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.
  • National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis, Version 1.2019. https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Accessed February 23, 2020.
  • 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.

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