vom 11.03.2021

Researchers recommend earlier start of breast cancer screening with family history of ovarian cancer

Women have an increased risk of breast cancer if they have a family history of this disease. However, the risk may also be higher if first-degree family members have another type of cancer, according to a study by a team of scientists and physicians from the National Center for Tumor Diseases (NCT) Heidelberg, the German Cancer Research Center (DKFZ) and Heidelberg University Hospital (UKHD), as well as international colleagues. This became particularly clear that when ovarian cancer occurred in the family, the breast cancer risk was 1.4 times the usual risk value. If ovarian cancer was diagnosed in a relative before the age of 50, the risk even increased by 1.7 times. The researchers therefore recommend starting mammography a few years earlier than usual for women with family history of ovarian cancer.

The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center (DKFZ), the University Hospital Heidelberg (UKHD) and the German Cancer Aid (DKH).

Breast cancer is the most common cancer worldwide and the leading cause of cancer death in women. If doctors detect breast carcinoma at an early stage, this can reduce breast cancer mortality. That is why early detection programs are recommended - especially to those women who are at increased risk for breast cancer. This can be the case, for example, if first-degree family members - i.e. the mother, sister or daughter - have already had breast cancer.* The risk of breast cancer is then about twice as high as that of the general population.

In a recent study, scientists from the NCT Heidelberg, DKFZ an UKHD, led by Dr. Mahdi Fallah and Dr. Elham Kharazmi, investigated how exactly other cancers in the family affect the risk of breast cancer in women. Analysis of the results shows that risk can increase even if first-degree family members had cancers other than breast cancer. However, for 14 of the 33 cancers studied, the risk is only slightly increased - between 1.1-fold (prostate cancer) to 1.2-fold (soft tissue cancers). For 17 other cancers that occurred in the family, the breast cancer risk does not change significantly.

A family history of ovarian cancer is an exception: Women whose mother, sister, or daughter was affected by this cancer also have only a 1.2-fold higher risk of developing breast cancer than the general population. The risk of breast cancer before the age of 50 is however 1.4 times higher. Moreover, if ovarian cancer was also diagnosed in relatives before the age of 50, the risk of early-onset breast cancer increases to even 1.7-fold.

In Germany, women between the ages of 50 and 69 can have a free mammogram every two years. "We advise that if you have a family history of ovarian cancer, you should start breast cancer screening four years earlier than is usual in this country - that is, as early as age 46 instead of 50," Fallah says. This recommendation is based on the so-called 10-year cumulative risk: among 50-year-old women, the average risk of developing breast cancer in the next ten years is 2.2 percent. According to the study, women with the described family history of ovarian cancer reach this risk value four years earlier. For the other cancers, the slightly increased risk did not justify an earlier start of screening exams, the authors said.

For their study, the researchers led by Fallah and Kharazmi analyzed data sets from more than five million Swedish women born after 1931, making the investigation the largest of its kind to date. The data sets consist of pedigree data linking the women studied to their parents, children and their descendants, as well as Swedish Cancer Registry data since 1958. The information is updated every two to three years. In total, the Swedish registries include pedigree data on more than 12.8 million people, about 1.7 million records of advanced cancers and about half a million cases of early-stage carcinomas. At this scale, the data set is unique in the world.

Original publication:
T. Mukama, E. Kharazmi, K. Sundquist, J. Sundquist, and M. Fallah (2021) Risk-adapted starting age of breast cancer screening in women with a family history of ovarian or other cancers: a nationwide cohort study. Cancer, https://doi.org/10.1002/cncr.33456.
* https://doi.org/10.1001/jamaoncol.2019.3876

Press contact:

Dr. Friederike Fellenberg
National Center for Tumor Diseases Heidelberg (NCT) Press and Public Relations Im Neuenheimer Feld 460
69120 Heidelberg
Tel.: +49 6221 42-1755
E-mail: friederike.fellenberg@nct-heidelberg.de

Dr. Sibylle Kohlstädt
German Cancer Research Center (DKFZ)
Strategic Communication and Public Relations Im Neuenheimer Feld 280
69120 Heidelberg
Tel.: +49 6221 42-2843
E-mail: s.kohlstaedt@dkfz.de

Doris Rübsam-Brodkorb
Heidelberg University Hospital and Medical Faculty of the University of Heidelberg Press and Public Relations Im Neuenheimer Feld 672
69120 Heidelberg
Tel.: +49 6221 56-5052
E-mail: doris.ruebsam-brodkorb@med.uni-heidelberg.de

National Center for Tumor Diseases Heidelberg (NCT)
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center, Heidelberg University Hospital (UKHD) and German Cancer Aid. The NCT's goal is to link promising approaches from cancer research with patient care from diagnosis to treatment, aftercare and prevention. This is true for diagnosis and treatment, follow-up care or prevention. The interdisciplinary tumor outpatient clinic is the central element of the NCT. Here, the patients benefit from an individual treatment plan prepared in interdisciplinary expert rounds, so-called tumor boards. Participation in clinical studies provides access to innovative therapies. The NCT thereby acts as a pioneering platform that translates novel research results from the laboratory into clinical practice. The NCT cooperates with self-help groups and supports them in their work. Since 2015, the NCT Heidelberg has maintained a partner site in Dresden. The Hopp Children's Cancer Center (KiTZ) was established in Heidelberg in 2017. The pediatric oncologists at KiTZ work together in parallel structures with the NCT Heidelberg.

German Cancer Research Center (DKFZ)
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.
Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Tumour Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent university medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

Heidelberg University Hospital (UKHD)
Heidelberg University Hospital (UKHD) is one of the most important medical centers in Germany; Heidelberg University's Medical Faculty is one of Europe's most prestigious biomedical research facilities. Their shared objective is the development of innovative diagnostics and treatments and their prompt implementation for the benefit of the patient. The hospital and faculty employ approximately 13,000 individuals and are involved in training and qualification. Every year approximately 65,000 patients are treated as inpatients and 56,000 as day patients in more than 50 specialized clinical departments with around 2,000 beds, with more than 1 million patients being treated as outpatients. Together with the German Cancer Research Center and German Cancer Aid, the Heidelberg University Hospital established The National Center for Tumor Diseases (NCT) Heidelberg as the leading oncology center of excellence in Germany. The Heidelberg Curriculum Medicinale (HeiCuMed) is at the forefront of medical training in Germany. At present 3,700 aspiring physicians and doctors are studying in Heidelberg.