Affiliations of authors:Department of Radiation Oncology and Institute for Health Policy, Management and Evaluation , University of Toronto, Toronto, Canada (DCH), Department of Pediatrics (PCN), and Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network (PC); Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto , Canada (DCH); Department of Statistics and Actuarial Science, University of Waterloo , Waterloo , Canada (CC); Division of Hematology/Oncology Hospital for Sick Children , Toronto , Canada (PCN).
J Natl Cancer Inst. 2016 Mar 1;108(7). doi: 10.1093/jnci/djw010. Print 2016 Jul.
Female survivors treated with thoracic radiation therapy (RT) for childhood cancer experience increased risks of breast cancer (BC). There are currently no data quantifying the potential mortality gains of early BC screening among such survivors.
A mathematical model of BC development was used to evaluate the marginal benefit of early-initiated screening of female survivors of adolescent Hodgkin's lymphoma (HL) starting at age 25 years on BC mortality compared with screening initiated at age 40 years. Sensitivity analyses were performed to evaluate the robustness of the estimates over a plausible range of conditions.
For survivors treated at age 15 years, the absolute risk of BC mortality by age 75 years was predicted to decrease from 16.65% with no early screening to 16.28% (annual mammography), 15.40% (annual MRI), 15.38% (same-day annual mammography and MRI), and 15.37% (alternating mammography and MRI every six months). Approximately 80 patients would need to be invited to MRI-based screening to prevent one BC death. In sensitivity analyses, the number needed to invite to MRI-based screening to prevent one BC death ranged from 71 to 333. Combinations of MRI plus mammography were predicted to produce 99.52 false positives per 1000 screenings done between age 25 to 39 years.
These findings are the first to indicate that early MRI-based screening should reduce BC mortality among women treated with RT for adolescent HL. The magnitude of this benefit is superior to that described for other accepted screening indications although MRI can produce a substantial rate of false-positive results.
接受胸部放射治疗（RT）治疗儿童癌症的女性幸存者乳腺癌（BC）的风险增加。目前尚无数据量化此类幸存者早期 BC 筛查的潜在死亡率获益。
使用 BC 发展的数学模型来评估从 25 岁开始对青少年霍奇金淋巴瘤（HL）幸存者进行早期筛查的潜在收益，与从 40 岁开始筛查相比，对 BC 死亡率的影响。进行敏感性分析以评估在合理范围内估计的稳健性。
对于 15 岁接受治疗的幸存者，预计到 75 岁时 BC 死亡率的绝对风险将从无早期筛查的 16.65%降低至 16.28%（每年进行乳房 X 线照相术），15.40%（每年进行 MRI），15.38%（当天进行年度乳房 X 线照相术和 MRI）和 15.37%（每六个月交替进行乳房 X 线照相术和 MRI）。需要邀请大约 80 名患者进行基于 MRI 的筛查，以预防 1 例 BC 死亡。在敏感性分析中，需要邀请到基于 MRI 的筛查以预防每 1000 次 BC 死亡的人数从 71 到 333 不等。预测 MRI 加乳房 X 线照相术的组合在 25 岁至 39 岁之间进行的每 1000 次筛查中会产生 99.52 个假阳性。
这些发现是第一个表明，早期基于 MRI 的筛查应降低接受 RT 治疗的青少年 HL 女性的 BC 死亡率。尽管 MRI 可以产生大量的假阳性结果，但这种益处的幅度优于其他公认的筛查指征。
