Heidi D. Nelson, MD, MPH; Bernadette Zakher, MBBS; Amy Cantor, MD, MPH
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2350.
Nelson H., Zakher B., Cantor A.; Risk Factors for Breast Cancer for Women Aged 40 to 49 Years. Ann Intern Med. 2012;157:529. doi: 10.7326/0003-4819-157-7-201210020-00017
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Published: Ann Intern Med. 2012;157(7):529.
We agree with the comments from Dr. Autier, that identifying factors associated with increased risk for death from breast cancer, not just incidence, to guide screening for women in their 40s would be useful. However, it is also correct that few studies have reported this association.
Our systematic review focused on the many published studies of risk factors for breast cancer incidence specifically for women in their 40s who would be candidates for mammography screening under current U.S. guidelines (1). Our results indicated that extremely dense breasts on mammography and first-degree relatives with breast cancer were each associated with at least a 2-fold increase in risk; prior benign breast biopsy, second-degree relatives with breast cancer, and heterogeneously dense breasts with a 1.5- to 2.0-fold increase; and current oral contraceptive use, nulliparity, and age at first birth of 30 years or older with a 1.0- to 1.5-fold increase. Several other risk factors were not statistically significantly associated with breast cancer incidence. Increased body mass index was associated with reduced breast cancer risk, an inverse relationship that reverses for women older than age 50 years. We did not emphasize risk factors related to reduced risk because this project was intended to identify risk above general population levels in collaboration with development of population screening models that did not consider reduced-risk scenarios (2).
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