Abstract
BackgroundAn increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening. This indication has been derived from estimates based on data from cancer-prone families or from BRCA1/2 mutation families, and might be biased because BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer. The aim of the current study was to determine the predictive value of a family history of cancer with regard to early onset of female breast cancer in a population based setting.MethodsAn unselected sample of 1,987 women with and without breast cancer was studied with regard to the age of diagnosis of breast cancer.ResultsThe risk of early-onset breast cancer was increased when there were: (1) at least 2 cases of female breast cancer in first-degree relatives (yes/no; HR at age 30: 3.09; 95% CI: 128-7.44), (2) at least 2 cases of female breast cancer in first or second-degree relatives under the age of 50 (yes/no; HR at age 30: 3.36; 95% CI: 1.12–10.08), (3) at least 1 case of female breast cancer under the age of 40 in a first- or second-degree relative (yes/no; HR at age 30: 2.06; 95% CI: 0.83–5.12) and (4) any case of bilateral breast cancer (yes/no; HR at age 30: 3.47; 95%: 1.33–9.05). The positive predictive value of having 2 or more of these characteristics was 13% for breast cancer before the age of 70, 11% for breast cancer before the age of 50, and 1% for breast cancer before the age of 30.ConclusionApplying family history related criteria in an unselected population could result in the screening of many women who will not develop breast cancer at an early age.
Highlights
An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening
As physicians and the general population are becoming more aware of this increased risk, the demand for referring healthy women with a family history of breast cancer for intensive screening or genetic testing, is rising
As BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer [9], estimates based on these high-risk families may have limited value for the prediction of the age of onset of breast cancer in the general population
Summary
An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening This indication has been derived from estimates based on data from cancer-prone families or from BRCA1/2 mutation families, and might be biased because BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer. As BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer [9], estimates based on these high-risk families may have limited value for the prediction of the age of onset of breast cancer in the general population. Empirical data of risks for family members of unselected cases of breast cancer are needed to improve current guidelines
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