FAMILY HISTORY AND SURVIVAL IN PREMENOPAUSAL BREAST-CANCER

The clinicopathological characteristics of breast cancer in 95 women b etween the ages of 24 and 45 years with a family history of breast can cer were compared with tumours from 329 women with sporadic disease ma tched for age and year of diagnosis. There was a trend for the family history patients to have slightly smaller tumours (mean size 2.49 cm) than the controls (mean 3.04 cm) (Mann-Whitney test, P = 0.09). A sign ificantly greater proportion of the familial cases had grade III infil trating ductal carcinoma than did the controls (40% vs 27%; chi(1)(2) = 5.64, P = 0.02). Despite this, there were more cases of operable nod e-negative disease among the study group than among the controls (48% vs 32%; chi(1)(2) = 8.2, P = 0.004). There was a highly significant su rvival advantage for patients with a family history (chi(2) = 22.4, P < 0.001). Five-and 10-year survival rates were 92% and 87% for those w ith a family history compared with 70% and 54% for those in the contro l group. This survival advantage was maintained when patients with ope rable disease only were considered. In multivariate analysis, which in cluded age, tumour size, stage, histological grade and family history, family history was an independent predictor of favourable prognosis a nd, in a Cox model, was associated with a relative risk of survival of 6.11 (95% CI 2.81-13.28). These results suggest that familial breast cancer has a more favourable clinical course than the more common spor adic forms of the disease.