Mammogram Guidelines for Women with Prior Radiation

Li Liu, MD
Last Modified: June 18, 2009

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Question
Dear OncoLink "Ask the Experts,"
I received mantle radiation for Hodgkin's disease at the age of 26. I have been advised that radiation to the chest leads to an increased risk of breast cancer in patients treated under the age of 30. However, there seems to be some controversy over when female patients treated with mantle radiation should begin mammography screening. Some sources state five years while others state 10 years? What are the practice guidelines? Thank you for your time.


Answer
Li Liu, MD, OncoLink editorial assistant, responds:

For women who never had radiation exposure, the American Cancer Society recommends screening mammogram every year starting at age 40. Between the ages of 20 and 39, women should have a clinical breast examination by a health professional every 3 years. After age 40, women should have a breast exam by a health professional every year. Women age 20 or older should perform breast self-examination (BSE) every month as well.

Radiation is a known risk factor for secondary breast cancer following treatment of Hodgkin’s disease. The estimated actual incidence approaches 35% by 40 years of age (New England Journal of Medicine 1996; 334(12): 745-751). The risk in these patients seemed to rise at around 10 years after they received their radiation treatments. Age at irradiation is strongly associated with risk; the younger the age, the higher the risk. The risk of breast cancer also increases significantly with radiation dose and time since treatment (Journal of National Cancer Institute 1993; 85(1): 25-31).

The high risk of breast cancer in women exposed to radiation at a young age raises important issues regarding screening programs. The process of diagnosing breast cancers in two Hodgkin’s disease series (Journal of Clinical Oncology 1994 Feb; 12(2): 312-25; Journal of National Cancer Institute 1993; 85(1): 25-31) illustrated that routine mammography alone has only limited value in this young patient group.

In 2007, the American Cancer Society made some changes to their screening guidelines to include MRI screening for women at high risk. The guidelines suggest that women who received radiation to the chest for Hodgkin’s disease between the ages 10 and 30 should undergo annual MRI, in conjunction with mammogram, for 30 years after the radiation treatment. While studies have not looked at this group specifically, experts believe that MRI screening might offer a similar benefit to that seen in women with a strong family history.