Family history of breast cancer, age and benign breast disease

Abstract

A major risk factor for breast cancer is having a firstdegree family history of the disease. Benign breast disease (BBD), particularly atypical hyperplasia, is also associated with an increased risk of breast cancer. However, the relationship between family history of breast cancer and BBD is unclear. Women with a history of benign breast disease (BBD) are at increased risk of developing breast cancer. 1 Although nonproliferative disease does not appear to be associated with increased risk, 2,3 proliferative disease without atypia and proliferative disease with atypia have been associated with approximately a 1.5-fold and a 4-fold increased risk of cancer, respectively. [3][4][5] This risk appears to be approximately equal for cancer developing in the same breast as the BBD or in the opposite breast 6 -8 and it is unclear whether the BBD is a precursor lesion or simply a marker for a generalized increased risk of cancer. Better understanding of the risk factors for BBD, especially the relation between BBD and known risk factors for breast cancer, will help to clarify the relation between BBD and breast cancer and increase understanding of the carcinogenic process.A major risk factor for breast cancer is having a history of breast cancer in a first-degree relative, 9 though this effect may diminish with increasing age. 10,11 The relation between breast cancer family history and BBD is less clear. Some studies have reported no association, 12,13 while others have reported an increased risk of BBD among women with a family history of breast cancer. 14 -16 These studies have included relatively small numbers of women with biopsy-confirmed BBD and have employed different definitions of BBD. Some have compared women with biopsy-confirmed BBD to unscreened hospital or population controls 13,14,16 and it is possible that women with a family history of breast cancer are more likely to consult a physician and/or undergo biopsy and thus be diagnosed with BBD, falsely elevating measures of association. Conversely, some studies have included women with a prior history of BBD in the control group, 12,14 potentially biasing estimates of association toward the null.Our present aim was to evaluate the association between family history of breast cancer and incidence of BBD in a cohort of 80,995 U.S. nurses and to evaluate variation in this association by the histologic type of BBD and age. MATERIAL AND METHODSThe Nurses' Health Study II is a prospective cohort study that began in 1989 when 116,671 female nurses aged 25-44 years completed a mailed questionnaire. Subsequent questionnaires have been mailed to the women every 2 years, and follow-up of this cohort in each 2-year interval is Ͼ90%. The protocol for the study was approved by the Harvard School of Public Health (Boston, MA).For the present study, all women who reported a prior physician diagnosis of fibrocystic disease or other BBD (n ϭ 33,375) or cancer (n ϭ 691) in 1989 were excluded, as were an additional 1,610 women (1.4% of the original cohort) with no follow-up i...

History of benign breast disease and risk of breast cancer among women in China: a case–control study

“…In this group of women, lobular proliferation (29.7%) followed by fibroadenoma (7.5%) were the most frequently identified types of BBD. We found that participants with BBD shared similar demographic and breast cancer-related risk factors with breast cancer patients, including higher educational and occupational levels, early menarche, no or few live births, late menopause, short breastfeeding duration, high BMI, high proportion of family history of breast cancer among first degree of relatives (22)(23)(24), and low proportion of oral contraceptive use (10,25).…”

Histological features of extratumoral breast lesions as a predictive factor of familial breast cancer

“…Our findings are in accord with those of Aaman et al (9) showing that patients with a family history of breast cancer had a slightly, but not significantly, decreased prevalence of ductal atypia (DCIS or ADH) and sclerosing adenosis when compared with patients with no family history of cancer. Instead, the study of Webb et al (32) showed that women with proliferative benign breast diseases, in particular with atypia, were significantly associated with family history. Other studies also showed that women with a hereditary predisposition for breast cancer (11) and women with BRCA mutations (32) are prone to develop high risk lesions in their breasts, in particular lesions associated with an increased risk of invasive carcinoma (ADH, atypical lobular hyperplasia and lobular carcinoma in situ).…”

Early Life Factors and Incidence of Proliferative Benign Breast Disease

“…Additional factors, such as a family history of breast cancer, may also influence the likelihood of a physician ordering a tissue biopsy (35). To address this potential for bias, we conducted secondary analyses restricted to participants who reported having a mammogram or a breast examination by a clinician in the past two years and to those with no history of breast cancer in a first-degree relative.…”