Women Who Receive Thoracic (i.e., Mantle) Radiation and Breast Cancer Risk

  • Women who receive thoracic (i.e., mantle) radiation prior to age 30:
    • Are at increased risk of breast cancer:
      • Although standardized incidence ratios vary from 13 to 55:
        • Based on:
          • Patient factors
          • Disease factors
          • Treatment factors
    • In the Late Effects Study Group trial:
      • The relative risk of breast cancer varied by follow-up interval:
        • And was greatest at 15 to 19 years after radiation exposure
  • Screening guidelines for those under age 25 include:
    • An annual clinical exam beginning 10 years after the radiation exposure
  • Screening guidelines for those over age 25 include:
    • An annual clinical exam beginning 8 to 10 years after the radiation exposure:
      • With the addition of:
        • Annual screening mammogram for patients ≥ age 30
        • Annual MRI is recommended for patients ≥ age 25
  • Recent studies reporting the persistence of gadolinium deposits in the brain:
    • Following serial contrast MRI scans:
      • Have led to a related FDA safety alert:
        • However, deposition is associated with only some gadolinium based contrast agents, and there is no clinical data that this results in detrimental long-term cognitive effects
  • There is currently no evidence that:
    •  Biannual MRI is more valuable than annual MRI for screening
  • References:
    • Henderson TO, Amsterdam A, Bhatia S, Hudson MM, Meadows AT, Neglia JP, et al. Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med. 2010;152(7):444-454.
    • van Leeuwen FE, Klokman WJ, Stovall M, Dahler EC, van’t Veer MB, Noordijk EM, et al. Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin’s disease. J Natl Cancer Inst. 2003;95(13):971-980.
    • Ramalho J, Ramalho M, Jay M, Burke LM, Semelka RC. Gadolinium toxicity and treatment. Magn Reson Imaging. 2016;34(10):1394-1398.
    • Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status. Neuroradiology. 2016;58(5):433-441.
    • Olchowy C, Cebulski K, Lasecki M, et al. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity – A systematic review. PLoS One. 2017;12(2):e0171704.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #CASO #CenterforAdvancedSurgicalOncology #PalmettoGeneralHospital

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