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Impact of self-reported data on the acquisition of multi-generational family history and lifestyle factors among women seen in a high-risk breast screening program: a focus on modifiable risk factors and genetic referral

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Abstract

Background

The phrase “high-risk for breast cancer” is used to identify various groups at elevated cancer risk, and the appropriate surveillance and risk-reducing strategies differ based on the etiology of risk. Here, we review the utility of patient-reported data to capture women with modifiable lifestyle risk factors and those suitable for genetic counseling referral.

Methods

Patient-reported data from a web-based survey were used to capture personal history, multi-generational family history, and lifestyle factors (body mass index, alcohol consumption, physical activity). Responses were tabulated, and percentage of patients who met criteria for possible intervention calculated.

Results

1277 women completed the survey from October 2014 to December 2015. Women were considered high risk for a combination of the following: family history of breast and/or ovarian cancer (77%), history of atypical hyperplasia or lobular carcinoma in situ (35%), known breast cancer-related gene mutation (11%). Based on self-reported data, 65% qualified for genetic evaluation but 40% reporting no prior testing. Only half of the population met national physical activity recommendations, nearly 40% were overweight/obese, and 18% reported consuming ≥1 alcoholic beverage per day.

Conclusions

Among women followed in a high-risk breast surveillance program, there is considerable opportunity for improved genetic referral and awareness of modifiable lifestyle factors based on self-reported data as 60% of respondents reported a possible area for intervention. While risk reduction associated with lifestyle changes is modest in comparison to chemoprevention or surgery, such changes are practically without risk, minimally expensive, and provide innumerable secondary health benefits.

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References

  1. Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM et al (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351(5):427–437. doi:10.1056/NEJMoa031759

    Article  CAS  PubMed  Google Scholar 

  2. Lostumbo L, Carbine NE, Wallace J (2010) Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev (11):Cd002748. doi:10.1002/14651858.CD002748.pub3

  3. Cuzick J, Sestak I, Forbes JF, Dowsett M, Knox J, Cawthorn S et al (2014) Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. Lancet 383(9922):1041–1048. doi:10.1016/s0140-6736(13)62292-8

    Article  CAS  PubMed  Google Scholar 

  4. Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A et al (2005) Tamoxifen for the prevention of breast cancer: current status of the National surgical adjuvant breast and bowel project P-1 study. J Natl Cancer Inst 97(22):1652–1662. doi:10.1093/jnci/dji372

    Article  CAS  PubMed  Google Scholar 

  5. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM et al (1998) Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project P-1 study. J Natl Cancer Inst 90(18):1371–1388

    Article  CAS  PubMed  Google Scholar 

  6. Goss PE, Ingle JN, Ales-Martinez JE, Cheung AM, Chlebowski RT, Wactawski-Wende J et al (2011) Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med 364(25):2381–2391. doi:10.1056/NEJMoa1103507

    Article  CAS  PubMed  Google Scholar 

  7. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN et al (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP study of tamoxifen and raloxifene (STAR) P-2 trial. JAMA 295(23):2727–2741. doi:10.1001/jama.295.23.joc60074

    Article  CAS  PubMed  Google Scholar 

  8. Port ER, Montgomery LL, Heerdt AS, Borgen PI (2001) Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol 8(7):580–585

    Article  CAS  PubMed  Google Scholar 

  9. Taylor R, Taguchi K (2005) Tamoxifen for breast cancer chemoprevention: low uptake by high-risk women after evaluation of a breast lump. Ann Fam Med 3(3):242–247. doi:10.1370/afm.284

    Article  PubMed  PubMed Central  Google Scholar 

  10. Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL et al (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 72(5):1117–1130. doi:10.1086/375033

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK (1994) Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 86(18):1403–1408

    Article  CAS  PubMed  Google Scholar 

  12. Collaborative Group on Hormonal Factors in Breast Cancer (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet 358(9291):1389–1399. doi:10.1016/s0140-6736(01)06524-2

    Article  Google Scholar 

  13. Dyrstad SW, Yan Y, Fowler AM, Colditz GA (2015) Breast cancer risk associated with benign breast disease: systematic review and meta-analysis. Breast Cancer Res Treat 149(3):569–575. doi:10.1007/s10549-014-3254-6

    Article  CAS  PubMed  Google Scholar 

  14. Friedenreich CM (2011) Physical activity and breast cancer: review of the epidemiologic evidence and biologic mechanisms. Recent Results Cancer Res 188:125–139. doi:10.1007/978-3-642-10858-7_11

    Article  CAS  PubMed  Google Scholar 

  15. Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, Heath CW Jr et al (2002) Alcohol, tobacco and breast cancer–collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 87(11):1234–1245. doi:10.1038/sj.bjc.6600596

    Article  CAS  PubMed  Google Scholar 

  16. Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K et al (2005) Benign breast disease and the risk of breast cancer. N Engl J Med 353(3):229–237. doi:10.1056/NEJMoa044383

    Article  CAS  PubMed  Google Scholar 

  17. Ibrahim EM, Abouelkhair KM, Kazkaz GA, Elmasri OA, Al-Foheidi M (2012) Risk of second breast cancer in female Hodgkin’s lymphoma survivors: a meta-analysis. BMC Cancer 12:197. doi:10.1186/1471-2407-12-197

