Does a Positive Family History Influence the Presentation of Breast Cancer?

Abstract

<br/><b>Introduction</b>: An important risk factor for developing breast cancer is a positive family history of breastcancer. In Malaysia, there is no population-based breast screening programme, but the clinical practice guidelinessuggest increased surveillance for those with a positive family history ie mammography for those 40 years oldand above, breast self-examination and clinical breast examination yearly. <br/><b>Objective</b>: To determine if womenwith a family history of breast cancer present with earlier stages of disease.Methodology: From Jan 2001 to Dec2006, 1553 women with breast cancer presenting to the University Malaya, where family history was recorded,were eligible for this study. Women with a first or second degree relative with breast cancer were compared withthose who have no family history with regard to their race, age, stage, size and duration of symptoms. The ChiSquare test of significance was used for analysis. <br/><b>Results</b>: Out of 1553 patients, 252 (16.2%) were found to havea relative with breast cancer out of which 174 (11.2%) had at least one affected first degree relative. There wereno significant difference in the incidence of positive family history between the Malays, Chinese and Indians.20% below the age of 40 years old had a positive family history compared with 12.6% in women with no familyhistory. (p<0.05). There was no significant difference in stage at diagnosis between those with and withoutfamily history, ie 24.2% late stages (Stage 3 and 4) in the group with no family history compared with 21.8% inthe group with family history. (p>0.05). The mean size in the group with no family history was 4.4 cm comparedto 4.1 cm in the group with family history. There was a significant difference in screen-detected cancers in thewomen with family history, 10.7% compared with 5.1% of screen-detected cancers in the group without afamily history. However there was no difference in the duration of symptoms between the 2 groups – 25.8% inthe women without a family history presented after 1 year of symptoms compared with 22.4% in the group witha family history (p>0.05). <br/><b>Conclusion</b>: Having a family history of breast cancer does not appear to have muchimpact on the health-seeking behavior of women. Even though there were more screen detected cancers, thesecomprised only 10% of the group with family history. Public education should target women at risk ie withfamily history to encourage these women to present earlier and to undergo screening for breast cancer.