Impact of breast cancer family history on tumor detection and tumor size in women newly-diagnosed with invasive breast cancer

Schwab, Fabienne ; Bürki, Nicole ; Huang, Dorothy ; Heinzelmann-Schwarz, Viola ; Schmid, Seraina ; Vetter, Marcus ; Schötzau, Andreas ; Güth, Uwe

In: Familial Cancer, 2014, vol. 13, no. 1, p. 99-107

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    This study evaluated the impact of family history (FH) on tumor detection, the patient's age and tumor size at diagnosis in breast cancer (BC). Furthermore, we investigated whether the impact of FH on these features was dependent on degree of relationship, number of relatives with a BC history, or the age of the affected relative at the time that her BC was diagnosed. Out of the entire cohort (n=1,037), 244 patients (23.5%) had a positive FH; 159 (15.3%) had first-degree relatives affected with BC and 85 patients (8.2%) had second-degree affected relatives. Compared to women who had no BC-affected relatives, the tumors of women who had positive FH were more often found by radiological breast examination (RBE: 31.7%/27.2%, p=0.008), and they were smaller (general tumor size: 21.8mm/26.4mm, p=0.003; size of tumors found by breast self-examination (BSE): 26.1mm/30.6mm, p=0.041). However, this positive effect of increased use of BC screening and smaller tumor sizes was only observed in patients whose first-degree relatives were affected (comparison with second-degree affected relatives: RBE: 43.8%/24.7%; odds ratio 2.38, p=0.007; general tumor size: 19.3mm/26.3mm; mean difference (MD) −6.9, p=0.025; tumor size found by BSE: 22.5mm/31.0mm; MD −8.5, p=0.044). When more second-degree relatives or older relatives were diagnosed with BC, the tumors of these patients were similarly often detected by RBE (relationship: 24.7%/27.2%, p=0.641; age: 33.7%/27.2%, p=0.177) and had similar tumor sizes (general size: 26.3mm/26.4mm, p=0.960; BSE: 31.0mm/30.6mm, p=0.902) as those of women without a FH. Women with a positive FH generally use mammography screening more often and perceive changes in the breast earlier than women without such history. The increased awareness of BC risk decreases if the relationship is more distant.