Familial breast cancer. Part IV: survival of familial breast cancer in Bulgarian patients.

Purpose: The aim of part IV of this study was to register and compare the survival rates of sporadic and familial breast cancer, and to estimate the prognostic value of familial predisposition of the disease as a risk factor.

Patients And Methods: We investigated retrospectively 504 patients belonging to families with accumulation of the disease (study group, group I) and 300 patients with the sporadic form of breast cancer (control group, group II). All patients were diagnosed, treated, and followed-up at the Clinic of Thoracic Surgery, National Oncological Centre. For determination of the familial predisposition we used the Anderson's classification. The statistical significance of the difference between two groups and subgroups was evaluated by the x(2) Pearson's test and Student's paired t-test.

Results: Women with familial breast cancer were characterized by worse survival rates compared to the sporadic cases. Of the patients in group I 20.79% survived more than 5 years versus 76.74% in group II (p <0.0000). Group I patients with first degree of kinship had the lowest survival rates. Highly significant differences were found in survival, depending on stage: in group I stage IIA patients the survival was 42.86% versus 97.73% for group II; in IIB it was 14.17% versus 89.41%; and in IIIA it was 4.76% versus 75.00%, respectively. Tumor size, lymph nodes status, metastases and steroid receptors also showed a high statistical difference in survival between the 2 groups. Five-year survival in group I patients without metastases was 22.34%, while it was 80.71% in group II. In patients with metastases 4-year survival rates were 2.94% and 22.22%, respectively. Estrogen receptor (ER)-negative patients in groups I and II had 5-year survival of 17.41% and 72.06%, respectively. Progesterone receptor (PR)-negative patients in groups I and II had 5-year survival of 17.50% and 83.67%, respectively. Invasive lobular and invasive ductal carcinoma showed very poor survival in both groups (18.75% and 17.73% in group I versus 53.33% and 77.48% in group II, respectively).

Conclusion: Familial breast cancer displays particular clinical characteristics that differ from the sporadic form of the disease in terms of clinical, histological and biochemical features. Our results show that patients with familial breast cancer have significantly lower survival rates in comparison with women with the sporadic form of the disease. The need for surveillance and diagnosis of the disease at an earlier stage is crucial for women with familial predisposition for breast cancer.