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Open Access 01-12-2006 | Research article

Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience

Authors: Laura Cortesi, Daniela Turchetti, Isabella Marchi, Antonella Fracca, Barbara Canossi, Rachele Battista, Silvia Ruscelli, Anna Rita Pecchi, Pietro Torricelli, Massimo Federico

Published in: BMC Cancer | Issue 1/2006

Abstract

Background

Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification.

Methods

We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio (SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided.

Results

After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased (SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk (SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P = .74).

Conclusion

The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/6/210/prepub

Title: Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience
Authors: Laura Cortesi
Daniela Turchetti
Isabella Marchi
Antonella Fracca
Barbara Canossi
Rachele Battista
Silvia Ruscelli
Anna Rita Pecchi
Pietro Torricelli
Massimo Federico
Publication date: 01-12-2006
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2006
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/1471-2407-6-210

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