Personal history alone presents similar breast cancer risk as personal plus family history

Subsequent breast cancers occur in patients with just their own premenopausal history of the disease at close to the same rate as in patients with both personal and family breast cancer history, according to a study published online Jan. 7 in Academic Radiology.

The research points to comparable risk levels for new cancers in both groups—and so suggests a benefit from screening breast MRI for women with solely personal history.

Stamatia Destounis, MD, of the University of Rochester (N.Y.), and colleagues retrospectively reviewed 4,436 screening MRIs performed on women with premenopausal breast cancer from December 2003 through October 2014.

Whittling the cohort to compare the two subgroups, the team analyzed 146 MR scans of 52 patients with personal history only, as well as 235 scans of 79 patients with both personal history and family history.

The total number of MRIs performed per patient ranged from 1 to 10, with an average of 2.9 in the personal history/family history (PHFH) group and 2.8 in the personal history-only (PH-only) group.

Malignancy was detected in 27.3 percent of the patients, the rates coming in at 53.3 percent in the PHFH group and 46.7 percent in the PH-only group.  

There was no significant difference when the pathology between the PH-only group and the PHFH group was compared (P  = 0.5692).  

Likewise, of those diagnosed with cancer, average time between diagnoses was 6.9 years for the PHFH group and 7.1 for the PH-only group.

In their study discussion, the authors state that, overall, their results support the intuition that premenopausal history of breast cancer is an important risk factor, whether or not the patient has a family history on top of her own.  

Coming up with the optimal screening protocol for women with solely a personal history of breast cancer is needed, they note, adding that potential improvements in MRI technology may lead to wider use of the technology for screening this population of patients.

The authors also flag variations in insurance coverage for MRI screening of these women at intermediate risk. They connect the inconsistency with a lack of recommendations for MRI screening of the PH-only population.

“We have had unpredictable experience with insurance providers in our region,” they write. Because of this, “we continue to perform MRI in this population of women with breast cancer history at a premenopausal age when requested by the patient’s physician and submit the claim to the insurance providers.”