Significance of Family History in Breast Cancer Treated with Breast Conservation Therapy

Abstract

: The purpose of this study was to evaluate the impact of family history (FH) of breast cancer on the outcome of patients with local-regional breast cancer treated with breast conservation therapy. Of 974 patients treated with breast conservation therapy, a total of 794 consecutive cases were evaluable with adequate FH data and a greater-than-1-year follow-up. All patients had local-regional disease (stages O-IIIA) and underwent lumpectomy, axillary node dissection, and radiation therapy. Seventeen percent of patients had a positive family history of breast cancer, which was defined as a first degree relative (mother, sister, daughter). A significant difference was seen in overall survival in patients with and without an FH of breast cancer (p = 0.027). While FH did not correlate with differences in local failure, distant failure, disease specific survival, or overall survival in patients less than or equal to age 50, a positive FH correlated with a worse disease specific survival (p = 0.045) and a worse overall survival (p = 0.017) in patients over age 50. Multivariate (Cox) analysis confirmed the significance of FH (p = 0.008), tumor size (p = 0.001), and nodal status (p = 0.015). Comparing patients with and without an FH, no differences were seen in age at presentation, age of menarche, age of menopause, parity, tumor size, histologic and nuclear grade, nodal status, or estrogen receptor status. In patients with an FH of breast cancer, the most commonly affected relative was the mother (9.4%). While FH did not impact on outcome of patients age 50 or younger, it was prognostic for a poorer overall survival in older patients, and poorer disease-specific survival. Patients with an FH of breast cancer are similar to patients without a family history in tumor and patient characteristics. An FH of breast cancer does not correlate with an increased local or distant failure in our study population as a whole, but does correlate with a poorer overall survival when compared to patients without an FH of breast cancer.?