title: Mammography and MRI for screening women who underwent chest radiation therapy (lymphoma survivors): recommendations for surveillance from the Italian College of Breast Radiologists by SIRM.
abstract: Women who underwent chest radiation therapy (CRT) during pediatric/young-adult age (typically, lymphoma survivors) have an increased breast cancer risk, in particular for high doses. The cumulative incidence from 40 to 45 years of age is 13-20 %, similar to that of BRCA mutation carriers for whom contrast-enhanced magnetic resonance imaging (MRI) is recommended. However, in women who underwent CRT, MRI sensitivity is lower (63-80 %) and that of mammography higher (67-70 %) than those observed in women with hereditary predisposition, due to a higher incidence of ductal carcinoma in situ with microcalcifications and low neoangiogenesis. A sensitivity close to 95 % can be obtained only using mammography as an adjunct to MRI. Considering the available evidence, women who underwent CRT before 30 receiving a cumulative dose ≥10 Gy should be invited after 25 (or, at least, 8 years after CRT) to attend the following program: 1. interview about individual risk profile and potential of breast imaging; 2. annual MRI using the same protocol recommended for women with hereditary predisposition; 3. annual bilateral two-view full-field digital mammography or digital breast tomosynthesis (DBT) with synthetic 2D reconstructions. Mammography and MRI can be performed at once or alternately every 6 months. In the case of MRI or contrast material contraindications, ultrasound will be performed instead of MRI. Reporting using BI-RADS is recommended. At the age for entering population screening, the individual risk profile will be discussed with the woman about opting for only mammography/DBT screening or for continuing the intensive protocol.
authors.affiliation: Radiologia 1U, Dipartimento di Diagnostica per Immagini, A. O. U. Città della Salute e della Scienza di Torino, Università di Torino, Via Genova, 3, 10126, Turin, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mariscotti
authors.affiliation: Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 0168, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Belli
authors.affiliation: U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiologia, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bernardi
authors.affiliation: Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio, 2, 50139, Florence, Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Brancato
authors.affiliation: UOC Senologia Diagnostica, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Carbonaro
authors.affiliation: Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena, 324, 00161, Rome, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Cavallo-Marincola
authors.affiliation: UOSD Breast Unit ULSS20, Piazza Lambranzi, 1, 37142, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Caumo
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria.|Institute of Radiology, University of Udine, P.le S. M. della Misericordia, 15, 33100, Udine, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Clauser
authors.affiliation: Unit of Radiology, Institute for Cancer Research and Treatment (IRCC)-FPO, 10060, Candiolo, Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Martinchich
authors.affiliation: DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, P.le A. Stefani, 1, 37126, Verona, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Montemezzi
authors.affiliation: U.O. Radiologia Senologica, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Panizza
authors.affiliation: Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena, 324, 00161, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Pediconi
authors.affiliation: Department of Experimental Medicine, DIMES, Institute of Anatomy, University of Genova, Via de Toni, 14, 16132, Genoa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Tagliafico
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Rubina M
authors.initials: RM
authors.lastname: Trimboli
authors.affiliation: Institute of Radiology, University of Udine, P.le S. M. della Misericordia, 15, 33100, Udine, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zuiani
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy. francesco.sardanelli@unimi.it.|Unit of Radiology, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milano, Italy. francesco.sardanelli@unimi.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D032921:Consensus; D003287:Contrast Media; D005260:Female; D006801:Humans; D007558:Italy; D008223:Lymphoma / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging*; D011159:Population Surveillance; D012307:Risk Factors
chemical_list: D003287:Contrast Media
keywords: Breast cancer; Lymphoma survivors; MRI; Screening