title: Impact of Early Breast Cancer Screening on Mortality Among Young Survivors of Childhood Hodgkin's Lymphoma.
abstract: BACKGROUND
  Female survivors treated with thoracic radiation therapy (RT) for childhood cancer experience increased risks of breast cancer (BC). There are currently no data quantifying the potential mortality gains of early BC screening among such survivors.
  
  
  METHODS
  A mathematical model of BC development was used to evaluate the marginal benefit of early-initiated screening of female survivors of adolescent Hodgkin's lymphoma (HL) starting at age 25 years on BC mortality compared with screening initiated at age 40 years. Sensitivity analyses were performed to evaluate the robustness of the estimates over a plausible range of conditions.
  
  
  RESULTS
  For survivors treated at age 15 years, the absolute risk of BC mortality by age 75 years was predicted to decrease from 16.65% with no early screening to 16.28% (annual mammography), 15.40% (annual MRI), 15.38% (same-day annual mammography and MRI), and 15.37% (alternating mammography and MRI every six months). Approximately 80 patients would need to be invited to MRI-based screening to prevent one BC death. In sensitivity analyses, the number needed to invite to MRI-based screening to prevent one BC death ranged from 71 to 333. Combinations of MRI plus mammography were predicted to produce 99.52 false positives per 1000 screenings done between age 25 to 39 years.
  
  
  CONCLUSIONS
  These findings are the first to indicate that early MRI-based screening should reduce BC mortality among women treated with RT for adolescent HL. The magnitude of this benefit is superior to that described for other accepted screening indications although MRI can produce a substantial rate of false-positive results.
authors.affiliation: Affiliations of authors:Department of Radiation Oncology and Institute for Health Policy, Management and Evaluation , University of Toronto, Toronto, Canada (DCH), Department of Pediatrics (PCN), and Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network (PC); Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto , Canada (DCH); Department of Statistics and Actuarial Science, University of Waterloo , Waterloo , Canada (CC); Division of Hematology/Oncology Hospital for Sick Children , Toronto , Canada (PCN).
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.affiliation: Affiliations of authors:Department of Radiation Oncology and Institute for Health Policy, Management and Evaluation , University of Toronto, Toronto, Canada (DCH), Department of Pediatrics (PCN), and Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network (PC); Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto , Canada (DCH); Department of Statistics and Actuarial Science, University of Waterloo , Waterloo , Canada (CC); Division of Hematology/Oncology Hospital for Sick Children , Toronto , Canada (PCN).
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cotton
authors.affiliation: Affiliations of authors:Department of Radiation Oncology and Institute for Health Policy, Management and Evaluation , University of Toronto, Toronto, Canada (DCH), Department of Pediatrics (PCN), and Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network (PC); Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto , Canada (DCH); Department of Statistics and Actuarial Science, University of Waterloo , Waterloo , Canada (CC); Division of Hematology/Oncology Hospital for Sick Children , Toronto , Canada (PCN).
authors.forename: Pavel
authors.initials: P
authors.lastname: Crystal
authors.affiliation: Affiliations of authors:Department of Radiation Oncology and Institute for Health Policy, Management and Evaluation , University of Toronto, Toronto, Canada (DCH), Department of Pediatrics (PCN), and Joint Department of Medical Imaging, Mount Sinai Hospital and University Health Network (PC); Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto , Canada (DCH); Department of Statistics and Actuarial Science, University of Waterloo , Waterloo , Canada (CC); Division of Hematology/Oncology Hospital for Sick Children , Toronto , Canada (PCN).
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D002648:Child; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D008962:Models, Theoretical; D011159:Population Surveillance / Q000379:methods*; D011878:Radiotherapy / Q000009:adverse effects; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult