We’ve long known that mammography is a tool with both risks and benefits, and not a silver bullet solution to the breast cancer epidemic. A new study published today adds more information to the “risk” side of mammography for women with BRCA1 and 2 mutations. A study conducted by the Netherlands Cancer Institute and reported in the latest edition of the BMJ showed that exposure to diagnostic radiation before age 30 is associated with an increased risk of breast cancer for women with BRCA1 and 2 mutations.
Ionizing radiation, used in mammography and other diagnostic and screening tools, damages genetic material in the body. Researchers had hypothesized that women with the BRCA genetic mutations might be especially vulnerable to the risks of radiation, as the BRCA genes are involved in the repair of DNA damage, which can be caused by radiation.
Researchers found that women who carry the BRCA1 or 2 genetic mutations and have a history of chest radiation in their 20s had a 43 percent increased relative risk of breast cancer compared to women who had no chest radiation at that age. Any exposure before age 20 increased their relative risk of breast cancer by 62 percent. Researchers found that if all BRCA carriers had one mammogram before age 30, the number developing breast cancer by age 40 would rise from nine to 14 out of every 100. The study did not find a link between ionizing radiation and an increased risk of breast cancer for women in the study who were over 30. This reinforces what we already know about windows of susceptibility – exposure to harmful substances during certain periods of breast development is more harmful than the same exposure once the breast tissue is fully developed.
Women with the BRCA1 and 2 mutations should talk to their healthcare provider about the screening and follow-up they need given their increased risk of breast cancer, and take this new information into account.
In terms of the big picture, this information further reinforces why we need readily available, safer, and affordable alternatives to mammography. MRIs, often offered as the alternative to mammography for women at high risk, do not come with a dose of ionizing radiation but are often prohibitively expensive, even for women with health insurance. This study highlights the need for more approved alternatives to mammography that are safe, effective, affordable, and accessible.