10 Year Experience of a National Breast Screening Programme Following Radiotherapy for Hodgkin Lymphoma in South East Wales

Abstract

In 2003, the UK Department of Health initiated a recall and breast screening programme for women who received radiotherapy as treatment for HL. Velindre Cancer Centre in SE Wales (population 1.5 million) identified 300 female HL patients treated with RT through a case record search. Of these 100 had received RT to the mediastinum and/or axilla at age < 36 years. 7 patients had already died (3 lymphoma, 1 breast cancer, 1 treatment toxicity, 2 unknown). 83 patients treated with RT between 1968 – 2003 were traced and contacted. 3 patients were alive with breast cancer, and 1 with breast and thyroid cancer. Since 2003, a further 8 have died (5 lymphoma, 3 breast cancer, 2 brain metastases unknown primary, 1 lung cancer, 1 AML and 3 other/unknown). 2 breast cancers have been detected, 1 at the initial recall and 1 on the annual screening programme. The national programme for HL breast screening in Wales is provided by 3 regional centres and at-risk patients are registered on a database at time of RT. Screening starts 8 years after RT or at the age of 25yrs following a consultation with an oncologist for informed consent. Annual MRI is used for patients < 30yrs, and mammography ± MRI between 30 – 50yrs. HL patients are screened in 2 dedicated sessions at the Breast Test Wales (BTW) National Screening Centre in Cardiff, while MRI scans are performed at local hospitals. Standard 3-yearly screening is performed after the age of 50. Results are reviewed at an annual meeting, and a user survey has been very positive, with women finding screening reassuring. 40 patients currently have annual screening, 17 of these with MRI. 1 patient chose to have bilateral mastectomies. 18 patients are in standard 3 yearly screening, and 12 patients have not yet commenced screening. Numbers of patients at risk will fall with evolving treatment strategies, and the risk of breast cancer for treated patients may fall with smaller fields and lower doses. A treatment-risk adapted approach to screening combined with newer low dose mammographic techniques may improve outcomes and cost effectiveness of the programme.