title: Predictors of breast cancer development in a high-risk population.
abstract: BACKGROUND
  The purpose of this study was to investigate the strongest predictors of breast cancer in a high-risk population and to increase our understanding of the possible interactions between risk factors.
  
  
  METHODS
  The Women At Risk High-Risk Registry provided the study population. The variables of interest included age at enrollment, presence of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, family history of breast cancer, body mass index, and Gail scores (5-year high-risk > or =1.7%). Univariate and multivariate analyses were conducted with the Cox proportional hazards regression model and years of follow-up evaluation as the time scale.
  
  
  RESULTS
  Out of 1553 high-risk women, 79 (5%) developed breast cancer during a median follow-up period of 5 years. Results from the multivariate Cox model demonstrated that FHBC (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.05-2.97), ADH (HR = 1.90; 95% CI, 1.16-3.13), LCIS (HR = 1.71; 95% CI, .99-2.95), and a body mass index > or =30 (HR = 2.22; 95% CI, 1.14-4.35) were statistically significant predictors of breast cancer within this high-risk population.
  
  
  CONCLUSIONS
  These results support current literature showing the synergistic increase in risk for patients with ADH, LCIS, and a positive family history of breast cancer. Obesity was also a strong predictor of breast cancer risk, which suggests that there may be a potentiating effect of obesity on other risk factors. Obesity may represent a modifiable risk factor, providing women with an opportunity to reduce their risk with lifestyle modification. Women with a strong family history of breast cancer or a diagnosis of ADH or LCIS may benefit most from risk-reduction strategies, chemoprevention, and surveillance.
authors.affiliation: Department of Surgery, Columbia University Comprehensive Breast Center, Women At Risk, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA. jec41@columbia.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chun
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Tamer
authors.forename: Kathie-Ann
authors.initials: KA
authors.lastname: Joseph
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Ditkoff
authors.forename: Freya
authors.initials: F
authors.lastname: Schnabel
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000208:ethnology / Q000209:etiology* / Q000473:pathology; D002278:Carcinoma in Situ / Q000235:genetics / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000150:complications; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors