Department of Health Sciences, Hanyang University College of Medicine, Seoul, Republic of Korea.
Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Breast. 2022 Oct;65:180-186. doi: 10.1016/j.breast.2022.08.008. Epub 2022 Aug 23.
This study investigated whether the association between family history of breast cancer in first-degree relatives and breast cancer risk varies by breast density.
Women aged 40 years and older who underwent screening between 2009 and 2010 were followed up until 2020. Family history was assessed using a self-reported questionnaire. Using Breast Imaging Reporting and Data System (BI-RADS), breast density was categorized into dense breast (heterogeneously or extremely dense) and non-dense breast (almost entirely fatty or scattered areas of fibro-glandular). Cox regression model was used to assess the association between family history and breast cancer risk.
Of the 4,835,507 women, 79,153 (1.6%) reported having a family history of breast cancer and 77,238 women developed breast cancer. Family history led to an increase in the 5-year cumulative incidence in women with dense- and non-dense breasts. Results from the regression model with and without adjustment for breast density yielded similar HRs in all age groups, suggesting that breast density did not modify the association between family history and breast cancer. After adjusting for breast density and other factors, family history of breast cancer was associated with an increased risk of breast cancer in all three age groups (age 40-49 years: aHR 1.96, 95% confidence interval [CI] 1.85-2.08; age 50-64 years: aHR 1.70, 95% CI 1.58-1.82, and age ≥65 years: aHR 1.95, 95% CI 1.78-2.14).
Family history of breast cancer and breast density are independently associated with breast cancer. Both factors should be carefully considered in future risk prediction models of breast cancer.
本研究旨在探讨一级亲属乳腺癌家族史与乳腺癌风险之间的关联是否因乳腺密度而异。
本研究纳入了 2009 年至 2010 年期间接受筛查的 40 岁及以上女性，并随访至 2020 年。通过自我报告问卷评估家族史。使用乳腺影像报告和数据系统（BI-RADS），将乳腺密度分为致密型（不均匀或极度致密）和非致密型（几乎完全为脂肪或散在纤维腺体）。使用 Cox 回归模型评估家族史与乳腺癌风险之间的关联。
在 4835507 名女性中，79153 名（1.6%）报告有乳腺癌家族史，77238 名女性发生乳腺癌。家族史导致致密型和非致密型乳腺女性的 5 年累积发病率增加。在调整和不调整乳腺密度的回归模型中，所有年龄组的 HR 结果相似，提示乳腺密度并未改变家族史与乳腺癌之间的关联。在调整乳腺密度和其他因素后，乳腺癌家族史与所有三个年龄组的乳腺癌风险增加相关（40-49 岁：aHR 1.96，95%置信区间 [CI] 1.85-2.08；50-64 岁：aHR 1.70，95% CI 1.58-1.82，≥65 岁：aHR 1.95，95% CI 1.78-2.14）。
乳腺癌家族史和乳腺密度均与乳腺癌独立相关。在未来的乳腺癌风险预测模型中，应仔细考虑这两个因素。
