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Breast MRI Screening in Women Treated with Mediastinal Irradiation for Hodgkin’s Disease
Detection, Diagnosis and Prognosis
Background: The risk of breast cancer in women treated with mantle irradiation for Hodgkin’s disease (HD) at a young age is significantly increased after a latency of 10-15 years. The magnitude of the risk is similar to that of carriers of BRCA-1 and BRCA-2, with an estimated cumulative risk of 20% by the time a patient reaches 40-45. Recent data showed that breast magnetic resonance imaging (MRI) is significantly more effective than mammogram in detecting breast cancer in carriers of BRCA-1 or BRCA-2, or in women with traditional breast cancer risk factors. It’s role in HD survivors, however, has not been studied. Compared with hereditary breast cancer, breast cancer after HD may have different radiographic and pathologic features, and natural history. Survivors of HD also face other competing mortality that may affect their benefit from early breast cancer detection. Objectives/Hypothesis: The objectives of this study are to compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mammography and breast MRI for breast cancer detection in women treated with mantle irradiation for HD, and to correlate the radiographic and pathologic findings. The hypothesis of the proposed study is that in these women, breast MRI may detect additional breast cancers that are not evident on mammogram, and breast MRI may have a higher sensitivity than mammogram in detecting breast cancer in this population. Study Design: Women treated with mantle irradiation for HD at age =< 35, and are now >= 8 years out from treatment are eligible. Participants will be recruited from: 1. Joint Center for Radiation Therapy HD Database (consists of over 1,500 patients with HD treated our institution since 1969). 2. The Lance Armstrong Adult Cancer Survivorship Clinic. 3. Local cancer survivorship organizations. Participants will undergo yearly breast MRI and mammogram for a total of 3 years. Biopsies will be performed for findings that are suspicious or highly suggestive of malignancy. Interval breast cancers that developed during the study period will be recorded. The sensitivity, specificity, PPV and NPV of mammography and breast MRI for breast cancer detection will be calculated and compared. Potential Outcomes and Benefits of the Research : Early detection of breast cancer in these high-risk women may translate into earlier stage at diagnosis and potential breast-conserving therapy options despite their prior radiation exposure. It may also lead to better treatment outcome and reduced breast cancer-related mortality.
Background : Studies have shown that women who have received chest radiation therapy for Hodgkin's disease (a form of cancer of the lymph glands that mostly affect young adults) at a young age are at increased risk for breast cancer later on in life. The risk is similar to that of women who are at high genetic risk, and is estimated to be around 20% by the time the patient reaches age 40 to 45. In women at high genetic risk, breast magnetic resonance imaging (MRI) has been shown to be more effective than mammography in detecting breast cancer. However, the role of breast MRI in female survivors of Hodgkin's disease is unknown. These breast cancers that develop as a result of prior radiation therapy exposure may appear differently on MRI, and they may also behave differently. Whether female survivors of Hodgkin's disease may benefit from breast MRI screening should therefore be studied separately. Objectives/Hypothesis : The goals of this study are to compare the effectiveness of breast MRI versus mammography in detecting breast cancer in women who have received chest radiation therapy for Hodgkin's disease, and to study the appearance of these breast cancers on MRI. We hypothesize that breast MRI may detect additional breast cancers that are missed by mammography in these high-risk young women. Study Design : Women who have received chest radiation therapy for Hodgkin's disease at or before the age of 35, and are now more than 8 years out from treatment, are eligible for this study. Patients will be recruited from a pre-existing Hodgkin's disease database that consist of over 1,500 Hodgkin's disease patients treated at our institution over the last 30 years, the Lance Armstrong Adult Cancer Survivorship Clinic, and websites of local cancer survivorship organizations. Participants will undergo yearly breast MRI and mammogram over 3 years. The MRI and mammogram will be reviewed by the study radiologist, who is a specialist in breast imaging. We will track all breast cancers that were detected by the breast imaging studies, as well as those that were diagnosed in between studies. We will then calculate and compare the effectiveness of breast MRI versus mammogram in breast cancer detection. Potential Outcomes and Benefits of the Research : Breast MRI may allow the detection of smaller and more curable breast cancers in these women who are at high risk as a result of their prior cancer therapy. The results will also help guide doctors in the follow-up of these cancer survivors.