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pharoah PD, Day NE, Duffy S, Easton DF, Ponder BA (1997) Family history and the risk of breast cancer: a systematic review and meta-analysis. Int J Cancer 71(5):800–809

    Article  CAS  PubMed  Google Scholar 

  19. Schatzkin A, Jones DY, Hoover RN, Taylor PR, Brinton LA, Ziegler RG et al (1987) Alcohol consumption and breast cancer in the epidemiologic follow-up study of the first National Health and Nutrition Examination Survey. N Engl J Med 316(19):1169–1173. doi:10.1056/NEJM198705073161901

    Article  CAS  PubMed  Google Scholar 

  20. Singletary KW, Gapstur SM (2001) Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. JAMA 286(17):2143–2151

    Article  CAS  PubMed  Google Scholar 

  21. van den Brandt PA, Spiegelman D, Yaun SS, Adami HO, Beeson L, Folsom AR et al (2000) Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 152(6):514–527

    Article  PubMed  Google Scholar 

  22. National Comprehensive Cancer Network Genetic/Familial High-Risk Assessment: Breast and Ovarian. Breast and/or Ovarian Cancer Genetic Assessment (2016). https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed 14 May 2016

  23. National Comprehensive Cancer Network Genetic/Familial High-Risk Assessment: Breast and Ovarian. Breast and/or Ovarian Cancer Genetic Assessment (2017). https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed 20 Dec 2016

  24. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV et al (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67. doi:10.3322/caac.20140

    Article  PubMed  Google Scholar 

  25. Sweet KM, Bradley TL, Westman JA (2002) Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol 20(2):528–537

    Article  PubMed  Google Scholar 

  26. Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D (2008) Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med 148(9):671–679

    Article  PubMed  Google Scholar 

  27. Moller P, Stormorken A, Jonsrud C, Holmen MM, Hagen AI, Clark N et al (2013) Survival of patients with BRCA1-associated breast cancer diagnosed in an MRI-based surveillance program. Breast Cancer Res Treat 139(1):155–161. doi:10.1007/s10549-013-2540-z

    Article  CAS  PubMed  Google Scholar 

  28. Morrow M (2011) Prophylactic mastectomy of the contralateral breast. Breast 20(Suppl 3):S108–S110. doi:10.1016/s0960-9776(11)70306-x

    Article  PubMed  Google Scholar 

  29. Lostumbo L, Carbine N, Wallace J, Ezzo J (2004) Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev (4):CD002748. doi:10.1002/14651858.CD002748.pub2

  30. Ropka ME, Keim J, Philbrick JT (2010) Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. J Clin Oncol 28(18):3090–3095. doi:10.1200/JCO.2009.27.8077

    Article  PubMed  PubMed Central  Google Scholar 

  31. Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Cogliano V (2007) Carcinogenicity of alcoholic beverages. Lancet Oncol 8(4):292–293

    Article  PubMed  Google Scholar 

  32. Williams RR, Horm JW (1977) Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey. J Natl Cancer Inst 58(3):525–547

    Article  CAS  PubMed  Google Scholar 

  33. Smith-Warner SA, Spiegelman D, Yaun SS, van den Brandt PA, Folsom AR, Goldbohm RA et al (1998) Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA 279(7):535–540

    Article  CAS  PubMed  Google Scholar 

  34. Mezzetti M, La Vecchia C, Decarli A, Boyle P, Talamini R, Franceschi S (1998) Population attributable risk for breast cancer: diet, nutrition, and physical exercise. J Natl Cancer Inst 90(5):389–394

    Article  CAS  PubMed  Google Scholar 

  35. Schoenborn CA, Adams PF, Pergoy JA (2013) Health behaviors of adults: United States, 2008–2010. National Center for Health Statistics. Vital Health Stat 10(257). http://www.cdc.gov/nchs/data/series/sr_10/sr10_257.pdf. Accessed 31 May 2016

  36. Bergstrom A, Pisani P, Tenet V, Wolk A, Adami HO (2001) Overweight as an avoidable cause of cancer in Europe. Int J Cancer 91(3):421–430

    Article  CAS  PubMed  Google Scholar 

  37. Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF, Longcope C et al (2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst 95(16):1218–1226

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was funded in part by NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA

    Laura H. Rosenberger, Debra A. Mangino, Monica Morrow & Melissa L. Pilewskie

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Ryan Weber, Daniel Sjoberg & Andrew J. Vickers

Authors
  1. Laura H. Rosenberger
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  2. Ryan Weber
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  3. Daniel Sjoberg
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  5. Debra A. Mangino
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  6. Monica Morrow
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  7. Melissa L. Pilewskie
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Correspondence to Melissa L. Pilewskie.

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All authors have no conflicts of interest to disclose.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Rosenberger, L.H., Weber, R., Sjoberg, D. et al. Impact of self-reported data on the acquisition of multi-generational family history and lifestyle factors among women seen in a high-risk breast screening program: a focus on modifiable risk factors and genetic referral. Breast Cancer Res Treat 162, 275–282 (2017). https://doi.org/10.1007/s10549-017-4115-x

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  • DOI: https://doi.org/10.1007/s10549-017-4115-x

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