Summary The clinicopathological characteristics of breast cancer in 95 women between the ages of 24 and 45 years with a family history of breast cancer were compared with tumours from 329 women with sporadic disease matched for age and year of diagnosis. There was a trend for the family history patients to have slightly smaller tumours (mean size 2.49 cm) than the controls (mean 3.04 cm) (Mann-Whitney test, P= 0.09). A significantly greater proportion of the familial cases had grade IlIl infiltrating ductal carcinoma than did the controls (40% vs 27%; 2= 5.64, P = 0.02). Despite this, there were more cases of operable node-negative disease among the study group than among the controls (48% vs 32%; X2 = 8.2, P = 0.004). There was a highly significant survival advantage for patients with a family history (X2 = 22.4, P < 0.001).Five-and 1 0-year survival rates were 92% and 87% for those with a family history compared with 70% and 54% for those in the control group. This survival advantage was maintained when patients with operable disease only were considered. In multivariate analysis, which included age, tumour size, stage, histological grade and family history, family history was an independent predictor of favourable prognosis and, in a Cox model, was associated with a relative risk of survival of 6.11 (95% Cl 2.81-13.28). These results suggest that familial breast cancer has a more favourable clinical course than the more common sporadic forms of the disease.Keywords: breast cancer; survival; family historyThe prognostic significance of breast cancer morphology has been reviewed extensively. In contrast, there are few studies that have examined the association between breast cancer histopathology and a family history of breast cancer (Rosen et al, 1982;Claus et al, 1993; Fukutomi et al, 1993). There are, however, several anecdotal reports of improved survival rates in patients with a family history of breast cancer (Lynch et al, 1981;Albano et al, 1982). The few studies carried out since the identification of the BRCAJ gene have reported a more favourable prognosis for patients from BRCAI-linked breast/ovarian cancer families (Malone et al, 1996;Marcus et al, 1996;Rubin et al, 1996).We have examined the histological characteristics of breast cancer in women with and without a positive family history to determine whether familial breast cancers had features similar to or distinct from sporadic forms. The issue of an improved clinical outcome has also been explored in this study to determine whether or not a family history confers a survival advantage to women with breast cancer. METHODSA review of all women with breast cancer diagnosed below the age of 45 years at the ICRF Clinical Oncology Unit or referred to the SE Thames Regional Genetics Centre at Guy's Hospital between June 1965 and December 1995 was undertaken. Detailed pedigree data were obtained to determine the extent of a hereditary predisposition Correspondence to: SN Mohammed in these women. A total of 95 breast cancer families were ascertained throu...

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