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Original Investigation
November 14, 2019

Risk-Adapted Starting Age of Screening for Relatives of Patients With Breast Cancer

Author Affiliations
  • 1Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases, Heidelberg, Germany
  • 2Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
  • 3School of Public Health, College of Health Sciences, Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
  • 4Center for Primary Health Care Research, Lund University, Malmö, Sweden
  • 5Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
  • 6Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
  • 7Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
  • 8German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
JAMA Oncol. Published online November 14, 2019. doi:https://doi.org/10.1001/jamaoncol.2019.3876
Key Points

Question  At what age should women with differing family histories of breast cancer start screening?

Findings  In this nationwide cohort study of 5 099 172 women in Sweden, risk-adapted starting age of breast cancer screening varied by the number of affected first- or second-degree relatives and by age at diagnosis of first-degree relatives. For example, when mass screening was recommended at age 50 years, women with multiple affected first-degree relatives reached the screening risk level at age 27 to 36 years, depending on the youngest age at diagnosis in relatives.

Meaning  This study identifies risk-based starting ages for breast cancer screening that may provide guidance to clinicians and relatives of patients with breast cancer on when to start risk-adapted screening.


Importance  Breast cancer screening guidelines acknowledge the need for earlier screening for women at increased risk but provide limited guidance for women with a family history of breast cancer. A risk-adapted starting age of screening for relatives of patients with breast cancer may help supplement current screening guidelines.

Objective  To identify the risk-adapted starting age of breast cancer screening on the basis of a woman’s detailed family history.

Design, Setting, and Participants  This nationwide cohort study analyzed data recorded in the Swedish family-cancer data sets. All women born from 1932 onward and with at least 1 known first-degree relative (FDR) were included (N = 5 099 172). Data from January 1, 1958, to December 31, 2015, were collected. Data were analyzed from October 1, 2017, to March 31, 2019.

Exposures  Family history of breast cancer in FDRs and second-degree relatives (SDRs).

Main Outcomes and Measures  Primary invasive breast cancer diagnosis and the age at which women with different constellations of family history attained the risk level at which breast screening is usually recommended.

Results  Of the 5 099 172 women included in the study, 118 953 (2.3%) received a diagnosis of primary invasive breast cancer. A total of 102 751 women (86.4%; mean [SD] age at diagnosis, 55.9 [11.1] years) did not have family history of breast cancer in FDRs and SDRs at the time of their diagnosis. Risk-adapted starting age of breast cancer screening varied by number of FDRs and SDRs with breast cancer diagnosis and the age at diagnosis of the FDRs. For example, for screening recommendation at age 50 years for the general population (2.2% 10-year cumulative risk), women with multiple affected FDRs, with the youngest affected relative receiving a diagnosis before age 50 years, reached the benchmark risk level at age 27 years. When the youngest relative received a diagnosis after age 50 years, however, this risk level was attained at age 36 years.

Conclusions and Relevance  This study identifies possible risk-based starting ages for breast cancer screening based on population-based registers. These results may serve as high-quality evidence to supplement current screening guidelines for relatives of patients with breast cancer.

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