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Impact of familial risk factors on management and survival of women with early-onset breast cancer
One
of the most important risk factors for breast cancer is the occurrence of
breast or ovarian cancer among family members. Treatment guidelines of
breast cancer occurring in patients with an increased familial risk are
not well established and conflicting data exist on the impact of a family
history of breast or ovarian cancer on the outcome of breast cancer. We
used population-based data from the Geneva familial breast cancer registry
study to compare tumour characteristics, treatment patterns and survival
of early-onset (≤50 years) breast cancer patients with a strong
family history with those of early-onset patients without affected first
or second degree relatives. Compared to patients at low familial risk
(n=575), those at high familial risk (n=58) were not more frequently
detected by screening nor at an earlier stage. High familial risk patients
received significantly more often systemic therapy, especially for
node-negative or receptor-positive disease. Five year disease-specific
survival rates of patients at high versus low familial risk were
86% and 90% respectively. After adjustment for other prognostic variables,
there was no difference in breast cancer mortality in general. A strong
family history was, however, associated with a non-significantly increased
breast cancer mortality risk in patients ≤40 years (adjusted hazard
ratio [HR] 4.0, 95% CI 0.8-19.7) and in patients treated without
chemotherapy (adjusted HR 2.7, 95% CI 0.6-12.5).
Based on this study, we conclude that guidelines on screening and management of young women at high familial risk are needed. Additional research is required to confirm whether a strong family history of breast cancer impairs survival of very young patients and those treated without chemotherapy.
Bibliographical reference:
Helena M Verkooijen, Christine Bouchardy
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