Correlations between family history and cancer characteristics in 2256 breast cancer patients

Abstract

A comparison of 692 early invasive breast cancer with, and 1564 without, a family history of breast cancer showed that the former were younger at diagnosis (P ¼ 0.002), had smaller tumours (P ¼ 0.012), were more frequently oestrogen receptor positive (P ¼ 0.006) and diagnosed preclinically (Po0.001). A long recognised risk factor for breast cancer is a family history of the disease, although the majority of affected women do not have an affected close relative, and only 5 -10% do have a true hereditary predisposition (Carter, 2001). The overall risk of developing breast cancer is 1.9-3.9 times higher in women with an affected mother or sister (Collaborative Group on Hormonal Factors in Breast Cancer, 2001), but only a few studies have investigated the characteristics of breast cancer in women with a family history. We analysed the pathological, biological and clinical features of breast cancer in patients with (FH þ ) and without (FHÀ) a family history of breast cancer, the former being further subdivided into those with an affected first-or second-degree relative. MATERIALS AND METHODSA total of 2256 women with early invasive operable breast cancer, who underwent surgery at Verona Hospitals between January 1992 and April 2001, were asked at their first visit whether they had any first-or second-degree relatives who had had breast cancer. Our analysis first compared those reporting at least one affected relative (FH þ ) with those reporting no affected relative (FHÀ); subsequently, the FH þ patients were divided into those with at least one first-degree relative (1st DFH) and those with only second-degree relatives with breast cancer (2nd DFH): only firstand second-degree relatives were considered in order to reduce ascertainment bias. Answers were always checked at the subsequent visit (at the time of the first cycle for the patients receiving chemotherapy, after 3 months for the others).All of the patients were assigned a UICC pathological TNM stage. On the basis of pathologist-defined tumour size, patients were divided into three categories: pT1 (o2 cm), pT2 (2 -5 cm) and pT3 (45 cm); the number of pathologically positive axillary nodes was divided into none, o3, 4 -10 and 410; tumour grading was recorded as G1 (well differentiated), G2 (moderately differentiated) or G3 (undifferentiated).Immunohistochemistry (IHC) defined oestrogen (ER) and progesterone receptor (PgR) status and was considered positive if more than 10% of the cells were stained for either. The replicative cell fraction was IHC stained using the Ki-67 monoclonal antibody (Mab-DAKO-PC); given the lack of an accepted cutoff point, the results were arbitrarily classified as low, medium or high (p10%, 11 -25% or 425% of stained cells). CerbB-2 levels were determined by IHC using the DAKO-PC monoclonal antibody, and considered positive if at least one cell was stained.At their first visit to the Department of Medical Oncology, all patients were asked about their disease presentation and divided into those who underwent mammography and ultrasonogra...

The relationship between knowledge of family history and cancer characteristics at diagnosis in women newly-diagnosed with invasive breast cancer

“…In this study of women with newly-diagnosed invasive BC, only one-third of participants reported a family history of BC, a finding consistent with previous reports [7,14,18]. Women diagnosed with a smaller cancer and earlier stage were more likely to report a family history of BC than women with more advanced cancer at diagnosis.…”

“…However the evidence in relation to this issue is not consistent. It has been reported that women with a family history of BC may have smaller [14,15], the same-sized [16,17] or even larger [18] BCs at diagnosis than women diagnosed with BC with no family history of the disease. Similarly, the relationship between stage of BC at diagnosis between women with a positive family history of BC and women with no family history of the disease also varies between studies [16][17][18].…”

Histological features of extratumoral breast lesions as a predictive factor of familial breast cancer

“…Moreover, Aaman et al (9) evidenced that the prevalence of proliferative breast diseases was slightly but not significantly lower in familial patients compared to sporadic. Differently from our study, Mohammed et al (20) and Molino et al (23) reported a significantly higher percentage of small tumors in women with family history.…”

Influence of young age at diagnosis and family history of breast or ovarian cancer on breast cancer outcomes in a population-based cohort study

“…In our study, detection of tumors by mammography (either diagnostic or routine screening) was more common among cases with a first-degree family history of BOC, which may partially explain the higher proportion of pT1 tumors in these individuals. Other studies have also observed that individuals with a family history were more likely to have smaller tumors [5] and to be diagnosed pre-clinically by mammography [5,40,41]; some have failed to find these associations [2,4,[6][7][8]42]. Increased awareness [43] and the publication of guidelines for the management of highrisk cases [44] likely contributed to increased detection of tumors by mammography in those with a family history.…”

“…The association of a family history with presentation and outcome of BC has been investigated in several studies, but results are conflicting and few are population-based using high-quality family history and clinical data. Some studies have found that family history is not associated with tumor size, nodal status, hormone receptor status, or grade [1][2][3][4], while others have yielded mixed results, reporting that tumors in women with a family history are more likely to be smaller [5], higher tumor stage [6], lymph node-negative [7,8], estrogen receptor (ER)-positive [5], ER-negative/progesterone receptor (PgR)-negative [9], and higher grade [8]. Some studies have reported differences in the clinical management of patients with an increased familial risk [2,3,6,10].…”