Experts say female childhood cancer survivors who have had radiation should get mammograms earlier than the general population of women.
Almost half of female childhood cancer survivors under the age of 40 who had chest radiation as part of their treatment are not following this recommended advice.
Physicians suggest starting screening mammograms at age 25, or eight years after the last radiation treatment, whichever comes last.
These guidelines are in place because women who have had chest radiation as children, teens, or young adults have a significantly higher risk for breast cancer.
Results of the study were reported in the Journal of the American Medical Association.
"Although the majority of women who've had chest radiation will never have breast cancer, between 12 and 20 percent will have breast cancer by age 45," says study author Dr. Kevin Oeffinger, director of the program for adult survivors of pediatric cancer at Memorial Sloan-Kettering Cancer Center in New York City.
"When we looked at how frequently these women were having breast cancer screening, we found that only 37 percent of women age 25 to 39 had been screened in the last two years,” he notes. “In women between 40 and 50, about 77 percent had been screened in the last two years, but most were not in a regular pattern of screening.”
The risk of developing breast cancer begins as soon as eight years after radiation treatment ends. Those at highest risk of breast cancer are women who survived Hodgkin lymphoma through treatment with high-dose radiation.
However, any woman who received radiation for cancer treatment as a child is at increased risk, as are women who received radiation prior to heart-lung transplants, notes Dr. Freya Schnabel, director of breast surgery at the New York University Cancer Institute.
Dr. Oeffinger's study included 551 randomly selected women who had survived a pediatric cancer and had undergone chest radiation as part of their treatment.
Overall, 55 percent of the women reported having a screening mammogram during the past two years. Forty-seven percent of those under 40 had never had a screening mammogram.
Only 53 percent of those between 40 and 50 years old participated in regular mammogram screenings.
The study found that screening rates were three times higher among women whose physicians recommended the test.
Dr. Oeffinger says many different factors could account for why these women are not being screened.
"These are women who were treated in the 70s and 80s, largely before we had survivor programs, and they weren't given treatment summaries," he explains.
And, only about 20,000 to 25,000 women across the US are affected, most physicians will only have one patient or less who has survived a childhood cancer and had chest radiation.
Dr. Schnabel recommends that when "women transition to an adult practitioner, make sure you let them know what your pediatric diagnosis was, and the details of your treatment.
“And you need to be aware that having this radiation does put you at an increased risk of breast cancer, and if you have any family history of breast cancer, it's even more important to get screened," she emphasizes.
Always consult your physician for more information.
A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge. It may also be used in women who have no breast complaints.
The procedure allows detection of breast cancers, benign tumors, and cysts before they can be detected by palpation (touch).
Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy.
Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer.
Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results.
Today, dedicated equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose. Radiation risks are considered to be negligible.
The recent development of digital mammography technology shows promise for improved breast imaging, in particular, for women less than 50 years of age, women with dense breast tissue, and women who are premenopausal or perimenopausal.
Digital mammography provides electronic images of the breasts that can be enhanced by computer technology, stored on computers, and even transmitted electronically in situations where remote access to the mammogram is required.
The procedure for digital mammography is basically the same as a standard mammogram.
A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.
In contrast, a diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.
A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.
Always consult your physician for more information.