Early initiation of breast cancer screening may reduce breast cancer mortality for female survivors of childhood cancer who did not receive chest radiation, according to research published in the Journal of the National Cancer Institute

The study indicated that starting screening at 25 to 40 years of age could reduce breast cancer deaths by more than 50%, but starting screening before age 40 was not cost-effective.

The researchers noted that early initiation of breast cancer screening is recommended for survivors of childhood cancer treated with chest radiation. However, there are no specific recommendations for childhood cancer survivors treated without radiation.

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With this in mind, the researchers used simulation models to determine the potential clinical benefits and cost-effectiveness of early breast cancer screening in childhood leukemia and sarcoma survivors who were treated without chest radiation.

The researchers used data from the Childhood Cancer Survivor Study, which included 2343 survivors of leukemia or sarcoma. The team compared no screening to joint digital mammography screening with MRI starting at 25, 30, 35, or 40 years of age.

The models predicted that 36.3% to 43.4% of survivors would develop breast cancer in their lifetime. Without screening, the estimated lifetime risk of dying from breast cancer was 6.8% to 7.0%.

The researchers also found that starting annual screening at 25 to 40 years of age would eliminate 52.6% to 64.3% of breast cancer deaths.

A cost analysis indicated that starting screening at age 40 was the only strategy with an incremental cost-effectiveness ratio (ICER) below the $100,000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold.

“[O]ur findings suggest that early initiation of screening with mammography and MRI starting at age 40 may reduce half of breast cancer deaths and is cost-effective among survivors of childhood leukemia and sarcoma without a history of radiation,” the researchers wrote.

“These findings could help inform screening guidelines for these high-risk survivors. At this time, our findings are most relevant to women with a sporadic (non-familial) primary leukemia or sarcoma and can improve follow-up care for survivors of childhood cancer.”


Yeh JM, Lowry KP, Schechter CB, et al.  Breast cancer screening among childhood cancer survivors treated without chest radiation: Clinical benefits and cost-effectiveness. J Natl Cancer Inst. Published July 29, 2021. doi:10.1093/jnci/djab149