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Does Family History of Breast Cancer Increase Risk?

JAMA Intern Med; ePub 2018 Feb 12; Braithwaite, et al

Publish date:

First-degree family history is associated with increased risk of invasive breast cancer among older women, a recent study found. The prospective cohort study between 1996 and 2012 included a total of 10,929 invasive breast cancers diagnosed in a cohort of 403,268 women aged ≥65 years with data from 472,220 mammography examinations. 5-year cumulative incidence of invasive breast cancer was estimated by first-degree family history, breast density, and age groups. Researchers found:

  • In the study population, first-degree family history was associated with an increased risk of breast cancer among women ages 65 to 74 years (HR, 1.48), and aged ≥75 years (HR, 1.44).
  • Estimates were similar for women aged 65 to 74 years with first-degree relative’s diagnosis age <50 years vs ≥50 years and for women aged ≥75 years with the relative’s diagnosis age <50 years vs ≥50 years.
  • Among women aged 65 to 74 years, the risk associated with first-degree family history was highest among those with fatty breasts; this risk in women aged ≥75 years was highest in those with dense breasts.

Citation:

Braithwaite D, Miglioretti DL, Zhu W, et al. Family history and breast cancer risk among older women in the Breast Cancer Surveillance Consortium cohort. [Published online ahead of print February 12, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.8642.

Commentary:

Family history is an accepted strong risk factor for breast cancer among younger women, but is not currently considered a risk factor for women aged >65 years. This study shows a significant effect of family history even for women aged >75 years. This is important as it may influence decisions about continued mammography screening for older women. USPSTF guidelines recommend biennial screening mammography in women aged 65 to 74 years, but state there is insufficient data to recommend screening in women aged ≥75 years.1 This study suggests increased consideration of screening for healthy older women with a family history of breast cancer. —Neil Skolnik, MD

  1. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296.

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