Tailoring Breast Cancer Surveillance for Childhood Cancer Survivors Who Received Chest Radiotherapy

Some 55,000 U.S. women have received chest radiation therapy for childhood cancer, placing them at an estimated 30% risk for diagnosis of secondary breast cancer by age 50 — a degree of risk similar to that faced by BRCA1 mutation carriers. Investigators used two models derived from data from a childhood cancer survivor study as well as other published reports to evaluate benefits, harms, and incremental cost-effectiveness ratios (ICERs) of annual magnetic resonance imaging (MRI) with or without mammography beginning at age 25, 30, or 35.

Without screening, lifetime breast cancer mortality risk was 10%–11%. Compared with no screening, annual MRI with mammography beginning at age 25 reduced breast cancer mortality by 56%–71%. In contrast, ann…