Risk Adapted Prevention Group, Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.
Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Cancer. 2021 Jun 15;127(12):2091-2098. doi: 10.1002/cncr.33456. Epub 2021 Feb 23.
There is a lack of evidence-based recommendations for the age at which women with a family history of cancers other than breast cancer should start breast cancer screening.
Using Swedish family cancer data sets, the authors conducted a nationwide cohort study including 5,099,172 Swedish women born after 1931 (follow-up, 1958-2015). Accounting for calendar time, they calculated the relative risk of breast cancer for women with a family history of a discordant cancer in 1 first-degree relative. Furthermore, the authors used 10-year cumulative risk to determine the ages at which women with a family history of discordant cancer reached risk thresholds at which women in the general population were recommended to start breast cancer screening.
A family history of cancer at 15 sites was associated with an increased risk of breast cancer. Among women younger than 50 years, the highest risk of breast cancer was observed for those with a family history of ovarian cancer (standardized incidence ratio, 1.44; 95% confidence interval, 1.26-1.64). In these women, the risk of breast cancer associated with a family history at other cancer sites ranged from 1.08-fold for prostate cancer to 1.18-fold for liver cancer. When breast cancer screening was recommended to be started at the age of 50 years for the general population, women with 1 first-degree relative with ovarian cancer attained the threshold risk for screening at the age of 46 years. Women with a family history of other discordant cancers did not reach the risk thresholds for screening at younger ages.
Many cancers showed familial associations with breast cancer, but women with a family history of these cancers (except for ovarian cancer) did not reach risk thresholds for screening at younger ages.
对于有乳腺癌以外家族史的女性，何时开始乳腺癌筛查缺乏循证医学推荐。
作者利用瑞典家族癌症数据库，开展了一项全国性队列研究，纳入了 1931 年后出生的 5099172 名瑞典女性（随访时间为 1958 年至 2015 年）。作者考虑了日历时间，计算了 1 级亲属中患有不一致癌症家族史的女性患乳腺癌的相对风险。此外，作者使用 10 年累积风险来确定患有不一致癌症家族史的女性达到一般人群推荐开始乳腺癌筛查的风险阈值的年龄。
15 个部位的癌症家族史与乳腺癌风险增加相关。在 50 岁以下的女性中，卵巢癌家族史与乳腺癌风险最高（标准化发病比 1.44；95%置信区间 1.26-1.64）。在这些女性中，其他癌症部位家族史与乳腺癌相关的风险范围从前列腺癌的 1.08 倍到肝癌的 1.18 倍。当建议一般人群在 50 岁开始进行乳腺癌筛查时，有 1 位一级亲属患有卵巢癌的女性在 46 岁时达到了筛查的阈值风险。有家族史的其他不一致癌症的女性在较年轻时未达到筛查的风险阈值。
许多癌症与乳腺癌存在家族相关性，但有这些癌症家族史（除卵巢癌外）的女性在较年轻时未达到筛查的风险阈值。
