Conference Coverage
Hodgkin's Survivors Face High Breast Cancer Risk
Major Finding: Nearly a third (30%) of females treated with chest radiation for Hodgkin’s lymphoma was diagnosed with breast cancer by age 50.Data...
ESTES PARK, COLO. – Primary care physicians are uniquely positioned to help their younger adult female patients who have a history of thoracic radiation therapy for lymphoma by arranging for them to begin undergoing annual screening breast MRI, Dr. Jennifer R. Diamond said.
"That mantle cell radiation includes the upper inner quadrants of both breasts; those patients are at extremely high risk for developing breast cancer," explained Dr. Diamond, a medical oncologist at the University of Colorado, Aurora. "Many times, they’re no longer being followed by their oncologist, and it’s up to their primary care physician to pull the trigger and order the test."
Dr. Jennifer R. Diamond
Many patients likely wouldn’t know that they should do breast cancer screening at such an early age, she added, because breast cancer wasn’t an anticipated outcome back when they had their radiotherapy.
National Comprehensive Cancer Network guidelines call for annual breast MRI and mammography along with clinical breast exams every 6-12 months, beginning 8-10 years after thoracic radiotherapy or at age 25 years, whichever occurs later. Dr. Diamond typically has patients stagger the two imaging modalities 6 months apart.
Both annual breast MRI and mammography are necessary. Screening MRI is far more sensitive than mammography alone in high-risk women, and it leads to cancer diagnosis at an earlier stage. However, MRI can miss ductal carcinoma in situ that would be evident as abnormal calcifications on screening mammography, she continued.
Annual breast MRI, in addition to mammography, is also indicated for women at high breast cancer risk as defined by a lifetime estimated risk in excess of 20%, or because they possess a BRCA 1 or 2 mutation, according to the NCCN. Dr. Diamond recommended BRCAPRO as a very useful tool for estimating the lifetime risk of breast cancer in women with no previous breast cancer.
In response to an audience question, she said she’s had no problem in getting insurers to pay for annual breast MRI to supplement annual mammography, so long as she clearly documents in her note that the patient has a greater than 20% lifetime estimated risk of breast cancer.
"They won’t cover it even a week earlier than annually, though," Dr. Diamond added.
She is a big fan of breast tomosynthesis, also known as three-dimensional mammography. The Food and Drug Administration–licensed technology produces a 3-D view of the breast tissue in addition to the standard two-dimensional images, all obtained in one compression with only about 2 seconds of additional compression time. Studies have shown that this tool substantially reduces patient recall rates for nondefinitive mammograms, Dr. Diamond said.
"It allows the mammographer to scroll through the breast, looking up and down sort of like with a CT scan, but without the same radiation exposure," she explained. "It’s a really great new technology, and I think most mammography centers will increasingly turn to it."
Dr. Diamond reported having no financial conflicts.