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Breast Cancer Risk Estimates Increased With Repeated Prior CT And Nuclear Imaging

The research team collected CT dose information from 1,656 patients who underwent CT examinations that exposed the breast to radiation and, using a new automated computational method, estimated the patients' effective radiation dose and the amount of radiation absorbed by the breast. The team also analyzed the radiopharmaceutical volume and associated radiation exposure used in 5,507 nuclear medicine exams that exposed the breast to radiation.

"We found that the estimated breast radiation doses from CT were highly variable across patients, with the highest doses coming from multiple-phase cardiac and chest CT examinations, where successive images of the organ being studied are captured," Dr. Smith-Bindman said.

The researchers then estimated the women's imaging-related risk of breast cancer and compared it to their underlying risk of developing breast cancer. Each woman's 10-year imaging-related risk of developing breast cancer, beginning 10 years after her exposure to imaging and based on her age at exposure, was estimated using the breast-specific radiation data and a statistical risk model. A women's underlying risk of developing breast cancer was estimated based on data collected by the National Cancer Institute-funded Breast Cancer Surveillance Consortium.

"Young women receiving several chest and or cardiac CTs had the greatest increased risk of developing breast cancer at approximately 20 percent," said Diana Miglioretti, Ph.D., study coauthor and senior investigator at the Group Health Research Institute. "A 15-year-old girl with no risk factors for breast cancer would double her 10-year risk of developing breast cancer at 25."

To lower imaging-related risk of developing breast cancer, Dr. Smith-Bindman said imaging providers should analyze the radiation doses associated with each exam, reduce the use of multi-phase protocols and employ dose-reduction software wherever possible to minimize exposures.

"If imaging is truly indicated, then the risk of developing cancer is small and should not dissuade women from getting the test they need," she said. "On the other hand, a lot of patients are undergoing repeat chest and cardiac CT, many of which aren't necessary. Women, and particularly young women, should understand there is a small but real potential risk of breast cancer associated with cardiac and chest CT, and the risk increases with the number of scans."

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