Comparison of radiation exposure and associated radiation‐induced cancer risks from mammography and molecular imaging of the breasta)

Abstract

Purpose: Recent studies have raised concerns about exposure to low-dose ionizing radiation from medical imaging procedures. Little has been published regarding the relative exposure and risks associated with breast imaging techniques such as breast specific gamma imaging ͑BSGI͒, molecular breast imaging ͑MBI͒, or positron emission mammography ͑PEM͒. The purpose of this article was to estimate and compare the risks of radiation-induced cancer from mammography and techniques such as PEM, BSGI, and MBI in a screening environment. Methods: The authors used a common scheme for all estimates of cancer incidence and mortality based on the excess absolute risk model from the BEIR VII report. The lifetime attributable risk model was used to estimate the lifetime risk of radiation-induced breast cancer incidence and mortality. All estimates of cancer incidence and mortality were based on a population of 100 000 females followed from birth to age 80 and adjusted for the fraction that survives to various ages between 0 and 80. Assuming annual screening from ages 40 to 80 and from ages 50 to 80, the cumulative cancer incidence and mortality attributed to digital mammography, screen-film mammography, MBI, BSGI, and PEM was calculated. The corresponding cancer incidence and mortality from natural background radiation was calculated as a useful reference. Assuming a 15%-32% reduction in mortality from screening, the benefit/risk ratio for the different imaging modalities was evaluated. Results: Using conventional doses of 925 MBq Tc-99m sestamibi for MBI and BSGI and 370 MBq F-18 FDG for PEM, the cumulative cancer incidence and mortality were found to be 15-30 times higher than digital mammography. The benefit/risk ratio for annual digital mammography was Ͼ50: 1 for both the 40-80 and 50-80 screening groups, but dropped to 3:1 for the 40-49 age group. If the primary use of MBI, BSGI, and PEM is in women with dense breast tissue, then the administered doses need to be in the range 75-150 MBq for Tc-99m sestamibi and 35 MBq-70 MBq for F-18 FDG in order to obtain benefit/risk ratios comparable to those of mammography in these age groups. These dose ranges should be achievable with enhancements to current technology while maintaining a reasonable examination time. Conclusions:The results of the dose estimates in this study clearly indicate that if molecular imaging techniques are to be of value in screening for breast cancer, then the administered doses need to be substantially reduced to better match the effective doses of mammography.

89Zr-Bevacizumab PET Imaging in Primary Breast Cancer

“…The limiting factor for more general application of imaging with radionuclides is the radiation burden. In a study comparing the risks of radiation-induced cancer from mammography, molecular breast imaging, and positron emitting mammography, the cumulative cancer incidence is 15-30 times higher for positron emission mammography and molecular breast imaging than for mammography (22). The estimated radiation burden of 89 Zr-bevacizumab-PET is 19 mSv per tracer injection, on the basis of extrapolation from 111 In-bevacizumab data and a dosimetry study on 89 Zr-U36, compared with 5.3 mSv for 18 F-FDG PET (23)(24)(25).…”

Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer

“…The uncertainties associated with each of the models are close to, or exceed, the variation between the models 32 . We have chosen to use the BEIR VII model as it provides model parameters for specific organs for each sex and includes a parameter describing incidence with age at exposure and attained age.…”

“…Harrison et al expressed reluctance to assign risk estimates to their measured organ doses although, other groups have found the risk models useful to compare different treatment methods whilst accepting the large uncertainties in an absolute risk value. [31][32] Given these developments, it is timely that estimates of second cancer incidence risk with modern methods are made for the early breast cancer group. We present a set of organ doses measured in an anthropomorphic phantom, and estimates of the risk of second cancer 25 These techniques span the range from simple tangential fields, applicable to older patients with a low recurrence risk, to complex techniques, which might be appropriate for women with a high recurrence risk (e.g.…”

“…Harrison et al expressed reluctance to assign risk estimates to their measured organ doses although, other groups have found the risk models useful to compare different treatment methods whilst accepting the large uncertainties in an absolute risk value. [31][32] Given these developments, it is timely that estimates of second cancer incidence risk with modern methods are made for the early breast cancer group. We present a set of organ doses measured in an anthropomorphic phantom, and estimates of the risk of second cancer induction in those organs for five techniques to treat the left breast : (i) a conventional tangential field whole breast treatment (WBRT), (ii) a non-coplanar conformal delivery applicable to APBI treatment 21 , (iii) a two volume SIB, (iv) a three volume forward planned SIB (FP SIB) and (v) a three volume inverse planned SIB (IP SIB).…”

VEGF in nuclear medicine: Clinical application in cancer and future perspectives (Review)

“…The limiting factor for more general application of imaging with radionuclides is the radiation burden. In a study comparing the risks of radiation-induced cancer from mammography, molecular breast imaging, and positron emitting mammography, the cumulative cancer incidence is 15-30 times higher for positron emission mammography and molecular breast imaging than for mammography (113). The estimated radiation burden of 89Zr-bevacizumab-PET is 19 mSv per tracer injection, on the basis of extrapolation from 111 In-bevacizumab data and a dosimetry study on 89Zr-U36, compared with 5.3 mSv for 18 F-FDG PET (114)(115)(116)(117).…”