61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30

61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30

Background

Women who have undergone thoracic radiation therapy (RT) prior to age 30, for malignancies such as Hodgkin lymphoma (HL), have an approximately 30% risk of breast cancer (BC) by age 50. Screening guidelines for these patients include annual screening mammography (MMG) and breast MRI beginning 8 years after RT but not prior to age 25. The aim of this study was to determine compliance with screening guidelines in these patients who are high risk prior to their BC diagnoses.

Materials and Methods

A retrospective review of a prospectively maintained database was used to identify patients diagnosed with invasive or in situ BC between 2010 and 2021 who had undergone RT for HL prior to age 30. A chart review of the electronic medical record was performed to determine screening adherence prior to the patient’s BC diagnosis.

Results

A total of 6 patients met the inclusion criteria. The mean age at HL diagnosis was 21 (range, 13-26), and the mean age of BC diagnosis was 50 (range, 38-70). The majority of patients were diagnosed with invasive ductal carcinoma (n = 5; 83.3%), and most tumors were high grade (n = 4; 66%). Two patients (33%) had triple-negative BC. Half of the cohort had ductal carcinoma in situ (DCIS) or microinvasive DCIS, while the other half had stage II or III disease. Most patients underwent bilateral mastectomy at the time of their initial cancer diagnosis (n = 5; 83.3%). One patient underwent lumpectomy for their initial cancer diagnosis in 1993 but underwent mastectomies for contralateral BC and an ipsilateral new primary tumor in 2009 and 2012, respectively. No patient began BC screening within 8 to 10 years of thoracic radiation or earlier than age 38. The median time interval between the presumed initiation of BC screening and BC diagnosis was 4 years (range, 0-20). All patients underwent screening MMG, and half had their BC diagnosed with this modality. Only 1 patient had screening breast MRI (16.7%) and 3 patients (50%) had screening breast ultrasound. Most patients were compliant with screening once it began (n = 5; 83.3%); however, 1 patient had an 8-year interval between the MMG that diagnosed her BC and prior screening MMG.

Conclusions

This study found delayed initiation of high-risk BC screening in women diagnosed with BC who had prior thoracic radiation before age 30. Screening breast MRI was also underutilized in this population. This study reveals the importance of educating patients and primary care providers regarding guidelines for the initiation of appropriate BC screening in this high-risk population.