Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases, Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
JAMA Oncol. 2020 Jan 1;6(1):68-74. doi: 10.1001/jamaoncol.2019.3876.
Breast cancer screening guidelines acknowledge the need for earlier screening for women at increased risk but provide limited guidance for women with a family history of breast cancer. A risk-adapted starting age of screening for relatives of patients with breast cancer may help supplement current screening guidelines.
To identify the risk-adapted starting age of breast cancer screening on the basis of a woman's detailed family history.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study analyzed data recorded in the Swedish family-cancer data sets. All women born from 1932 onward and with at least 1 known first-degree relative (FDR) were included (N = 5 099 172). Data from January 1, 1958, to December 31, 2015, were collected. Data were analyzed from October 1, 2017, to March 31, 2019.
Family history of breast cancer in FDRs and second-degree relatives (SDRs).
Primary invasive breast cancer diagnosis and the age at which women with different constellations of family history attained the risk level at which breast screening is usually recommended.
Of the 5 099 172 women included in the study, 118 953 (2.3%) received a diagnosis of primary invasive breast cancer. A total of 102 751 women (86.4%; mean [SD] age at diagnosis, 55.9 [11.1] years) did not have family history of breast cancer in FDRs and SDRs at the time of their diagnosis. Risk-adapted starting age of breast cancer screening varied by number of FDRs and SDRs with breast cancer diagnosis and the age at diagnosis of the FDRs. For example, for screening recommendation at age 50 years for the general population (2.2% 10-year cumulative risk), women with multiple affected FDRs, with the youngest affected relative receiving a diagnosis before age 50 years, reached the benchmark risk level at age 27 years. When the youngest relative received a diagnosis after age 50 years, however, this risk level was attained at age 36 years.
This study identifies possible risk-based starting ages for breast cancer screening based on population-based registers. These results may serve as high-quality evidence to supplement current screening guidelines for relatives of patients with breast cancer.
乳腺癌筛查指南认识到需要为高危女性更早地进行筛查，但对于有乳腺癌家族史的女性提供的指导有限。根据患者亲属的家族史，采用风险适应的起始筛查年龄可能有助于补充当前的筛查指南。
根据女性详细的家族史，确定乳腺癌筛查的风险适应起始年龄。
设计、设置和参与者：这项全国性队列研究分析了瑞典家族癌症数据集中记录的数据。所有出生于 1932 年及以后、至少有 1 位已知一级亲属（FDR）的女性均被纳入（n=5099172）。数据收集时间为 1958 年 1 月 1 日至 2015 年 12 月 31 日。数据分析时间为 2017 年 10 月 1 日至 2019 年 3 月 31 日。
FDR 和二级亲属（SDR）的乳腺癌家族史。
原发性浸润性乳腺癌诊断和具有不同家族史组合的女性达到通常推荐进行乳腺癌筛查的风险水平的年龄。
在这项研究中，5099172 名女性中，118953 人（2.3%）被诊断为原发性浸润性乳腺癌。共有 102751 名女性（86.4%；诊断时的平均[标准差]年龄为 55.9[11.1]岁）在诊断时没有 FDR 和 SDR 的乳腺癌家族史。乳腺癌筛查的风险适应起始年龄因 FDR 和 SDR 中乳腺癌诊断数量以及 FDR 的诊断年龄而有所不同。例如，对于一般人群的 50 岁筛查建议（2.2%的 10 年累积风险），有多个受影响 FDR 的女性，如果最年轻的受影响亲属在 50 岁之前被诊断出患有疾病，那么达到基准风险水平的年龄为 27 岁。然而，如果最年轻的亲属在 50 岁以后被诊断出患有该疾病，则达到该风险水平的年龄为 36 岁。
本研究根据基于人群的登记处确定了乳腺癌筛查可能基于风险的起始年龄。这些结果可以作为高质量的证据来补充当前针对乳腺癌患者亲属的筛查指南。
