Annual breast cancer screening mammography at ages 30-74 years is effective and cost-effective for female survivors of Hodgkin lymphoma (HL) who received chest radiation, according to research published in the Journal of Clinical Oncology.

The research also suggests that adjunct breast MRI is not a cost-effective screening strategy for this patient group.

These findings are not in line with Children’s Oncology Group (COG) Long-term Follow-up Guidelines, which recommend annual mammography and breast MRI starting at age 25 or 8 years after chest radiation, whichever is later, and do not specify when screening should stop.

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Researchers conducted this study to evaluate the outcomes and cost-effectiveness of following the guidelines in patients who had received chest radiation for HL in childhood.

The researchers first compared 3 breast cancer screening age intervals — from age 25 to end of life; from age 25 to 74 years; and from age 25 or 8 years after chest radiation, whichever is later, to age 74.

The researchers found small absolute differences in life years and breast cancer mortality between the 3 screening age intervals. Therefore, they used 25-74 years as the interval in subsequent analyses of various screening strategies, including mammography alone, digital breast tomosynthesis (DBT) alone, MRI alone, mammography plus MRI, and DBT plus MRI.

When compared with no screening, annual breast cancer screening with any strategy prolonged life years and reduced the lifetime risk of breast cancer mortality.

The life-year gains ranged from 0.3424 with DBT alone to 0.4632 with mammography plus MRI. The reduction in breast cancer mortality ranged from 1.21% with MRI alone to 1.76% with mammography plus MRI.

The researchers also found that annual mammography at 25-74 years was the only cost-effective screening strategy. When accounting for nonadherence, however, annual mammography at 30-74 years was the only cost-effective strategy.

“Promoting regular screening using MAM [mammography] for chest-irradiated Hodgkin lymphoma survivors from age 30 years will save lives and is cost-effective,” Bruce G. Haffty, MD, deputy editor of the Journal of Clinical Oncology, wrote in a comment. “Guidelines for survivors of childhood cancers should take into consideration cost-effectiveness in their screening recommendations.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Wong FL, Lee JM, Leisenring WM, et al. Health benefits and cost-effectiveness of Children’s Oncology Group breast cancer screening guidelines for chest-irradiated Hodgkin lymphoma survivors. J Clin Oncol. 2023;41(5):1046-1058.