Comparison of radiation exposure and associated radiation-induced cancer risks from mammography and molecular imaging of the breast

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 (BSGI), molecular breast imaging (MBI), or positron emission mammography (PEM). 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 >50:1 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.

Figure 1

(a) Estimated cumulative cancer incidence attributed to annual screening performed from ages 40 to 80 for digital mammography at a MGD of 3.91 mGy, screen-film mammography at a MGD of 4.98 mGy, MBI∕BSGI using 925 MBq Tc-99m sestamibi, and PEM using 370 MBq F-18 FDG. (b) Estimated cumulative cancer mortality attributed to annual screening performed from ages 40 to 80 for digital mammography at a MGD of 3.91 mGy, screen-film mammography at a MGD of 4.98 mGy, MBI∕BSGI using 925 MBq Tc-99m sestamibi, and PEM using 370 MBq F-18 FDG.

Figure 2

(a) Estimated cumulative cancer incidence attributed to annual screening performed from ages 50 to 80 for digital mammography at a MGD of 3.91 mGy, screen-film mammography at a MGD of 4.98 mGy, MBI∕BSGI using 925 MBq Tc-99m sestamibi, and PEM using 370 MBq F-18 FDG. (b) Estimated cumulative cancer mortality attributed to annual screening performed from ages 50 to 80 for digital mammography at a MGD of 3.91 mGy, screen-film mammography at a MGD of 4.98 mGy, MBI∕BSGI using 925 MBq Tc-99m sestamibi, and PEM using 370 MBq F-18 FDG.

Figure 3

(a) Estimated cumulative cancer incidence from natural background radiation (3.1 mSv∕yr from ages 0 to 80). The comparable cancer incidence attributed to digital mammography (3.91 mGy) and MBI∕BSGI (925 MBq Tc-99m sestamibi) performed annually from ages 40 to 80 are also shown. (b) Estimated cumulative cancer mortality from natural background radiation (3.1 mSv∕yr from ages 0 to 80). The comparable cancer mortality attributed to digital mammography (3.91 mGy) and MBI∕BSGI (925 MBq Tc-99m sestamibi) performed annually from ages 40 to 80 are also shown. (c) Estimated cumulative cancer mortality from all sources (National Program of Cancer Registries) and from natural background radiation (3.1 mSv∕yr from ages 0 to 80). Estimated cancer mortality attributed to digital mammography (3.91 mGy) and MBI∕BSGI (925 MBq Tc-99m sestamibi) performed annually from ages 40 to 80 are also shown.