Family history in breast cancer is not a prognostic factor?

The aim of this study is to determine if breast conservative treatment is j ustified for patients with a positive family history of breast cancer and t o investigate whether they have a worse prognosis. We performed a prospective cohort study of breast cancer patients, treated with breast conservative treatment with radiotherapy at the Radiotherapy De partment of the Medisch Spectrum Twente. Between 1984 and 1996, 1204 patien ts with T1 and T2 less than or equal to 3cm were treated. Family history (F H) was recorded according to first degree relative (FDR). Treatment consist ed of lumpectomy with axillary dissection followed by radiotherapy to the w hole breast with a boost to the primary area. Adjuvant systemic therapy was given to patients with positive nodes. A positive FH was noted in 243 (20.5%) patients, of whom 208 (17.6%) had on e FDR, and 35 (3.0%) greater than or equal to 2 FDRs. The local recurrence rate was 4.1%, with similar rates for all groups. In young patients, less t han or equal to 40 years, a significant relation between local recurrence a nd FH was found. The distant metastasis rate was 15.5%, with the lowest rat e (5.7%) among patients with greater than or equal to 2 FDRs. Patients with a positive FH had significantly more contralateral tumours. The 5-year cor rected survival was 91.3%. Among patients with a positive FH, a 5-year corr ected survival of 91% was observed and the survival 100% among patients wit h one and greater than or equal to 2 FDR. Family history is not a contraindication for breast conservative treatment and is not associated with a worse prognosis. Family history is not a progn ostic factor for local recurrence rate in patients older than 40 years. (C) 2000 Harcourt Publishers Ltd.