Family history, ethnicity, and relative risk of breast cancer in a prospective cohort study of older women.
In a cohort of 27,578 postmenopausal Iowa women, we examined whether the risk with a family history of breast cancer differs by self-reported ethnicity. A total of 1042 breast cancer cases occurred over 10 years of follow-up. Using a phylogenetic tree, ethnicities were combined into five groups: Scandinavian; English, Scottish, Welsh, and Dutch (ESWD); Irish; German; and Other European. The incidence of breast cancer did not differ significantly by ethnicity, although the highest rates were observed among Scandinavian women (488 per 100,000 per year) and the lowest among Irish women (353 per 100,000 per year). The prevalence of a family history of breast cancer was not significantly associated with ethnicity when only first-degree relatives were considered (P = 0.17), but inclusion of data on second-degree relatives increased the statistical significance of the association (P = 0.003). Differences in mean levels of breast cancer risk factors between ethnicities were generally small but statistically significant. Proportional hazards regression was performed to evaluate potential interactions of family history with ethnicity on breast cancer incidence. A family history of breast cancer was associated with increased relative risks among ESWD, Germans, and Other Europeans but not among Irish and Scandinavians. Relative risk estimates were not attenuated upon addition of known breast cancer risk factors to the model, implying that the distribution of these risk factors by ethnicity is unlikely to explain some of the observed ethnic-specific differences between family history and risk of breast cancer. Results of this study could have implications for studies of common genetic polymorphisms and cancer risk.