Risk of radiation-induced breast cancer from mammographic screening.

PURPOSE To assess a schema for estimating the risk of radiation-induced breast cancer following exposure of the breast to ionizing radiation as would occur with mammography and to provide data that can be used to estimate the potential number of breast cancers, cancer deaths, and woman-years of life lost attributable to radiation exposure delivered according to a variety of screening scenarios. MATERIALS AND METHODS An excess absolute risk model was used to predict the number of radiation-induced breast cancers attributable to the radiation dose received for a single typical digital mammography examination. The algorithm was then extended to consider the consequences of various scenarios for routine screening beginning and ending at different ages, with examinations taking place at 1- or 2-year intervals. A life-table correction was applied to consider reductions of the cohort size over time owing to nonradiation-related causes of death. Finally, the numbers of breast cancer deaths and woman-years of life lost that might be attributable to the radiation exposure were calculated. Cancer incidence and cancer deaths were estimated for individual attained ages following the onset of screening, and lifetime risks were also calculated. RESULTS For a cohort of 100 000 women each receiving a dose of 3.7 mGy to both breasts and who were screened annually from age 40 to 55 years and biennially thereafter to age 74 years, it is predicted that there will be 86 cancers induced and 11 deaths due to radiation-induced breast cancer. CONCLUSION For the mammographic screening regimens considered that begin at age 40 years, this risk is small compared with the expected mortality reduction achievable through screening. The risk of radiation-induced breast cancer should not be a deterrent from mammographic screening of women over the age of 40 years.