Presentation
Predictors of breast cancer development in a high-risk population

Presented at the 7th Annual Meeting of the American Society of Breast Surgeons, Baltimore, Maryland, April 5–9, 2006
https://doi.org/10.1016/j.amjsurg.2006.06.015Get rights and content

Abstract

Background

The purpose of this study was to investigate the strongest predictors of breast cancer in a high-risk population and to increase our understanding of the possible interactions between risk factors.

Methods

The Women At Risk High-Risk Registry provided the study population. The variables of interest included age at enrollment, presence of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, family history of breast cancer, body mass index, and Gail scores (5-year high-risk ≥1.7%). Univariate and multivariate analyses were conducted with the Cox proportional hazards regression model and years of follow-up evaluation as the time scale.

Results

Out of 1553 high-risk women, 79 (5%) developed breast cancer during a median follow-up period of 5 years. Results from the multivariate Cox model demonstrated that FHBC (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.05–2.97), ADH (HR = 1.90; 95% CI, 1.16–3.13), LCIS (HR = 1.71; 95% CI, .99–2.95), and a body mass index ≥30 (HR = 2.22; 95% CI, 1.14–4.35) were statistically significant predictors of breast cancer within this high-risk population.

Conclusions

These results support current literature showing the synergistic increase in risk for patients with ADH, LCIS, and a positive family history of breast cancer. Obesity was also a strong predictor of breast cancer risk, which suggests that there may be a potentiating effect of obesity on other risk factors. Obesity may represent a modifiable risk factor, providing women with an opportunity to reduce their risk with lifestyle modification. Women with a strong family history of breast cancer or a diagnosis of ADH or LCIS may benefit most from risk-reduction strategies, chemoprevention, and surveillance.

Section snippets

Study population

The Women At Risk Registry at Columbia University Medical Center provided the study population. All participants had 1 or more of the following criteria: 1 or more first-degree relatives (mother, daughter, or sister) with premenopausal breast cancer; 2 or more first-degree relatives with postmenopausal breast cancer; a biopsy-proven history of LCIS, ADH, or ALH.

The variables of interest included age at enrollment, presence of LCIS, ADH, ALH, family history of breast cancer (FHBC), BMI, and Gail

Results

Of a total population of 1,553 high-risk women, 79 (5%) developed breast cancer during the study period with a median follow-up period of 5 years. Within this high-risk population, 90% were Caucasian, with a median age of 47 years. They were defined as high risk by having a FHBC (58%), a biopsy examination–proven history of ADH (28%), ALH (9%), and LCIS (20%) (Table 1). Results from the univariate Cox proportional hazards regression model showed that age (P = .03), ADH (P = .02), LCIS (P =

Comments

In a select group of 1,553 women at high-risk for developing breast cancer, having a strong FHBC, a biopsy-proven history of ADH or LCIS, and obesity (BMI ≥30) were all associated significantly with the development of breast cancer within our median follow-up time of 5 years. These results support current literature showing the synergistic increase in risk for patients with a positive FHBC, ADH, or LCIS.

The Gail model was not a predictor of breast cancer risk in our study population. Although

Conclusions

Identifying and defining a target group of high-risk breast cancer patients has become a very important component of breast cancer prevention and intervention trials. A well-defined high-risk population would benefit most from surveillance, risk assessment, effective risk-reduction strategies, and chemoprevention trials.

The findings of our study support the established medical literature, which shows an increased risk of breast cancer in women with ADH, LCIS, or a family history of the disease.

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