16 Local Recurrence and Contralateral Breast Cancer Risks in Patients With Family History Are Comparable to Population-Based Data: A Single-Center Experience of 278 Cases

Background

A positive family history often triggers high anxiety regarding recurrence in patients diagnosed with breast cancer, leading to increased rates of unilateral or bilateral prophylactic surgery. However, the actual impact of family history on recurrence patterns and contralateral breast cancer (CBC) risk under modern treatment regimens remains controversial. This study aims to evaluate recurrence risks in patients with a positive family history compared with population-based data to question the necessity of routine radical surgical approaches.

Materials and Methods

We retrospectively analyzed 278 patients with breast cancer with a positive family history who underwent surgery between 2007 and 2021. Local recurrence, regional recurrence, and CBC rates were compared with general population data using standardized ıncidence ratio (SIR) analysis.

Results

The mean age of patients was 52.3 (±12.5) years, with 15.8% being under the age of 40 years. A first-degree family history of breast cancer was detected in 29.5%, while high-risk family history (defined as ≥ 2 first-degree relatives or 1 first-degree relative diagnosed at age< 40 years) was identified in 9.4%. Distribution by stage included stage II (49.3%), stage I (31.7%), and stage III (19.1%). The most common molecular subtype was luminal HER2 negative (68.0%). Luminal HER2-positive cases accounted for 10.4%, nonluminal HER2 positive for 6.5%, and triple negative for 15.1%. Neoadjuvant chemotherapy was administered to 22.3% of patients. At a median follow-up of 96 months, the local recurrence rate was 2.2% and the systemic recurrence rate was 8.6%. SIR analyses showed no significant increase comparable with the general population in terms of locoregional recurrence (SIR, 1.07; P = .754), breast recurrence after breast-conserving surgery (SIR, 1.32; P = .555), or total CBC risk (SIR, 1.28; P = .391; Table).

Notably, the 5-year CBC risk was found to be 1.1%, which is lower than the expected population rate of 1.3% (SIR, 0.83; P >.999). Subgroup analysis revealed that recurrence risk was more closely associated with biological subtype rather than the degree of family history, with the highest local recurrence rate observed in the triple-negative group (11.9%).

Conclusions

Our study demonstrates that disease control observed with modern therapies in patients with a positive family history is comparable with that of the general population. These findings suggest that a positive family history alone does not constitute an absolute indication for unilateral or bilateral prophylactic surgery. Such surgical decisions should be based on biological subtypes and individualized risk assessments, supporting the potential to defer these procedures, particularly within the first 5 years post diagnosis.