Abstract
Purpose: The aim of the presented study was to determine the hormonal and familial risk factors that might play a role in development of breast cancer in Turkish population and to evaluate the reliability of Gail Model in our society.
Materials and Methods: Patients over 35 years old and in whom all breast cancer risk factors are known were selected as the study group, among them; patients who had breast biopsy at least 5 years ago with a diagnosis of non-proliferative lesion was called as Group 1; control patients as Group 2; patients in Group 1 and 2 who were free of breast cancer at the end of the 5 years follow up were called as Group 3; and the patients who had been operated for breast cancer were named as Group 4. Individual risk of breast cancer was calculated for 5 years by Gail Model for the patients in Group 1 and 2, and the patients in whom breast cancer developed during this time period were determined within these groups. Besides, for the determination of the risk factors in development of breast cancer in Turkish Society, all known risk factors of the patients in Group 3 and 4 were evaluated with the multiple regression test.
Results: In Group 1 (n=343), breast cancer developed in the 2.6% of low-risk patients according to Gail Model, while the rate was 12% in high-risk patients (RR=5). In Group 2 (n=601), breast cancer developed in 4.7% of the low-risk patients, and the corresponding rate was 11.7% in high-risk group (RR=2.6). After evaluation of all the risk factors of Group 3 (n=896) and Group 4 (n=630), risk factors which were found to be significant were the first degree family history for breast cancer; second degree family history for breast cancer, nulliparity, nonbreast-feeding and age (p<0.05).
Conclusions: It is found that Gail Model is a reliable model in calculation of individual risk for development of a breast cancer for Turkish Society. It has come to a decision that the main risk factors that determine the risk of a breast cancer development in Turkish Society are familial or genetic factors rather than the hormonal ones, and with the increasing age risk of breast cancer development increases evidently.
Keywords:
Breast cancer, Gail Model, risk factors
References
1Ries L, Eisner M, Kosary C, et al. SEER cancer statistics review, 1973-1999. Bethesda (MD): National Cancer Institute; 2002.
2Phillips KA, Glendon G, Knight JA. Putting the risk of breast cancer in perspective. N Engl J Med, 1999; 340: 141-144.
3Tchou J, Morrow M. Overview of clinical risk assessment. In: Managing breast cancer. (Eds) Morrow M, Jordan C. BC Decker Inc, Hamilton, London, 2003.
4Morrow M. Identification of the woman at risk for breast cancer: problem solved? Recent Results Cancer Res, 1999; 151: 85-95.
5Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst, 1989; 81: 1879-1886.
6Costantino JP, Gail MH, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst, 1999; 91: 1541-1548.
7Bondy ML, Lustbader ED, Halabi S, et al. Validation of a breast cancer risk assessment model in woman with a positive family history. J Natl Cancer Inst, 1994; 86: 620-625.
8Spiegelman D, Colditz GA, Hunter D, et al. Validation of the Gail et al. model for predicting individual breast cancer risk. J Natl Cancer Inst, 1994; 86: 600-607.
9Rockhill B, Spiegelman D, Byrne C, et al. Validation of the Gail et al model of breast cancer risk prediction and implications for chemoprevention. J Natl Cancer Inst, 2001; 93: 358-366.
10Gail MH, Constantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen for preventing breast cancer. J Natl Cancer Inst, 1999; 91: 1829–1846.
11Breast cancer risk assessment tool for health care providers. Bethesda (MD): National Cancer Institute; 1998.
12Henderson IC. What can a woman do about her risk of dying from breast cancer? Current Problems in Cancer, 1990; 14: 161-230.
13Anderson DE, Badzioch MD. Risk of familial breast cancer. Cancer, 1985; 56: 383-387.
14Bilimoria MM, Morrow M. The woman at increased risk for breast cancer; evaluation and management strategies. CA: a Cancer Journal for Clinicians, 1995; 45: 263-278.
15Pharaoh PD, Day NE, Duffy SE, et al. Family history and the risk of breast cancer: a systemic review and meta-analysis. Int J Cancer, 1997; 71: 800-809.
16Colloborative Group on Hormonal Factors in Breast Cancer. Familial breast cancer; a colloborative reanalysis of individual data from 52 epidemiological studies including 58209 women with breast cancer and 101896 women without the disease. Lancet, 2001; 358: 1389-1399.
17Sakorafas GH, Tsiotou AG. Genetic predisposition to breast cancer; a surgical perspective. Br J Surg, 2000; 87: 149-162.
18Bowcock AM. Breast cancer genes. Breast Journal 1997; 3(Suppl): 1-6.
19Statement of the American Society of Clinical Oncology. Genetic testing for cancer susceptibility. J Clin On, 1996; 14: 1730-1736.
20Henderson BE, Ross R, Bernstein L. Estrogens as a cause of human cancer: the Richard and Hinda Rosenthal Foundation Award lecture. Cancer Res,1988; 48: 246-253.
21MacMahon B, Trichopoulos D, Brown J, et al. Age at menarche, probability of ovulation and breast cancer risk. Int J Cancer, 1982; 29: 13-16.
22Trichopoulos D, MacMahon B, Cole P. Menopause and breast cancer risk. J Natl Cancer Inst, 1972; 48: 605-613.
23MacMahon B, Cole P, Lin TM, et al. Age at first birth and breast cancer risk. Bull World Health Organ, 1970; 43: 209-221.
