors at very early stages, when cure rates are expected to be excellent, according to recent findings of the largest clinical study ever done to evaluate breast cancer screening of female survivors of childhood Hodgkin lymphoma (HL). These patients are at increased risk because they received chest radiation.

The findings, published online May 28, 2014, in the American Cancer Society’s journal Cancer, emphasizes the need for at-risk childhood HL survivors and primary care physicians to be cognizant of established guidelines that advocate breast MRI screening from the age of 25 years or eight years after chest radiation (whichever is later), according to lead investigator Dr. David Hodgson, a radiation oncologist at Princess Margaret Cancer Center, University Health Network (UHN; Toronto, ON, Canada).

“Female survivors of childhood HL who had chest radiation should speak with their family doctor about after-care assessment and breast cancer screening,” remarked Dr. Hodgson. “We estimate that 75% of women who are at high risk because of prior radiotherapy to the chest are not being screened. So my hope is that this new evidence will encourage these survivors to discuss early screening with their physicians. There is a provincial pediatric oncology aftercare system already in place to help them, organized by the Pediatric Oncology Group of Ontario [POGO].”

Dr. Hodgson’s study colleagues, in collaboration with colleagues at the Dana Farber Cancer Institute (Boston, MA, USA), performed 274 breast MRI scans on 96 women from 2005 to 2012. Ten breast tumors—50% of them invasive cancers—were diagnosed in nine women during 363 person-years follow up. The median age of breast cancer diagnosis was 39 years (range 24 to 43 years), and the median latency time period between HL diagnosis and age at breast cancer diagnoses was 21 years (range 12 to 27 years). “This illustrates the young age at which these cancers can occur. For some of these women, if they had been screened starting at age 40 or 50 like average risk women, it would have been too late,” commented Dr. Hodgson.

Of the 10 identified breast tumors, five were seen on both MRI and mammogram; three were visible only on MRI; and two were detected on mammogram by itself (but were noninvasive). The median size of invasive tumors size was 8 mm (range 3–15 mm) and none had metastasized to the lymph nodes. These findings are considerably better than earlier studies using only mammographic screening in these young patients, in which almost half of the cancers identified had cancer spread to the lymph nodes.

Dr. Hodgson noted that because MRI screening is so much more sensitive to small alterations in the appearance of the breast tissue than mammography, up to one-third of patients may be called back for further testing of suspicious findings, many of which are benign or not clinically significant and therefore require no treatment. “It’s important to forewarn at-risk HL survivors because call backs definitely heighten anxiety.”

Related Links:
Princess Margaret Cancer Center
Dana Farber Cancer Institute