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Family history of breast cancer not prognostic for recurrence
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A positive family history of breast cancer did not appear to increase the risk for poor outcomes in women with the disease, according to study results.
Approximately 25% of breast cancer cases in developed countries are believed to be hereditary, which often present at a much younger age than sporadic tumors, according to study background. However, it was unclear how a family history of breast cancer independently affects prognosis in younger women.
“Successful treatment for breast cancer is just as likely in young patients with a family history of breast cancer as in those without a family history,” Ramsey Cutress, BM, BCh, MA, PhD, FRCS, associate professor in breast surgery in the cancer sciences academic unit and the clinical trials unit at the University of Southampton, United Kingdom, said in a press release. “Patients with a family history of breast cancer can therefore be reassured that their family history alone does not mean that their outcome will be worse.”
Cutress and colleagues evaluated data from 2,850 women aged 40 years or younger who were diagnosed with breast cancer between 2000 and 2008 and who were treated in the UK as part of the Prospective Outcomes in Sporadic vs. Hereditary breast cancer (POSH) study. Researchers collected data on patient and tumor characteristics, treatment, and family history of breast and ovarian cancer for a period of 15 years.
A majority (65.9%) of the patients reported no familial history of breast or ovarian cancers, whereas the remaining 34.1% reported at least one incidence of those malignancies in a first- or second-degree relative.
A greater proportion of women with a family history had grade 3 tumors compared with women with no family history (63.3% vs. 58.9%). A smaller proportion of women with a family history had HER-2 positive tumors (24.7% vs. 28.8%).
Median follow-up was 5.9 years. Estimated 5-year distant disease-free interval rates — or the time from date of invasive breast cancer diagnosis to distant relapse or death from breast cancer — were 77.4% in the family history-positive cohort and 74.9% in the family history-negative cohort.
Multivariable analyses showed no significant differences in distant disease-free intervals among the two groups when compared as a collective cohort (HR = 0.89; 95% CI, 0.76-1.03) or after ER status stratification. Those who were ER negative had an HR of 0.8 (95% CI, 0.62-1.04) and those who were ER positive had an HR of 0.95 (95% CI, 0.78-1.15).
The researchers acknowledged survival bias as one of the limitations of the study because patients were enrolled up to 1 year after diagnosis, meaning that very early deaths could have been under-represented. Additionally, the study lacked independent confirmation of the self-reported family history, which could skew the data.
“In general, younger women have a greater fear of breast cancer recurrence than older women,” Cutress and colleagues wrote. “Furthermore, patients with a strong family history may have a high level of anxiety about recurrence and death from breast cancer after witnessing cancer within their family.
“This study demonstrates that family history per se is not an independent prognostic feature for recurrence in young-onset breast cancer treated in the modern era.” – by Anthony SanFilippo
Disclosure: The researchers report honoraria from GlaxoSmithKline, Pfizer and Roche and educational support from Illumina, Janssen-Cilag, Tepnel (Gen-Probe) and Vista Diagnostics.
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