Family history is not an independent risk factor for worse outcome in young women with breast cancer. This is the result of a British study in which the data of 2850 female patients were analyzed.
The patient population was drawn from the prospective UK cohort study Prospective Outcomes in Sporadic versus Hereditary breast cancer (POSH), which enrolled women aged less than 41 years and with breast cancer. Of the 2850 patients, 65.9% had a negative family history and 34.1% had a positive family history (breast/ovarian cancer in first- or second-degree relatives).
A positive family history made grade 3 tumors more likely (63.3 vs. 58.9%) and HER2-positive tumors less likely (24.7 vs. 28.8%). Family history did not play a role for the presence of an estrogen/progesterone receptor. Similarly, there were no differences in tumor diameter, lymph node involvement, or metastases at diagnosis. When estrogen receptor-positive and -negative patients were considered separately, the differences in tumor grade and HER2 status resolved.
Multivariable analyses after a median of 5.9 years of follow-up, which included receptor status, age at diagnosis, tumor grade/size, lymph node involvement, etc., revealed no significant differences in the distant metastasis-free interval for either the entire cohort or the cohort disaggregated by estrogen receptor status. Thus, with currently available therapies, patients with a positive family history do not have a worse outcome to worry about.
Reassure worried patients
Many young women with breast cancer are very well informed about their family history and are afraid that it could worsen their prognosis. According to the authors, it is important to reassure these women that cases of breast cancer in the family generally do not significantly affect outcome.
Advantages of the study are the sample size and its prospective nature. It is problematic that the family burden was not verified, but only collected by means of information provided by the patients. The follow-up period of 5.9 years for the first analysis is also somewhat short. Recurrences tend to occur later, particularly in estrogen receptor-positive breast carcinomas.
Source: Eccles BK, et al: Family history and outcome of young patients with breast cancer in the UK (POSH study). Br J Surg 2015; doi: 10.1002/bjs.9816 [Epub ahead of print].
InFo ONCOLOGY & HEMATOLOGY 2015; 3(7): 2.
