Women with a family history of breast cancer are often encouraged to be tested to see if they carry a mutation in the BRCA1 or BRCA2 genes which control the suppression of breast and ovarian cancer. If they do carry a mutated gene, they are often encouraged to have mammograms at far younger-than-normal ages to catch any malignancy early. This common practice ignores the obvious, however -- not every woman with the gene mutation develops cancer so some environmental factor or factors are implicated in "switching on" the gene. And the radiation from mammograms may be one of those factors that can actually trigger breast cancer in these high risk women.

A study just published in the British Medical Journal (BMJ) backs up this idea. It concludes that women with a BRCA1 or BRCA2 gene mutation who have undergone diagnostic radiation to the chest before the age of 30 (such as a chest x-ray or mammogram) are far more likely to develop breast cancer than those who carry the gene mutation but who have not had x-ray exposure.

Scientists at the Netherlands Cancer Institute studied 1,993 female BRCA1/2 mutation carriers, all ages 18 or older, in the Netherlands, France and the UK between 2006 and 2009 to see whether variations in DNA raised the risk of of radiation-induced breast cancer. The research team delved into how many mammograms or x-rays the women had received before age 20, at ages 20-29, 30-39 and at their age when last exposed to these tests.

The results showed that 43 percent (848) of the 1,993 women in the study were eventually diagnosed with breast cancer and about half of them had reported having an x-ray; approximately 33 percent (637) had received mammograms. The average age at first mammogram for the women studied was 29. A history of any exposure to diagnostic or screening radiation to the chest between the ages of 20 and 29 appeared to be especially dangerous -- it increased breast cancer risk by an alarming 43 percent. Women who had been exposed to tests involving radiation before the age of 20 had an increased risk of breast cancer of 62 percent. Older women didn't seem to have this increased risk.

The study concluded that for every 100 BRCA1 or BRCA2 mutation carriers aged 30, nine will have developed breast cancer by the age of 40. However, the number of cases in every group of 100 BRCA1/2 carriers would be expected to increase by five if the women had even a single mammogram before age 30.

Earlier studies have also suggested that women with a mutated BRCA1 or BRCA2 gene may have increased sensitivity to the cancer-causing properties of radiation because BRCA1 and BRCA2 are the genes involved in the repair of DNA breaks and those breaks are caused by radiation. Bottom line: it's hard to fathom how any supposed benefit from mammograms, especially in young BRCA1/2 mutation carriers, could outweigh the risk of the screening radiation actually triggering breast cancer.

A recent commentary published in the BMJ flat out accused a breast cancer "charity" of, in fact, using frightening and misleading statistics to persuade women to undergo mammography instead of giving them the facts -- including disclosing to women that exposure to radiation is an established risk factor for breast cancer in the general population.

The authors of the new research paper conclude that "exposure to diagnostic radiation before age 30 was associated with an increased breast cancer risk in BRCA1/2 mutation carriers." They recommend non-ionizing radiation imaging techniques, such as magnetic resonance imaging (MRI), for mutation carriers.

Should all women turn to MRIs instead of mammograms? At first glance, that might make sense. But a review of breast cancer treatments published in CA: A Cancer Journal for Clinicians revealed that the growing use of MRIs to assess the extent of early breast cancer could also be harming instead of helping women who are found to have early breast malignancies. The study shows MRIs increase the odds a woman will be subjected to more extensive surgery, i.e. a mastectomy, over conservative approaches such as a simple lumpectomy despite the fact there is no conclusive evidence that a radical surgical approach improves the treatment or prognosis of women with early breast cancer.

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