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Breast Cancer Risk Estimates for Relatives of White and African American Women With Breast Cancer in the Women's Contraceptive and Reproductive Experiences Study

Michael S. Simon, Jeannette F. Korczak, Cecilia L. Yee, Kathleen E. Malone, Giske Ursin, Leslie Bernstein, Jill A. McDonald, Dennis Deapen, Brian L. Strom, Michael F. Press, Polly A. Marchbanks, Ronald T. Burkman, Linda K. Weiss, Ann G. Schwartz

From the Division of Hematology and Oncology; Population Studies and Prevention Program; Breast Cancer Program, Karmanos Cancer Institute at Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Division of Public Health Sciences; University of Washington, School of Public Health and Community Medicine; Department of Epidemiology, Seattle, WA; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA; National Cancer Institute, Bethesda, MD; and the Department of Nutrition, University of Oslo, Oslo, Norway

Address reprint requests to Michael S. Simon, MD, MPH, Barbara Ann Karmanos Cancer Institute, Room 4221 HWCRC, 4100 John R, Detroit MI 48201; e-mail: Simonm{at}karmanos.org

PURPOSE: Family history is a well-recognized risk factor for breast cancer. Familial aggregation and segregation analyses have estimated breast cancer risk based on family history primarily for white women; such information is limited for African American (AA) women. The purpose of this report is to update breast cancer risk estimates associated with a family history of breast cancer for white and AA women.

METHODS: We used family cancer history from 2,676 white and 1,525 AA women with breast cancer (probands) in the population-based National Institute of Child Health and Human Development's Women's Contraceptive and Reproductive Experiences (CARE) Study to estimate age-specific breast cancer risks in their first degree adult female relatives. Cumulative hazard curves were calculated for relatives of all probands using Cox proportional hazards models, and were stratified by the proband's race and age at diagnosis and number of relatives affected.

RESULTS: Breast cancer risks for white and AA women with a family history of the disease are similar through age 49 years, but diverge afterwards, with higher risks by age 79 in white women than in AA women (17.5% [SE, 0.9%] v 12.2% [SE, 1.1%]; P < .001). These risks increase as the number of affected first degree relatives increases, reaching 25.2% (SE, 3.4%) and 16.9% (SE, 4.0%) in white and AA women with more than one affected relative, respectively (P = .3).

CONCLUSION: We found age-related racial differences in breast cancer risk in women with a family history of breast cancer and have updated risk estimates for white and AA women for clinical use.

Supported by the National Institute of Child Health and Human Development with additional support through National Cancer Institute (Bethesda, MD) contract CN65064, the Michigan Health Care Education and Research Foundation, and institutional funds from the Karmanos Cancer Institute Population Studies and Prevention Program.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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