Risk-Adapted Starting Age of Screening for Relatives of Patients With Breast Cancer

Abstract

Importance: 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.

Objective: 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.

Exposures: Family history of breast cancer in FDRs and second-degree relatives (SDRs).

Main outcomes and measures: 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.

Results: 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.

Conclusions and relevance: 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.

Figure 1.. Ten-Year Cumulative Breast Cancer Risk Curves by Number of Affected First-Degree Relatives (FDRs) and Second-Degree Relatives (SDRs) for Women

The blue horizontal line represents population-level 10-year cumulative risk of 2.2%, when starting mass breast cancer screening is recommended at age 50 years.

Figure 2.. Ten-Year Cumulative Breast Cancer Risk Curves by Age at Diagnosis of First-Degree Relative (FDR) for Women With 1 Affected FDR

The blue horizontal line is drawn at a 10-year cumulative risk of 1.1% and represents the population-level risk of starting screening at the recommended age of 40 years.