Dual-modality breast cancer screening compared to MRI or mammography alone among female Hodgkin lymphoma survivors who received chest radiotherapy

Purpose: 

Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) before the age of 40 years face increased breast cancer (BC) risk. Dutch guidelines recommend annual magnetic resonance imaging (MRI) and mammography at ages 30–60 years starting eight years after RT. Dual-modality screening is burdensome and may increase false positive rates. We therefore compared the diagnostic value of each individual modality with MRI and mammography combined. 

Methods: 

Results of dual-modality BC screenings performed in 2005–2021 at two Dutch survivorship clinics were used to estimate sensitivity and specificity for each modality and MRI and mammography combined. 

Results: 

We retrospectively reviewed 550 screening rounds in 134 HL survivors (median follow-up: 3 years) during which 19 early-stage tumors occurred. Sensitivity was 79% (95% Confidence Interval (CI): 54–94) for MRI alone, 63% (95% CI: 38–84) for mammography alone and 95% (95% CI: 74–100) for both modalities combined. Specificity was 89% (95% CI: 86–91) for MRI alone, 97% (95% CI: 95–98) for mammography alone and 86% (95% CI: 83–89) when combining modalities. Additional ultrasound was performed in 15.3% of screening rounds (in 74.4% due to MRI findings) and puncture/biopsy in 8.0%. 

Conclusions: 

In conclusion, to obtain a sufficiently high screening sensitivity in female HL survivors treated with chest RT, we recommend screening with both MRI and mammography. However, MRI is associated with a high false positive rate. Our findings inform survivors and clinicians about effectiveness of BC screening and its burden.