Abstract PS7-80: Family history (FH) of breast cancer (BC) and associated risk-factors and screening: Analysis of an internet-based risk assessment tool
Authors: O'Keefe Ryan , LaRiviere Michael , Vachani Carolyn , Hampshire Margaret , Bach Christina , Arnold-Korzeniowski Karen , Healy Marisa , Metz James , Hill-Kayser Christine 
Published: February 2021

Abstract
BackgroundBreast cancer (BC) is the most common cancer in women worldwide, and a leading cause of death. There are well established risk-factors for BC: Lifestyle factors include smoking, drinking alcohol, obesity, and low physical activity, and biologic factors may include increased exposure to estrogen and specific genetic mutations. The impact of having a family history (FH) of BC on associated risk factors is poorly understood. Results from previous literature suggest that those with FH of BC are more likely to adopt screening behaviors, but do not differ in risk-related behaviors. Because women with a FH of BC have an increased risk of developing BC themselves, we sought to better understand the co-present modifiable risk and screening behaviors associated with both BC and other common cancers. MethodsAn Internet based tool designed to provide personalized information on cancer risk was designed by healthcare providers and made publicly available in 2009 (OncoLink.org). Data from female responders in a convenience sample frame were analyzed as part of this study. All procedures were approved by IRB. Differences between respondents with v. without FH of BC were analyzed using chi-square test. Results15,712 female responses were analyzed; 10,800 (68.7%) had a FH of any cancer, 4578 (29.1%) BC. Median age was 26 (IQR 19-38); 84.4% of respondents were between 18-45; 76.7% were white, 88.3% pre-menopausal, 83.5% from North America, and 76% completed some college. Respondents had an average of 1.88 listed cancers in their FH with 15.89% reporting more than 4 cancers in FH. 248 (1.58%) and 202 (1.29%) reported a FH of BRCA1 and BRCA2, respectively. 3939 reported a FH of just one cancer, with 815 reporting just a FH of BC. Among those with FH of just BC, 20.74% were the respondent’s mother, 2.1% sister, and 50.3% grandmother. Those with a FH of BC were more likely to be current smokers and to have a history of secondhand smoke exposure (Table). There was no difference in rates of heavy smoking (1+ packs per day) (Table). Those with a FH of BC were more likely to be current drinkers, but not more likely to be heavy drinkers (7+ per week) (Table). Median BMI in those with FH of BC was higher than in those without; those with FH of BC were also more likely to be overweight or obese, and to exercise less than once per week (Table). Those with FH of BC were more likely to have had menarche before age 12 or to have taken OCPs, but showed no difference in menopause after 50, or rate of taking HRT for 2+ years (Table). They were also more likely to have performed a self-breast exam or to have received one in clinic (Table). Those with a FH of BC were not more likely to engage in common preventive and screening behaviors for cervical cancer, including being vaccinated against HPV or receiving regular pap screening (Table).ConclusionsOur results suggest many with FH of BC have both modifiable and non-modifiable risk factors that increase risk for development of cancer. We found that a FH of BC was associated with increased rates of smoking, drinking, obesity, and sedentary lifestyle when compared to those without FH. Importantly, our results lend further support to previous findings that these individuals are more engaged with BC-related screening behaviors. However, we found that FH of BC did not impact rates of screening for cervical cancer. Future work should explore targeted interventions to reduce risk-increasing behaviors among those with FH of BC.
Total Pos FH BC Neg FH BCN%N%N%RRARChi-Square p-valueBehavioral Risk FactorsAny Smoking-Related Risk965161.4%291163.6%674060.5%1.053.1%&lt; 0.001Current Smoker171510.9%53911.8%117610.6%1.111.2%0.031+ Packs Per Day (among smokers)36320.8%12422.9%23919.9%1.153.0%0.15Ever Smoke527333.6%157634.4%369733.2%1.041.2%0.14Ever Quit361623.0%105323.0%256323.0%1.000.0%0.98Secondhand Smoke Exposure516532.9%164135.8%352431.7%1.134.2%&lt; 0.001Currently Drinks Alcohol787950.1%240852.6%547149.1%1.073.5%&lt; 0.0017+ Drinks Per Week124315.6%38816.0%85515.5%1.030.5%0.78Overweight (BMI 25-30)335526.8%100928.3%234626.1%1.082.1%0.02Obese (BMI 30+)317025.7%101028.3%216024.6%1.153.7%&lt; 0.001Diet Risk1121871.4%335773.3%786170.6%1.042.7%&lt; 0.001Exercise &lt;1x per week608438.7%189141.3%419337.7%1.103.6%&lt; 0.001Exercise 5+ Times Per Week214013.6%56812.4%157214.1%0.88-1.7%0.004UV Exposure Risk570436.3%178138.9%392335.2%1.103.7%&lt; 0.001Tanning Salon455029.0%142331.1%312728.1%1.113.0%&lt; 0.001Estrogen Risk FactorsAge Menarche Before age 12489932.4%154034.8%335931.4%1.113.4%&lt; 0.001Age Menopause After 50 (if menopausal)82844.9%24142.4%58746.0%0.92-3.6%0.15Age First Gave Birth &gt; 30 (if gave birth)131020.3%39920.7%91120.1%1.030.7%0.55Taken 2+ Years of HRT (postmenopausal)37420.3%12622.2%24819.5%1.142.7%0.18Ever Taken OCPs1060267.5%320269.9%740066.5%1.053.5%&lt; 0.001Preventive and Screening BehaviorsPrevious Tamoxifen Use1220.8%581.3%640.6%2.200.7%&lt; 0.001Ever Performed Self Breast Exam1056167.2%314268.6%741966.6%1.032.0%0.02Ever Had Clinical Breast Exam928659.1%284562.1%644157.8%1.074.3%&lt; 0.001Received HPV Vaccine (those &lt;35 yo)428838.4%120738.5%308138.3%1.010.2%0.84Regular Pap Screening (25-65 yo)704682.1%218282.7%486481.9%1.010.9%0.33
Citation Format: Ryan O'Keefe, Michael LaRiviere, Carolyn Vachani, Margaret Hampshire, Christina Bach, Karen Arnold-Korzeniowski, Marisa Healy, James Metz, Christine Hill-Kayser. Family history (FH) of breast cancer (BC) and associated risk-factors and screening: Analysis of an internet-based risk assessment tool [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-80.