Estimated risk of radiation-induced breast cancer from mammographic screening for young BRCA mutation carriers.

Notes: 

1 in 2000 undergoing mammograms have lifespan enhanced from detection and treatment. 10 in 2000 are hurt in some way from mammograms and subsequent treatment. 5 in 2000 with BRCA1 or BRCA2 genes for breast cancer have radiation induced increased mortality from mammograms

TitleEstimated risk of radiation-induced breast cancer from mammographic screening for young BRCA mutation carriers.
Publication TypeJournal Article
Year of Publication2009
AuthorsBerrington de Gonzalez A, Berg CD, Visvanathan K, Robson M
JournalJournal of the National Cancer Institute
Volume101
Issue3
Pagination205-9
Date Published2009 Feb 4
ISSN1460-2105
KeywordsAdult, Age Factors, Breast Neoplasms, Female, Genes, BRCA1, Genes, BRCA2, Heterozygote, Humans, Mammography, Mass Screening, Models, Statistical, Mutation, Neoplasms, Radiation-Induced, Risk Assessment, Risk Factors
Abstract

BRCA mutation carriers are recommended to start mammographic screening for breast cancer as early as age 25-30 years. We used an excess relative risk model (based on a pooled analysis of three cohorts with 7600 subjects who received radiation exposure) to estimate the lifetime risk of radiation-induced breast cancer from five annual mammographic screenings in young (<40 years) BRCA mutation carriers. We then estimated the reduction in breast cancer mortality required to outweigh the radiation risk. Breast cancer rates for mutation carriers were based on a pooled analysis of 22 pedigree studies with 8139 subjects. For BRCA1 mutation carriers, the estimated lifetime risk of radiation-induced breast cancer mortality per 10,000 women resulting from annual mammography was 26 (95% confidence interval [CI] = 14 to 49) for screening at age 25-29 years, 20 (95% CI = 11 to 39) for screening at age 30-34 years, and 13 (95% CI = 7 to 23) for screening at age 35-39 years. To outweigh these risks, screening would have to reduce breast cancer mortality by 51% (95% CI = 27% to 96%) at age 25-29 years, by 12% (95% CI = 6% to 23%) at age 30-34 years, and by 4% (95% CI = 2% to 7%) at age 35-39 years; estimates were similar for BRCA2 mutation carriers. If we assume that the mortality reduction from mammography is 15%-25% or less for young women, these results suggest that there would be no net benefit from annual mammographic screening of BRCA mutation carriers at age 25-29 years; the net benefit would be zero or small at age 30-34 years, but there should be some net benefit at age 35 or older. These results depend on a number of assumptions due to the absence of empiric data. The impact of varying these assumptions was therefore examined.

Alternate JournalJ. Natl. Cancer Inst.
PubMed ID19176458
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