Abstract P6-01-01: Impact of imaging surveillance on the risk of radiation induced malignancies in breast cancer survivors
Notice bibliographique
Résumé
Abstract Introduction: After curative treatment of breast cancer (BC), relevant clinical guidelines recommend against the use of imaging procedures other than yearly mammography for surveillance, based on the lack of survival benefit for intensive surveillance strategies. Nevertheless, use of non-recommended imaging tests occurs frequently in this context. Most BC surveillance studies have focused on the potential benefit of detection of early relapse, on financial burden, and risk of false positives with different follow-up regimens. No study has analyzed the risk of imaging radiation induced malignancies (IRIM) in BC survivors exposed to repeated body imaging during surveillance. We previously reported on the IRIM risk in the BC clinical trials setting (Fresco R. The Oncologist 2015). In this current study we report on this risk during surveillance in clinical practice in BC survivors. Objective: To estimate IRIM risk in patients curatively treated for BC undergoing imaging tests during surveillance. Methodology: We defined 6 surveillance strategies with differing imaging requirements, from a non imaging-intensive one (yearly mammography only) to intensive ones (mammography + CT, Bone scan, PET-CT and/or MUGA) (Table 1). For each strategy we calculated the imaging dose and excess lifetime attributable cancer risk (LAR) for a 60 year-old BC survivor, using NCI's Radiation Risk Assessment Tool (RadRat). Results: Total effective imaging radiation dose received by a 60 year-old BC survivor during surveillance was 8.4 miliSieverts (mSv) when only yearly mammography is performed to 199.9 mSv when CT, MUGA and bone scan are added. Mean IRIM LAR ranges from 37.2/100,000 with the first strategy to 1,330/100,000 with the latter. Performing MUGA scans increased IRIM risk 31% compared to not performing it. The addition of any additional radiating imaging procedure to yearly mammography significantly increases LAR. Imaging effective dose and LAR in different surveillance strategiesFollow-up strategyImaging effective dose (mSv)Excess lifetime attributable cancer risk: mean (90% uncertainty range) (/100,000)Yearly mammography only8.437.2 (21.4-60.3)Yearly mammography + Chest/abdomen CT q6mo for 3y, then annually for 2y128.4857.0 (503.0-1,350.0)Yearly mammography + Chest/abdomen CT q6mo for 3y, then annually for 2y + Bone scan q12mo for 5y159.91,060.0 (603.0-1,640.0)Yearly mammography + Chest/abdomen CT q6mo for 3y, then annually for 2y + MUGA q6mo for 2y168.41,130.0 (642.0-1,800.0)Yearly mammography + Chest/abdomen CT q6mo for 3y, then annually for 2y + MUGA q6mo for 2y + Bone scan q12mo for 5y199.91,330.0 (792.0-2,080.0)Yearly mammography + PET-CT q6mo for 3y, then annually for 2y184.41,310.0 (802.0-1,990.0) Conclusions: A number of incremental second cancers could be derived from imaging performed during BC surveillance after curative treatment. Addition of non-recommended imaging for relapse detection increases IRIM risk compared to performing only mammography. This, in addition to the lack of proven benefit in BC endpoints, emphasizes the need to follow recommendations for surveillance clinical guidelines, and forgo imaging studies other than annual mammography to detect relapses. Substituting MUGA with echocardiogram for cardiac assessment could also reduce IRIM risk. Citation Format: Spera G, Gonzalez V, Meyer C, Fung H, Mackey JR, Fresco R. Impact of imaging surveillance on the risk of radiation induced malignancies in breast cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-01-01.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».