Melvin Jennifer C, Wulaningsih Wahyu, Hana Zac, Purushotham Arnie D, Pinder Sarah E, Fentiman Ian, Gillett Cheryl, Mera Anca, Holmberg Lars, Van Hemelrijck Mieke
Faculty of Life Sciences and Medicine, Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, United Kingdom.
Faculty of Life Sciences and Medicine, Division of Cancer Studies, Section of Research Oncology, King's College London, London, United Kingdom.
Cancer Med. 2016 May;5(5):942-9. doi: 10.1002/cam4.648. Epub 2016 Jan 22.
A family history (FH) of breast cancer (BC) is known to increase an individual's risk of disease onset. However, its role in disease severity and mortality is less clear. We aimed to ascertain associations between FH of BC, severity and BC-specific mortality in a hospital-based cohort of 5354 women with prospective information on FH. We included women diagnosed at Guy's and St Thomas' NHS Foundation Trust between 1975 and 2012 (n = 5354). BC severity was defined and categorized as good, moderate, and poor prognosis. Data on BC-specific mortality was obtained from the National Cancer Registry and medical records. Associations between FH and disease severity or BC-specific mortality were evaluated using proportional odds models and Cox proportional hazard regression models, respectively. Available data allowed adjustment for potential confounders (e.g., treatment, socioeconomic status, and ethnicity). FH of any degree was not associated with disease severity at time of diagnosis (adjusted proportional OR: 1.00 [95% CI: 0.85 to 1.17]), which remained true also after stratification by period of diagnosis. FH of BC was not associated with BC-mortality HR: 0.99 (95% CI: 0.93 to 1.05). We did not find evidence to support an association between FH of BC and severity and BC-specific mortality. Our results indicate that clinical management should not differ between women with and without FH, when the underlying mutation is unknown.
已知乳腺癌（BC）家族史（FH）会增加个体发病风险。然而，其在疾病严重程度和死亡率方面的作用尚不清楚。我们旨在确定在一个有5354名女性的医院队列中，BC家族史、疾病严重程度与BC特异性死亡率之间的关联，该队列具有关于家族史的前瞻性信息。我们纳入了1975年至2012年间在盖伊和圣托马斯国民保健服务基金会信托医院确诊的女性（n = 5354）。BC严重程度被定义并分类为预后良好、中等和较差。BC特异性死亡率的数据来自国家癌症登记处和医疗记录。分别使用比例优势模型和Cox比例风险回归模型评估家族史与疾病严重程度或BC特异性死亡率之间的关联。现有数据允许对潜在混杂因素（如治疗、社会经济地位和种族）进行调整。任何程度的家族史在诊断时均与疾病严重程度无关（调整后的比例OR：1.00 [95% CI：0.85至1.17]），按诊断时期分层后也是如此。BC家族史与BC死亡率无关（HR：0.99 [95% CI：0.93至1.05]）。我们没有发现证据支持BC家族史与严重程度和BC特异性死亡率之间存在关联。我们的结果表明，当潜在突变未知时，有家族史和无家族史女性的临床管理不应有所不同。
