Colditz G A, Willett W C, Hunter D J, Stampfer M J, Manson J E, Hennekens C H, Rosner B A
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
JAMA. 1993 Jul 21;270(3):338-43.
To examine prospectively the risk of breast cancer as influenced by a maternal history of breast cancer, the mother's age at diagnosis, or a sister's history of breast cancer.
Prospective cohort study with biennial follow-up.
SETTING/PARTICIPANTS: 117,988 women in the Nurses' Health Study aged 30 to 55 years in 1976, followed up through 1988 (1.3 million person-years of follow-up).
We identified 2389 incident cases of invasive breast cancer. Compared with women without a maternal history of breast cancer, the age-adjusted relative risk (RR) of breast cancer was highest among women whose mother was diagnosed before the age of 40 years (RR, 2.1 [95% confidence interval, 1.6 to 2.8]). The RR decreased with advancing maternal age at time of diagnosis to 1.5 (95% confidence interval, 1.1 to 2.2) for maternal diagnosis after the age of 70 years. Having a sister with a history of breast cancer also was related to increased risk; for women with one sister with breast cancer compared with those with one sister without such a history, the age-adjusted RR was 2.3 (95% confidence interval, 1.6 to 3.4). Women whose mother and sister both had a history of breast cancer had an RR of 2.5 (95% confidence interval, 1.5 to 4.2) compared with those without a family history. These associations did not differ appreciably when stratified by age; menopausal status; history of benign breast disease; body mass index; age at menarche; or parity or age at first birth of the women at risk. The results remained unchanged when we controlled for these risk factors in multivariate models. Despite slightly greater mammography surveillance and earlier detection of tumors among women with a family history of breast cancer, detection bias is unlikely to account for more than a small part of the observed association.
Risk of breast cancer is approximately doubled among women whose mother had breast cancer diagnosed before the age of 40 years or who have a sister with breast cancer, and remains elevated even for those whose mothers were diagnosed with breast cancer at the age of 70 years or older. However, the risk associated with a mother or sister history of breast cancer is smaller than suggested by earlier retrospective studies. Overall, within this population of middle-aged women, only 2.5% of breast cancer cases are attributable to a positive family history.
前瞻性研究母亲患乳腺癌病史、母亲确诊时的年龄或姐妹患乳腺癌病史对乳腺癌风险的影响。
进行两年一次随访的前瞻性队列研究。
地点/参与者：护士健康研究中的117,988名女性，她们在1976年年龄为30至55岁，随访至1988年（随访人年数达130万）。
我们确定了2389例浸润性乳腺癌发病病例。与没有母亲患乳腺癌病史的女性相比，母亲在40岁之前被诊断出患乳腺癌的女性，其年龄调整后的乳腺癌相对风险（RR）最高（RR为2.1 [95%置信区间为1.6至2.8]）。随着母亲确诊时年龄的增加，RR值下降，母亲在70岁之后被诊断出患乳腺癌时，RR为1.5（95%置信区间为1.1至2.2）。有姐妹患乳腺癌病史也与风险增加有关；与有一个姐妹没有乳腺癌病史的女性相比，有一个姐妹患乳腺癌的女性，其年龄调整后的RR为2.3（95%置信区间为1.6至3.4）。与没有家族病史的女性相比，母亲和姐妹都有乳腺癌病史的女性RR为2.5（95%置信区间为1.5至4.2）。按年龄、绝经状态、良性乳腺疾病史、体重指数、初潮年龄、生育情况或有风险女性的首次生育年龄分层时，这些关联没有明显差异。当我们在多变量模型中控制这些风险因素时，结果保持不变。尽管有乳腺癌家族病史的女性接受乳房X线检查的监测略多，肿瘤发现也更早，但检测偏倚不太可能解释所观察到的关联中的很大一部分。
母亲在40岁之前被诊断出患乳腺癌或有姐妹患乳腺癌的女性，患乳腺癌的风险大约会增加一倍，即使母亲在70岁或更晚时被诊断出患乳腺癌，其风险仍然升高。然而，与母亲或姐妹患乳腺癌病史相关的风险比早期回顾性研究表明的要小。总体而言，在这群中年女性中，只有2.5%的乳腺癌病例可归因于阳性家族史。
