title: Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening.
abstract: BACKGROUND
  Women with a personal history of breast cancer (PHBC) have increased risk of an interval cancer. We aimed to identify risk factors for second (ipsilateral or contralateral) screen-detected or interval breast cancer within 1 year of screening in PHBC women.
  
  
  METHODS
  Screening mammograms from women with history of early-stage breast cancer at Breast Cancer Surveillance Consortium-affiliated facilities (1996-2008) were examined. Associations between woman-level, screen-level, and first cancer variables and the probability of a second breast cancer were modeled using multinomial logistic regression for three outcomes [screen-detected invasive breast cancer, interval invasive breast cancer, or ductal carcinoma in situ (DCIS)] relative to no second breast cancer.
  
  
  RESULTS
  There were 697 second breast cancers, of these 240 were interval cancers, among 67,819 screens in 20,941 women. In separate models for women with DCIS or invasive first cancer, first breast cancer surgery predicted all three second breast cancer outcomes (P < 0.001), and high ORs for second breast cancers (between 1.95 and 4.82) were estimated for breast conservation without radiation (relative to mastectomy). In women with invasive first breast cancer, additional variables predicted risk (P < 0.05) for at least one of the three outcomes: first-degree family history, dense breasts, longer time between mammograms, young age at first breast cancer, first breast cancer stage, and adjuvant systemic therapy for first breast cancer; and risk of interval invasive breast cancer was highest in women <40 years at first breast cancer (OR, 3.41; 1.34-8.70), those with extremely dense breasts (OR, 2.55; 1.4-4.67), and those treated with breast conservation without radiation (OR, 2.67; 1.53-4.65).
  
  
  CONCLUSIONS
  Although the risk of a second breast cancer is modest, our models identify risk factors for interval second breast cancer in PHBC women.
  
  
  CONCLUSIONS
  Our findings may guide discussion and evaluations of tailored breast screening in PHBC women, and incorporating this information into clinical decision-making warrants further research.
authors.affiliation: Screening and Test Evaluation Program, School of Public Health (A27), Sydney Medical School, University of Sydney, NSW 2006, Australia. nehmath@med.usyd.edu.au
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.forename: Linn A
authors.initials: LA
authors.lastname: Abraham
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.forename: Janie
authors.initials: J
authors.lastname: Lee
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology