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Le Provost B, Parent MÉ, Villeneuve PJ, Waddingham CM, Brook JR, Lavigne E, Dugandzic R, Harris SA. Residential exposure to ambient fine particulate matter (PM 2.5) and nitrogen dioxide (NO 2) and incident breast cancer among young women in Ontario, Canada. Cancer Epidemiol 2024; 92:102606. [PMID: 38986354 DOI: 10.1016/j.canep.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/10/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Air pollution has been classified as a human carcinogen based largely on findings for respiratory cancers. Emerging, but limited, evidence suggests that it increases the risk of breast cancer, particularly among younger women. We characterized associations between residential exposure to ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) and breast cancer. Analyses were performed using data collected in the Ontario Environmental Health Study (OEHS). METHODS The OEHS, a population-based case-control study, identified incident cases of breast cancer in Ontario, Canada among women aged 18-45 between 2013 and 2015. A total of 465 pathologically confirmed primary breast cancer cases were identified from the Ontario Cancer Registry, while 242 population-based controls were recruited using random-digit dialing. Self-reported questionnaires were used to collect risk factor data and residential histories. Land-use regression and remote-sensing estimates of NO2 and PM2.5, respectively, were assigned to the residential addresses at interview, five years earlier, and at menarche. Logistic regression was used to estimate odds ratios (OR) and their 95 % confidence intervals (CI) in relation to an interquartile range (IQR) increase in air pollution, adjusting for possible confounders. RESULTS PM2.5 and NO2 were positively correlated with each other (r = 0.57). An IQR increase of PM2.5 (1.9 µg/m3) and NO2 (6.6 ppb) at interview residence were associated with higher odds of breast cancer and the adjusted ORs and 95 % CIs were 1.37 (95 % CI = 0.98-1.91) and 2.33 (95 % CI = 1.53-3.53), respectively. An increased odds of breast cancer was observed with an IQR increase in NO2 at residence five years earlier (OR = 2.16, 95 % CI: 1.41-3.31), while no association was observed with PM2.5 (OR = 0.96, 95 % CI 0.64-1.42). CONCLUSIONS Our findings support the hypothesis that exposure to ambient air pollution, especially those from traffic sources (i.e., NO2), increases the risk of breast cancer in young women.
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Affiliation(s)
- Blandine Le Provost
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada; Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED), École de Santé Publique, Université de Bordeaux, Bordeaux, France
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Université du Québec, Laval, Québec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du CHUM, Montréal, Québec, Canada
| | - Paul J Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada.
| | | | - Jeffrey R Brook
- Divisions of Epidemiology and Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Civil and Mineral Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Rose Dugandzic
- Office of Environmental Health, Health Canada, Ottawa, Ontario, Canada
| | - Shelley A Harris
- Divisions of Epidemiology and Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Li X, Li J, Hu Q, Zhang X, Chen F. Association of physical weight statuses defined by body mass index (BMI) with molecular subtypes of premenopausal breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2024; 203:429-447. [PMID: 37882920 DOI: 10.1007/s10549-023-07139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND PURPOSE The association between overweight/obesity and postmenopausal breast cancer has been proven. However, uncertainty exists regarding the association between physical weight statuses and premenopausal breast cancer subtypes. This study aimed to explore the association of body weight statuses with molecular subtypes of premenopausal breast cancer. METHOD A systematic search of Medline, PubMed, Embase, and Web of Science was performed. The Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) Critical Appraisal tools were used to evaluate the quality of the literature. STATA and R software were used to analyze the extracted data. RESULT The meta-analysis included 35 observational studies with a total of 41,049 premenopausal breast cancer patients. The study showed that the proportion of underweight patients was 4.8% (95% CI = 3.9-5.8%, P = 0.01), overweight was 29% (95%CI = 27.1-30.9%, P < 0.01), obesity was 17.8% (95% CI = 14.9-21.2%, P < 0.0001), and normal weight was 51.6% (95% CI = 46.7-56.5%, P < 0.0001). The pooled results showed that in comparison to the normal weight group, being physically underweight is related to a 1.44-fold risk (OR = 1.44, 95%CI = 1.28-1.63, P < 0.0001) of HER2 + breast cancer. Overweight is related to a 1.16-fold risk (OR = 1.16, 95%CI = 1.06-1.26, P = 0.002) of TNBC and a 16% lower risk (OR = 0.84, 95%CI = 0.75-0.93, P = 0.001) of ER + breast cancer. When compared to underweight/normal weight populations, both overweight (OR = 0.74, 95%CI = 0.56-0.97, P = 0.032) and obesity (OR = 0.70, 95%CI = 0.50-0.98, P = 0.037) can reduce the risk of ER + PR + breast cancer. CONCLUSION In the premenopausal breast cancer population, the distribution of patients' numbers with different weight statuses was significantly distinct among the various breast cancer subtypes. Additionally, the associations between physical weight statuses and the risk of premenopausal breast cancer subtypes are divergent.
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Affiliation(s)
- Xuchu Li
- Department of Medical, Queen Mary School, Nanchang University, 461 Bayi Avenue, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Jinping Li
- Department of General Medical, People's Hospital of Fu City, Yan'an, 727505, Shaanxi Province, China
| | - Qirui Hu
- College of Food Science, Nanchang University, Nanchang, 330047, Jiangxi Province, China
| | - Xu Zhang
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Fang Chen
- College of Food Science, Nanchang University, Nanchang, 330047, Jiangxi Province, China.
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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Shayan NA, Rahimi A, Özcebe H. Cancer prevalence, incidence, and mortality rates in Afghanistan in 2020: A review study. Cancer Rep (Hoboken) 2023; 6:e1873. [PMID: 37574721 PMCID: PMC10480416 DOI: 10.1002/cnr2.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Afghanistan is in an epidemiological transition, as cancer is the second leading cause of mortality due to non-communicable diseases. This study is the first to provide a comprehensive perspective on the overall cancer situation in Afghanistan by discussing the top five most common cancers, their incidence variations, risk factors, and preventive measures. The limited number of cancer studies conducted in Afghanistan highlights the importance of the present review. RECENT FINDINGS This article provides an overview of cancer burden in Afghanistan in 2020. It utilizes IARC-generated GLOBOCAN 2020 data for one, three, and five-year prevalence rates, the estimated number of new cancer cases, and mortality rates by age group in Afghanistan. According to GLOBOCAN, the top five common cancers in both sexes in Afghanistan were breast (n = 3173, 14.3%), stomach (n = 2913, 7.8%), lung (n = 1470, 6.6%), cervix uteri (n = 1200, 5.4%), and colorectum (n = 1084, 4.9%). CONCLUSION This study provides a brief overview of the general cancer situation in Afghanistan, and a more in-depth analysis of the five common cancers identified. Effective therapies, awareness, and prevention initiatives targeting lifestyle, immunization, early diagnosis, and environmental risk factors are essential for addressing the impact of population growth and aging on cancer incidence in Afghanistan. Further research and extensive studies are needed to better understand cancer burden in the country.
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Affiliation(s)
- Nasar Ahmad Shayan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Ali Rahimi
- Scientific Research CenterJami UniversityHeratAfghanistan
| | - Hilal Özcebe
- Department of Public Health, Faculty of MedicineHacettepe UniversityAnkaraTurkey
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Ihenacho U, McKinley MA, Vu A, Hernandez BY, Loo LWM, Gomez SL, Wu AH, Cheng I. Characterizing breast cancer incidence and trends among Asian American, Native Hawaiian, and non-Hispanic White women in Hawai'i, 1990-2014. Cancer Causes Control 2023; 34:241-249. [PMID: 36504334 PMCID: PMC10441590 DOI: 10.1007/s10552-022-01659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To characterize breast cancer (BC) incidence by age at diagnosis and BC subtype among disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) women and non-Hispanic White (NHW) women in Hawai'i. METHODS Using 1990-2014 data from the Hawai'i tumor registry, we estimated age-adjusted incidence rates (AAIR) of BC and the annual percent change in BC incidence by age (<50 and ≥50 years) and BC subtype (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, HR+/HER2+, HR-/HER2+, triple negative BC) for Filipino American (FA), Japanese American (JA), Native Hawaiian (NH), and NHW women. RESULTS Among young (<50 years) women, annual BC incidence increased 2.9% (1994-2014) among JA and 1.0% (1990-2014) among NHW women. Incidence was highest among young JA women (2010-2014 AAIR 52.0 per 100,000; 95% confidence interval [CI] 45.6, 58.9). HR+/HER2- BC, the major BC subtype, was similarly highest among young JA women (AAIR 39.5; 95% CI 33.9, 45.4). Among older (≥50 years) women, annual BC incidence increased 1.6% (1990-2014) among FA and 4.2% (2006-2014) for JA women. BC incidence was highest among older NH women (AAIR 137.6, 95% CI 128.2, 147.4), who also displayed highest incidence of two subtypes: HR+/HER2- (AAIR 106.9; 95% CI 98.6, 115.5) and HR+/HER2+ (AAIR 12.1; 95% CI 9.4, 15.1). CONCLUSION We observed high and increasing BC incidence among JA women ages <50 years and high incidence among NH women ages ≥50 years. These results highlight racial and ethnic differences in BC incidence among disaggregated AANHPI populations in Hawai'i by age and BC subtype.
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Affiliation(s)
- Ugonna Ihenacho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Meg A McKinley
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, CA, USA
| | - Annie Vu
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, CA, USA
| | - Brenda Y Hernandez
- Population Sciences in the Pacific Program-Cancer Epidemiology, University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Lenora W M Loo
- Cancer Biology Program, University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Lalitkumar PGL, Lundström E, Byström B, Ujvari D, Murkes D, Tani E, Söderqvist G. Effects of Estradiol/Micronized Progesterone vs. Conjugated Equine Estrogens/Medroxyprogesterone Acetate on Breast Cancer Gene Expression in Healthy Postmenopausal Women. Int J Mol Sci 2023; 24:ijms24044123. [PMID: 36835533 PMCID: PMC9959219 DOI: 10.3390/ijms24044123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Recent studies suggest estradiol (E2)/natural progesterone (P) confers less breast cancer risk compared with conjugated equine estrogens (CEE)/synthetic progestogens. We investigate if differences in the regulation of breast cancer-related gene expression could provide some explanation. This study is a subset of a monocentric, 2-way, open observer-blinded, phase 4 randomized controlled trial on healthy postmenopausal women with climacteric symptoms (ClinicalTrials.gov; EUCTR-2005/001016-51). Study medication was two 28-day cycles of sequential hormone treatment with oral 0.625 mg CEE and 5 mg of oral medroxyprogesterone acetate (MPA) or 1.5 mg E2 as percutaneous gel/day with the addition of 200 mg oral micronized P. MPA and P were added days 15-28/cycle. Material from two core-needle breast biopsies in 15 women in each group was subject to quantitative PCR (Q-PCR). The primary endpoint was a change in breast carcinoma development gene expression. In the first eight consecutive women, RNA was extracted at baseline and after two months of treatment and subjected to microarray for 28856 genes and Ingenuity Pathways Analysis (IPA) to identify risk factor genes. Microarray analysis showed 3272 genes regulated with a fold-change of >±1.4. IPA showed 225 genes belonging to mammary-tumor development function: 198 for CEE/MPA vs. 34 for E2/P. Sixteen genes involved in mammary tumor inclination were subject to Q-PCR, inclining the CEE/MPA group towards an increased risk for breast carcinoma compared to the E2/P group at a very high significance level (p = 3.1 × 10-8, z-score 1.94). The combination of E2/P affected breast cancer-related genes much less than CEE/MPA.
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Affiliation(s)
| | - Eva Lundström
- Division for Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Birgitta Byström
- Division for Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Dorina Ujvari
- Division for Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Daniel Murkes
- Division for Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Edneia Tani
- Department of Pathology, Cytology Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Gunnar Söderqvist
- Division for Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, SE 17176 Stockholm, Sweden
- Correspondence:
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Pedersen DC, Jensen BW, Tjønneland A, Andersen ZJ, Mellemkjaer L, Bjerregaard LG, Aarestrup J, Baker JL. Birthweight, childhood body size, and timing of puberty and risks of breast cancer by menopausal status and tumor receptor subtypes. Breast Cancer Res 2022; 24:77. [DOI: 10.1186/s13058-022-01578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Associations of birthweight, childhood body size and pubertal timing with breast cancer risks by menopausal status and tumor receptor subtypes are inconclusive. Thus, we investigated these associations in a population-based cohort of Danish women.
Methods
We studied 162,419 women born between 1930 and 1996 from the Copenhagen School Health Records Register. The register includes information on birthweight, measured childhood weights and heights at the age of 7–13 years, and computed ages at the onset of the growth spurt (OGS) and at peak height velocity (PHV). The Danish Breast Cancer Cooperative Group database provided information on breast cancer (n = 7510), including estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2) and menopausal status. Hormone replacement therapy use came from the Danish National Prescription Registry. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regression.
Results
We found that birthweight was not associated with any breast cancer subtypes. While childhood BMI was not statistically significantly associated with ER+ tumors nor consistently with ER− tumors among pre-menopausal women, consistent inverse associations were found among postmenopausal women. At the age of 7 years, the HRs for postmenopausal ER+ and ER− tumors were 0.90 (95% CI 0.87–0.93) and 0.84 (95% CI 0.79–0.91) per BMI z-score, respectively. Similarly, childhood BMI was inversely associated with pre- and postmenopausal HER2− tumors, but not with HER2+ tumors. Childhood height was positively associated with both pre- and postmenopausal ER+ tumors, but not with ER− tumors. At the age of 7 years, the HRs for postmenopausal ER+ and ER− tumors were 1.09 (95% CI 1.06–1.12) and 1.02 (95% CI 0.96–1.09) per height z-score, respectively. In general, childhood height was positively associated with HER2+ and HER2− tumors among pre- and postmenopausal women. Ages at OGS and PHV were not associated with any breast cancer subtypes.
Conclusions
We showed that a high BMI and short stature in childhood are associated with reduced risks of certain breast cancer subtypes. Thus, childhood body composition may play a role in the development of breast cancer.
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Barnard ME, Martheswaran T, Van Meter M, Buys SS, Curtin K, Doherty JA. Body Mass Index and Mammographic Density in a Multiracial and Multiethnic Population-Based Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1313-1323. [PMID: 35511751 PMCID: PMC9250611 DOI: 10.1158/1055-9965.epi-21-1249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/25/2022] [Accepted: 04/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mammographic density (MD) is strongly associated with breast cancer risk. We examined whether body mass index (BMI) partially explains racial and ethnic variation in MD. METHODS We used multivariable Poisson regression to estimate associations between BMI and binary MD [Breast Imaging Reporting and Database System (BI-RADS) A&B versus BI-RADS C&D] among 160,804 women in the Utah mammography cohort. We estimated associations overall and within racial and ethnic subgroups and calculated population attributable risk percents (PAR%). RESULTS We observed the lowest BMI and highest MD among Asian women, the highest BMI among Native Hawaiian and Pacific Islander women, and the lowest MD among American Indian and Alaska Native (AIAN) and Black women. BMI was inversely associated with MD [RRBMI≥30 vs. BMI<25 = 0.43; 95% confidence interval (CI), 0.42-0.44] in the full cohort, and estimates in all racial and ethnic subgroups were consistent with this strong inverse association. For women less than 45 years of age, although there was statistical evidence of heterogeneity in associations between BMI and MD by race and ethnicity (P = 0.009), magnitudes of association were similar across groups. PAR%s for BMI and MD among women less than 45 years were considerably higher in White women (PAR% = 29.2, 95% CI = 28.4-29.9) compared with all other groups with estimates ranging from PAR%Asain = 17.2%; 95% CI, 8.5 to 25.8 to PAR%Hispanic = 21.5%; 95% CI, 19.4 to 23.6. For women ≥55 years, PAR%s for BMI and MD were highest among AIAN women (PAR% = 37.5; 95% CI, 28.1-46.9). CONCLUSIONS While we observed substantial differences in the distributions of BMI and MD by race and ethnicity, associations between BMI and MD were generally similar across groups. IMPACT Distributions of BMI and MD may be important contributors to breast cancer disparities.
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Affiliation(s)
- Mollie E Barnard
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tarun Martheswaran
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Saundra S Buys
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karen Curtin
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Pedigree and Population Resource, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer Anne Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
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Temporal patterns of chronic disease incidence after breast cancer: a nationwide population-based cohort study. Sci Rep 2022; 12:5489. [PMID: 35361864 PMCID: PMC8971484 DOI: 10.1038/s41598-022-09542-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 03/18/2022] [Indexed: 12/19/2022] Open
Abstract
We conducted a retrospective cohort study to evaluate the temporal pattern of incidence of chronic conditions after developing breast cancer using a population-based national registry. We selected 84,969 women with newly diagnosed breast cancer between 2002 and 2016 and a 1:10 sample of age-matched non-breast cancer controls (N = 1,057,674). The main study exposure was incident breast cancer, considered as a time-varying exposure. The outcomes were incident cases of leukemia, endometrial cancer, myeloma, cardiomyopathy, osteoporosis, end stage renal disease (ESRD), pulmonary fibrosis, hypothyroidism, type 2 diabetes, hypertension and hyperlipidemia. The development of breast cancer was associated with a significantly increased risk of all outcomes analyzed except for ESRD and hypertension. The fully-adjusted risks of leukemia (HR 3.09; 95% CI 2.11–4.51), cardiomyopathy (HR 2.65; 95% CI 1.90–3.68), endometrial cancer (HR 3.53; 95% CI 2.76–4.53), hypothyroidism (HR 1.29; 95% CI 1.19–1.40), pulmonary fibrosis (HR 1.84; 95% CI 1.12–3.02), and hyperlipidemia (HR 1.24; 95% CI 1.20–1.28) remained significantly elevated after more than 5 years since diagnosis. Optimal care for breast cancer survivors requires close collaboration between oncologists and allied health care professionals to identify and manage the long-term morbidity and mortality associated with these chronic conditions.
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Insulin resistance and the development of breast cancer in premenopausal women: the Kangbuk Samsung Health Study. Breast Cancer Res Treat 2022; 192:401-409. [PMID: 34997879 DOI: 10.1007/s10549-022-06513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Research on the role of insulin resistance (IR) in breast cancer risk in premenopausal women is scarce. We aimed to investigate the relationship between IR and the development of breast cancer in premenopausal women. METHODS We analyzed the prospective association of IR and incident breast cancer in premenopausal women without breast cancer at baseline using a subsample of the Kangbuk Samsung Health Study. RESULTS Among 134,488 Korean premenopausal women, 696 women developed incident breast cancers during a median follow-up of 4.34 years. After adjustment for dense breast and other potential confounders, HR (95% CI) for incident breast cancer comparing HOMA-IR quintiles 2, 3, 4, and 5 to the first quintile was 0.91 (0.71-1.17), 0.89 (0.69-1.15), 0.75 (0.57-0.98), and 0.87 (0.65-1.16), respectively (P for trend = 0.117), while HR (95% CI) comparing insulin quintiles 2, 3, 4, and 5 to the first quintile was 1.02 (0.80-1.30), 0.90 (0.69-1.16), 0.72 (0.54-0.96), and 0.96 (0.72-1.28), respectively (P for trend = 0.151). This pattern did not significantly differ by obesity. These results were attenuated and no longer significant in time-dependent analyses where updated status of insulin and other covariates over time were treated as time-varying covariates. CONCLUSION Our findings do not support the positive relationship of IR with the development of breast cancer in premenopausal women, unlike in postmenopausal women. Thus, the role of IR as a risk factor for breast cancer may differ by menopausal status.
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Ntirenganya F, Twagirumukiza J, Bucyibaruta G, Rugwizangoga B, Rulisa S. Breast cancer heterogeneity: Comparing pre- and postmenopausal breast cancer in an African population. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Zeleznik OA, Balasubramanian R, Zhao Y, Frueh L, Jeanfavre S, Avila-Pacheco J, Clish CB, Tworoger SS, Eliassen AH. Circulating amino acids and amino acid-related metabolites and risk of breast cancer among predominantly premenopausal women. NPJ Breast Cancer 2021; 7:54. [PMID: 34006878 PMCID: PMC8131633 DOI: 10.1038/s41523-021-00262-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Known modifiable risk factors account for a small fraction of premenopausal breast cancers. We investigated associations between pre-diagnostic circulating amino acid and amino acid-related metabolites (N = 207) and risk of breast cancer among predominantly premenopausal women of the Nurses' Health Study II using conditional logistic regression (1057 cases, 1057 controls) and multivariable analyses evaluating all metabolites jointly. Eleven metabolites were associated with breast cancer risk (q-value < 0.2). Seven metabolites remained associated after adjustment for established risk factors (p-value < 0.05) and were selected by at least one multivariable modeling approach: higher levels of 2-aminohippuric acid, kynurenic acid, piperine (all three with q-value < 0.2), DMGV and phenylacetylglutamine were associated with lower breast cancer risk (e.g., piperine: ORadjusted (95%CI) = 0.84 (0.77-0.92)) while higher levels of creatine and C40:7 phosphatidylethanolamine (PE) plasmalogen were associated with increased breast cancer risk (e.g., C40:7 PE plasmalogen: ORadjusted (95%CI) = 1.11 (1.01-1.22)). Five amino acids and amino acid-related metabolites (2-aminohippuric acid, DMGV, kynurenic acid, phenylacetylglutamine, and piperine) were inversely associated, while one amino acid and a phospholipid (creatine and C40:7 PE plasmalogen) were positively associated with breast cancer risk among predominately premenopausal women, independent of established breast cancer risk factors.
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Affiliation(s)
- Oana A Zeleznik
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Raji Balasubramanian
- Department of Biostatistics & Epidemiology, University of Massachusetts - Amherst, Amherst, MA, USA
| | - Yibai Zhao
- Department of Biostatistics & Epidemiology, University of Massachusetts - Amherst, Amherst, MA, USA
| | - Lisa Frueh
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Jeanfavre
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Julian Avila-Pacheco
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Clary B Clish
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Saleh K, Carton M, Dieras V, Heudel PE, Brain E, D'Hondt V, Mailliez A, Patsouris A, Mouret-Reynier MA, Goncalves A, Ferrero JM, Petit T, Emile G, Uwer L, Debled M, Dalenc F, Jouannaud C, Ladoire S, Leheurteur M, Cottu P, Veron L, Savignoni A, Courtinard C, Robain M, Delaloge S, Deluche E. Impact of body mass index on overall survival in patients with metastatic breast cancer. Breast 2020; 55:16-24. [PMID: 33307392 PMCID: PMC7725947 DOI: 10.1016/j.breast.2020.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High Body mass index (BMI) is a risk factor for breast cancer among postmenopausal women and an adverse prognostic factor in early-stage. Little is known about its impact on clinical outcomes in patients with metastatic breast cancer (MBC). METHODS The National ESME-MBC observational cohort includes all consecutive patients newly diagnosed with MBC between Jan 2008 and Dec 2016 in the 18 French comprehensive cancer centers. RESULTS Of 22 463 patients in ESME-MBC, 12 999 women had BMI data available at MBC diagnosis. Median BMI was 24.9 kg/m2 (range 12.1-66.5); 20% of women were obese and 5% underweight. Obesity was associated with more de novo MBC, while underweight patients had more aggressive cancer features. Median overall survival (OS) of the BMI cohort was 47.4 months (95% CI [46.2-48.5]) (median follow-up: 48.6 months). Underweight was independently associated with a worse OS (median OS 33 months; HR 1.14, 95%CI, 1.02-1.27) and first line progression-free survival (HR, 1.11; 95%CI, 1.01; 1.22), while overweight or obesity had no effect. CONCLUSION Overweight and obesity are not associated with poorer outcomes in women with metastatic disease, while underweight appears as an independent adverse prognostic factor.
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Affiliation(s)
- Khalil Saleh
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, INSERM U1194, University of Montpellier, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, 67000, Strasbourg, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de L'Argonne, F-33000, Bordeaux, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, 51100, Reims, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue Professeur Marion, 21079, Dijon, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, 76000, Rouen, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Lucie Veron
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexia Savignoni
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France; Department of Medical Oncology, CHU de Limoges, 2 Avenue Martin Luther King, Limoges, France
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13
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Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin 2020; 70:443-459. [PMID: 32940362 DOI: 10.3322/caac.21637] [Citation(s) in RCA: 566] [Impact Index Per Article: 141.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer statistics for adolescents and young adults (AYAs) (aged 15-39 years) are often presented in aggregate, masking important heterogeneity. The authors analyzed population-based cancer incidence and mortality for AYAs in the United States by age group (ages 15-19, 20-29, and 30-39 years), sex, and race/ethnicity. In 2020, there will be approximately 89,500 new cancer cases and 9270 cancer deaths in AYAs. Overall cancer incidence increased in all AYA age groups during the most recent decade (2007-2016), largely driven by thyroid cancer, which rose by approximately 3% annually among those aged 20 to 39 years and 4% among those aged 15 to 19 years. Incidence also increased in most age groups for several cancers linked to obesity, including kidney (3% annually across all age groups), uterine corpus (3% in the group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years). Rates declined dramatically for melanoma in the group aged 15 to 29 years (4%-6% annually) but remained stable among those aged 30 to 39 years. Overall cancer mortality declined during 2008 through 2017 by 1% annually across age and sex groups, except for women aged 30 to 39 years, among whom rates were stable because of a flattening of declines in female breast cancer. Rates increased for cancers of the colorectum and uterine corpus in the group aged 30 to 39 years, mirroring incidence trends. Five-year relative survival in AYAs is similar across age groups for all cancers combined (range, 83%-86%) but varies widely for some cancers, such as acute lymphocytic leukemia (74% in the group aged 15-19 years vs 51% in the group aged 30-39 years) and brain tumors (77% vs 66%), reflecting differences in histologic subtype distribution and treatment. Progress in reducing cancer morbidity and mortality among AYAs could be addressed through more equitable access to health care, increasing clinical trial enrollment, expanding research, and greater alertness among clinicians and patients for early symptoms and signs of cancer. Further progress could be accelerated with increased disaggregation by age in research on surveillance, etiology, basic biology, and survivorship.
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Affiliation(s)
| | | | - Theresa H Keegan
- Hematology and Oncology, University of California at Davis Health, Sacramento, California
| | - Heather S Hipp
- Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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14
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Zhou W, Chen X, Huang H, Liu S, Xie A, Lan L. Birth Weight and Incidence of Breast Cancer: Dose-Response Meta-analysis of Prospective Studies. Clin Breast Cancer 2020; 20:e555-e568. [PMID: 32665189 DOI: 10.1016/j.clbc.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many studies have shown the association between birth weight and breast cancer (BC), but the evidence remains limited and inconsistent, especially in different menopause status. We sought to clarify the relationship and shape of the dose-response relation between birth weight and BC. METHODS The Web of Science, PubMed, and Embase databases were searched for prospective studies involving the relationship between birth weight and risk of BC published to November 2019. Random effects of generalized least squares regression models were used to estimate the quantitative dose-response association, and restricted cubic splines were used to model the association. RESULTS We included reports of 16 prospective studies describing 16,000 incident cases among 553,644 participants. We identified a modest-in-magnitude, but significant, association between birth weight and BC risk: risk increased by 2% (risk ratio, 1.02, 95% confidence interval, 1.01-1.03) and 9% (risk ratio, 1.09, 95% confidence interval, 1.04-1.15) with a per-500 g birth weight increment in all ages and premenopausal women, respectively. Our results showed a linear dose-response relationship between birth weight and BC risk (Pnonlinearity = .311) in premenopausal women, with statistical significance when birth weight was above about 3.5 kg. No significant association was found in postmenopausal women. CONCLUSION Higher birth weight has a relationship with increased risk of BC in premenopausal women, particularly when birth weight is above 3.5 kg.
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Affiliation(s)
- Wen Zhou
- Department of Health Management Center, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Xu Chen
- Department of Health Services Section, The Eighth Affiliated Hospital Sun Yat-sen university, Shenzhen, China
| | - Hui Huang
- Department of Health Management Center, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Shaoxia Liu
- Department of Health Management Center, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Aixian Xie
- Department of Health Management Center, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Liqin Lan
- Department of Health Management Center, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China.
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15
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Nambiema A, Bertrais S, Bodin J, Fouquet N, Aublet-Cuvelier A, Evanoff B, Descatha A, Roquelaure Y. Proportion of upper extremity musculoskeletal disorders attributable to personal and occupational factors: results from the French Pays de la Loire study. BMC Public Health 2020; 20:456. [PMID: 32252693 PMCID: PMC7137334 DOI: 10.1186/s12889-020-08548-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/18/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Upper extremity musculoskeletal disorders (UEMSD) are one of the most common and costly occupational health problems. We aimed to assess the population-attributable fraction (PAF) of personal and occupational risk factors associated with incident UEMSD in a working population. METHODS From 2002 to 2005, a random sample of 3710 workers from the Pays de la Loire region in France, aged 20-59 were included by occupational physicians (OPs). Between 2007 and 2010, 1611 workers were re-examined by their OPs. Subjects free from UEMSD at baseline were included in this study (1275 workers, mean age: 38.2 years). Cox regression models with equal follow-up time and robust variance estimates were used to estimate age-adjusted and multivariable-adjusted relative risks (RRs) and their 95% confidence intervals (CIs). Based on multivariable models, PAF associated with each factor included in the models was estimated. RESULTS During the follow-up period, 143 (11%) cases of UEMSD were diagnosed. PAFs for factors associated with the incident UEMSD risk were 30% (7 to 51) for high physical exertion (RPE Borg scale ≥12), 12% (- 0.2 to 24) for low social support, 7% (- 3 to 17) for working with arms above shoulder level (≥2 h/day), 20% (12 to 28) for age group ≥45, 13% (3 to 22) for the age group 35-44, and 12% (0.3 to 24) for female gender. CONCLUSIONS Our study suggests that an important fraction of UEMSD can be attributed to occupational exposures after the contributions of personal and other work-related factors are considered. In terms of public health, our findings are in agreement with the ergonomic literature postulating that a high proportion of UEMSD are preventable through modifying workplace risk factors. Such information is useful to help public health practitioners and policy makers implement programs of prevention of UEMSD in the working population.
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Affiliation(s)
- Aboubakari Nambiema
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
| | - Sandrine Bertrais
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
| | - Julie Bodin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
| | - Natacha Fouquet
- Santé publique France, the French national public health agency, Direction of Occupational Health, EpiprevTMS team associated to the University of Angers, F-49000 Angers, France
| | - Agnès Aublet-Cuvelier
- INRS, Département Homme au travail, 1 rue du Morvan CS60027, 54519 Vandoeuvre, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, St. Louis, MO 13 63310 USA
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
- Inserm, UMS 011, unité cohortes épidémiologiques en population, Villejuif, France
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
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16
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Al Ajmi K, Lophatananon A, Mekli K, Ollier W, Muir KR. Association of Nongenetic Factors With Breast Cancer Risk in Genetically Predisposed Groups of Women in the UK Biobank Cohort. JAMA Netw Open 2020; 3:e203760. [PMID: 32329772 PMCID: PMC7182796 DOI: 10.1001/jamanetworkopen.2020.3760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The association between noninherited factors, including lifestyle factors, and the risk of breast cancer (BC) in women and the association between BC and genetic makeup are only partly characterized. A study using data on current genetic stratification may help in the characterization. OBJECTIVE To examine the association between healthier lifestyle habits and BC risk in genetically predisposed groups. DESIGN, SETTING, AND PARTICIPANTS Data from UK Biobank, a prospective cohort comprising 2728 patients with BC and 88 489 women without BC, were analyzed. The data set used for the analysis was closed on March 31, 2019. The analysis was restricted to postmenopausal white women. Classification of healthy lifestyle was based on Cancer Research UK guidance (healthy weight, regular exercise, no use of hormone replacement therapy for more than 5 years, no oral contraceptive use, and alcohol intake <3 times/wk). Three groups were established: favorable (≥4 healthy factors), intermediate (2-3 healthy factors), and unfavorable (≤1 healthy factor). The genetic contribution was estimated using the polygenic risk scores of 305 preselected single-nucleotide variations. Polygenic risk scores were categorized into 3 tertiles (low, intermediate, and high). MAIN OUTCOMES AND MEASURES Cox proportional hazards regression was used to assess the hazard ratios (HRs) of the lifestyles and polygenic risk scores associated with a malignant neoplasm of the breast. RESULTS Mean (SD) age of the 2728 women with BC was 60.1 (5.5) years, and mean age of the 88 489 women serving as controls was 59.4 (4.9) years. The median follow-up time for the cohort was 10 years (maximum 13 years) (interquartile range, 9.44-10.82 years). Women with BC had a higher body mass index (relative risk [RR], 1.14; 95% CI, 1.05-1.23), performed less exercise (RR, 1.12; 95% CI, 1.01-1.25), used hormonal replacement therapy for longer than 5 years (RR, 1.23; 95% CI, 1.13-1.34), used more oral contraceptives (RR, 1.02; 95% CI, 0.93-1.12), and had greater alcohol intake (RR, 1.11; 95% CI, 1.03-1.19) compared with the controls. Overall, 20 657 women (23.3%) followed a favorable lifestyle, 60 195 women (68.0%) followed an intermediate lifestyle, and 7637 women (8.6%) followed an unfavorable lifestyle. The RR of the highest genetic risk group was 2.55 (95% CI, 2.28-2.84), and the RR of the most unfavorable lifestyle category was 1.44 (95% CI, 1.25-1.65). The association of lifestyle and BC within genetic subgroups showed lower HRs among women following a favorable lifestyle compared with intermediate and unfavorable lifestyles among all of the genetic groups: women with an unfavorable lifestyle had a higher risk of BC in the low genetic group (HR, 1.63; 95% CI, 1.13-2.34), intermediate genetic group (HR, 1.94; 95% CI, 1.46-2.58), and high genetic group (HR, 1.39; 95% CI, 1.11-1.74) compared with the reference group of favorable lifestyle. Intermediate lifestyle was also associated with a higher risk of BC among the low genetic group (HR, 1.40; 95% CI, 1.09-1.80) and the intermediate genetic group (HR, 1.37; 95% CI, 1.12-1.68). CONCLUSIONS AND RELEVANCE In this cohort study of data on women in the UK Biobank, a healthier lifestyle with more exercise, healthy weight, low alcohol intake, no oral contraceptive use, and no or limited hormonal replacement therapy use appeared to be associated with a reduced level of risk for BC, even if the women were at higher genetic risk for BC.
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Affiliation(s)
- Kawthar Al Ajmi
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Krisztina Mekli
- Cathie Marsh Institute for Social Research, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Kenneth R Muir
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
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17
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The preoperative systemic inflammation response index (SIRI) independently predicts survival in postmenopausal women with breast cancer. Curr Probl Cancer 2020; 44:100560. [PMID: 32122667 DOI: 10.1016/j.currproblcancer.2020.100560] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/06/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022]
Abstract
The recently developed preoperative systemic inflammation response index (SIRI) was reported as a useful biomarker that could predict survival in certain types of malignant tumors. However, the prognostic value of preoperative SIRI in postmenopausal breast cancer remains unclear. This study aimed to explore the relationship between SIRI and survival in postmenopausal patients with breast cancer. A total of 390 postmenopausal patients with breast cancer who underwent a mastectomy at Sun Yat-sen University Cancer Center were retrospectively studied. SIRI was based on peripheral neutrophil, monocyte, and lymphocyte counts, calculated as: neutrophil count × monocyte count/lymphocyte count. The best cut-off value for SIRI was determined using receiver operating characteristic curve analysis. Patients were divided into 2 groups:Low SIRI < 0.54 and high SIRI > 0.54. High SIRI was significantly related to progesterone receptor status. Kaplan-Meier survival analysis showed that T stage, N stage, clinical stage, carcinoembryonic antigen, estrogen receptor, progesterone receptor, endocrinotherapy, and SIRI were significantly correlated with overall survival (OS). Multivariate analysis showed that SIRI could also independently predict OS. Preoperative SIRI may be a reliable predictor of OS in postmenopausal patients with operable breast cancer to provide personalized prognostication and to assist in the formulation of a clinical treatment strategy.
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18
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An Expanded Agenda for the Primary Prevention of Breast Cancer: Charting a Course for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030714. [PMID: 31979073 PMCID: PMC7036784 DOI: 10.3390/ijerph17030714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 02/07/2023]
Abstract
Advances in breast cancer science, early detection, and treatment have resulted in improvements in breast cancer survival but not in breast cancer incidence. After skin cancer, breast cancer is the most common cancer diagnosis in the United States. Each year, nearly a quarter million U.S. women receive a breast cancer diagnosis, and the number continues to rise each year with the growth in the population of older women. Although much remains to be understood about breast cancer origins and prevention, action can be taken on the existing scientific knowledge to address the systemic factors that drive breast cancer risk at the population level. The California Breast Cancer Research Program funded a team at Breast Cancer Prevention Partners (BCPP) to convene leaders in advocacy, policy, and research related to breast cancer prevention from across the state of California. The objective was the development of a strategic plan to direct collective efforts toward specific and measurable objectives to reduce the incidence of breast cancer. The structured, innovative approach used by BCPP to integrate scientific evidence with community perspectives provides a model for other states to consider, to potentially change the future trajectory of breast cancer incidence in the United States.
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19
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Harvie M, Pegington M, French D, Cooper G, McDiarmid S, Howell A, Donnelly L, Ruane H, Sellers K, Foden P, Evans DG. Breast cancer risk status influences uptake, retention and efficacy of a weight loss programme amongst breast cancer screening attendees: two randomised controlled feasibility trials. BMC Cancer 2019; 19:1089. [PMID: 31795966 PMCID: PMC6892016 DOI: 10.1186/s12885-019-6279-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background Excess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. There is little evidence that behaviour change is possible within screening programmes and whether this is influenced by prior knowledge of disease risk. We determined whether breast cancer risk influences uptake, retention and efficacy of a weight control programme in the UK National Health Service Breast Screening Programme, and whether additional cardiovascular disease and type 2 diabetes risk information improves uptake and retention further. Method Overweight/obese women in the UK National Health Service Breast Screening Programme identified at high, moderately increased, average and low-risk of breast cancer were randomised to receive individualised breast cancer risk information (breast cancer prevention programme), or individualised breast cancer, cardiovascular disease (QRISK2) and type 2 diabetes (QDiabetes, HbA1c) information (multiple disease prevention programme). Personalised breast cancer risk feedback was given before randomisation in Study-1, and after randomisation in Study-2. Results Recruitment was 9% (126/1356) in Study-1 and 7% (52/738) in Study-2. With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 (95% CI 1.24–3.17, P = 0.004) in Study-1 and 3.58 (95% CI 1.59–8.07, P = 0.002) in Study-2. Odds ratio of retention for high/moderately increased -risk vs. low risk women was 2.98 (95% CI 1.05–8.47, P = 0.041) in Study-1 and 3.88 (95% CI 1.07–14.04, P = 0.039) in Study-2. Weight loss of ≥5% at 12 months was achieved by 63% high/moderate vs. 43% low-risk women in Study-1 (P = 0.083) and 39% vs. 8% in Study-2 (P = 0.008). Uptake, retention and weight loss were equivalent in both the breast cancer prevention programme and the multiple disease prevention programme in both studies. Conclusions Women who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and consequently lose more weight across both studies. High risk women are more likely engage in a lifetyle prevention programme and also have the greatest potential benefit fom risk reduction strategies. Trial registration ISRCTN91372184 Registered 28 September 2014.
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Affiliation(s)
- Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England. .,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England. .,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England.
| | - Mary Pegington
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England.,Division of Cancer Sciences, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, England.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - David French
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England.,Manchester Centre for Health Psychology, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Coupland Street, Manchester, M13 9PL, England
| | - Grace Cooper
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Anthony Howell
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England.,Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, England
| | - Louise Donnelly
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Philip Foden
- Department of Medical Statistics, Education and Research Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England.,Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, England
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Bellanger M, Zeinomar N, Tehranifar P, Terry MB. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? J Glob Oncol 2019; 4:1-16. [PMID: 30085889 PMCID: PMC6223528 DOI: 10.1200/jgo.17.00207] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose There remains considerable international variation in breast cancer incidence and mortality, but a comprehensive examination of rates by country level economic, development and cancer prevention policies is lacking. Materials and Methods We compared GLOBOCAN 2012 age-specific breast cancer incidence and mortality rates for 177 countries by using development and policy data available from the WHO Global Cancer Country Profiles data base. We classified each country on the basis of gross national income per capita from the World Development Indicators data base, as follows: low-income country (LIC), lower-middle–income country (LMIC), upper-middle–income country (UMIC), and high-income country (HIC). Results There were 1,651,326 breast cancer cases and 516,868 breast cancer deaths estimated in 2012. Approximately three quarters of all breast cancer cases and 60% of the breast cancer deaths were in women from HICs and UMICs. Age and country-level income explained approximately 60% of the international variation in breast cancer incidence and mortality in women of all ages (adjusted R2 = 58% and 60%, respectively). Economic development indicators additionally increased the overall variation in incidence and mortality by approximately 5%. In women younger than age 50 years, country-level income explained 68% of incidence and 59% of mortality; economic development indicators additionally increased this percentage by approximately 4%. Country-level cancer prevention policy indicators contributed little to explanation of the overall variation in incidence and mortality after analysis accounted for age and country-level income; however, an overall resource summary index of greater economic development and cancer prevention policies was related to lower mortality within each major income level. Conclusion Although breast cancer incidence increases with higher income levels in all ages, women in the poorest countries bear a relatively higher burden of breast cancer mortality, particularly women younger than age 50 years.
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Affiliation(s)
- Martine Bellanger
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Nur Zeinomar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Parisa Tehranifar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Mary Beth Terry
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
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Arriaga ME, Vajdic CM, Canfell K, MacInnis RJ, Banks E, Byles JE, Magliano DJ, Taylor AW, Mitchell P, Giles GG, Shaw JE, Gill TK, Klaes E, Velentzis LS, Cumming RG, Hirani V, Laaksonen MA. The preventable burden of breast cancers for premenopausal and postmenopausal women in Australia: A pooled cohort study. Int J Cancer 2019; 145:2383-2394. [DOI: 10.1002/ijc.32231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/07/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Maria E. Arriaga
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney Australia
| | - Claire M. Vajdic
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney Australia
| | - Karen Canfell
- Cancer Research DivisionCancer Council New South Wales Sydney Australia
- Faculty of Medicine and Health, School of Public HealthUniversity of Sydney Sydney Australia
- Prince of Wales Clinical SchoolUniversity of New South Wales Sydney Australia
| | - Robert J. MacInnis
- Cancer Epidemiology and Intelligence DivisionCancer Council Victoria Melbourne Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of Melbourne Melbourne Australia
| | - Emily Banks
- ANU College of MedicineBiology and Environment, Australian National University Canberra Australia
| | - Julie E. Byles
- Research Centre for Gender, Health and AgeingUniversity of Newcastle Newcastle Australia
| | - Dianna J. Magliano
- Diabetes and Population Health LaboratoryBaker Heart and Diabetes Institute Melbourne Australia
| | - Anne W. Taylor
- Adelaide Medical SchoolUniversity of Adelaide Adelaide Australia
| | - Paul Mitchell
- Centre for Vision ResearchWestmead Institute for Medical research, University of Sydney Sydney Australia
| | - Graham G. Giles
- Cancer Epidemiology and Intelligence DivisionCancer Council Victoria Melbourne Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of Melbourne Melbourne Australia
| | - Jonathan E. Shaw
- Clinical Diabetes LaboratoryBaker Heart and Diabetes Institute Melbourne Australia
| | - Tiffany K. Gill
- Adelaide Medical SchoolUniversity of Adelaide Adelaide Australia
| | | | - Louiza S. Velentzis
- Cancer Research DivisionCancer Council New South Wales Sydney Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of Melbourne Melbourne Australia
| | - Robert G. Cumming
- Faculty of Medicine and Health, School of Public HealthUniversity of Sydney Sydney Australia
- ANZAC Research InstituteUniversity of Sydney and Concord Hospital Sydney Australia
| | - Vasant Hirani
- Faculty of Medicine and Health, School of Public HealthUniversity of Sydney Sydney Australia
- School of Life and Environmental Sciences Charles Perkins CentreUniversity of Sydney Sydney Australia
| | - Maarit A. Laaksonen
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney Australia
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World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes Control 2019; 30:1183-1200. [PMID: 31471762 DOI: 10.1007/s10552-019-01223-w] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/16/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the present study was to systematically review the complex associations between energy balance-related factors and breast cancer risk, for which previous evidence has suggested different associations in the life course of women and by hormone receptor (HR) status of the tumor. METHODS Relevant publications on adulthood physical activity, sedentary behavior, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, and weight change and pre- and postmenopausal breast cancer risk were identified in PubMed up to 30 April 2017. Random-effects meta-analyses were conducted to summarize the relative risks across studies. RESULTS One hundred and twenty-six observational cohort studies comprising over 22,900 premenopausal and 103,000 postmenopausal breast cancer cases were meta-analyzed. Higher physical activity was inversely associated with both pre- and postmenopausal breast cancers, whereas increased sitting time was positively associated with postmenopausal breast cancer. Although higher early adult BMI (ages 18-30 years) was inversely associated with pre- and postmenopausal breast cancers, adult weight gain and greater body adiposity increased breast cancer risk in postmenopausal women, and the increased risk was evident for HR+ but not HR- breast cancers, and among never but not current users of postmenopausal hormones. The evidence was less consistent in premenopausal women. There were no associations with adult weight gain, inverse associations with adult BMI (study baseline) and hip circumference, and non-significant associations with waist circumference and waist-to-hip ratio that were reverted to positive associations on average in studies accounting for BMI. No significant associations were observed for HR-defined premenopausal breast cancers. CONCLUSION Better understanding on the impact of these factors on pre- and postmenopausal breast cancers and their subtypes along the life course is needed.
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Rogers WA. Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:129-140. [PMID: 30030748 DOI: 10.1007/s11019-018-9852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.
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Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, North Ryde, NSW, 2107, Australia.
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Coughlin SS. Epidemiology of Breast Cancer in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:9-29. [PMID: 31456177 DOI: 10.1007/978-3-030-20301-6_2] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epidemiologic studies have contributed importantly to current knowledge of environmental and genetic risk factors for breast cancer. Worldwide, breast cancer is an important cause of human suffering and premature mortality among women. In the United States, breast cancer accounts for more cancer deaths in women than any site other than lung cancer. A variety of risk factors for breast cancer have been well-established by epidemiologic studies including race, ethnicity, family history of cancer, and genetic traits, as well as modifiable exposures such as increased alcohol consumption, physical inactivity, exogenous hormones, and certain female reproductive factors. Younger age at menarche, parity, and older age at first full-term pregnancy may influence breast cancer risk through long-term effects on sex hormone levels or by other biological mechanisms. Recent studies have suggested that triple negative breast cancers may have a distinct etiology. Genetic variants and mutations in genes that code for proteins having a role in DNA repair pathways and the homologous recombination of DNA double stranded breaks (APEX1, BRCA1, BRCA2, XRCC2, XRCC3, ATM, CHEK2, PALB2, RAD51, XPD), have been implicated in some cases of breast cancer.
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Affiliation(s)
- Steven S Coughlin
- Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Zakhari S, Hoek JB. Epidemiology of Moderate Alcohol Consumption and Breast Cancer: Association or Causation? Cancers (Basel) 2018; 10:E349. [PMID: 30249004 PMCID: PMC6210419 DOI: 10.3390/cancers10100349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023] Open
Abstract
Epidemiological studies have been used to show associations between modifiable lifestyle habits and the incidence of breast cancer. Among such factors, a history of alcohol use has been reported in multiple studies and meta-analyses over the past decades. However, associative epidemiological studies that were interpreted as evidence that even moderate alcohol consumption increases breast cancer incidence have been controversial. In this review, we consider the literature on the relationship between moderate or heavy alcohol use, both in possible biological mechanisms and in variations in susceptibility due to genetic or epigenetic factors. We argue that there is a need to incorporate additional approaches to move beyond the associations that are reported in traditional epidemiological analyses and incorporate information on molecular pathologic signatures as a requirement to posit causal inferences. In particular, we point to the efforts of the transdisciplinary field of molecular pathological epidemiology (MPE) to evaluate possible causal relationships, if any, of alcohol consumption and breast cancer. A wider application of the principles of MPE to this field would constitute a giant step that could enhance our understanding of breast cancer and multiple modifiable risk factors, a step that would be particularly suited to the era of "personalized medicine".
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Affiliation(s)
- Samir Zakhari
- Science Office, Distilled Spirits Council, Washington, DC 20005, USA.
| | - Jan B Hoek
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Al-Ajmi K, Lophatananon A, Ollier W, Muir KR. Risk of breast cancer in the UK biobank female cohort and its relationship to anthropometric and reproductive factors. PLoS One 2018; 13:e0201097. [PMID: 30048498 PMCID: PMC6062099 DOI: 10.1371/journal.pone.0201097] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/09/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anthropometric and reproductive factors have been reported as being established risk factors for breast cancer (BC). This study explores the contribution of anthropometric and reproductive factors in UK females developing BC in a large longitudinal cohort. METHODS Data from the UK Biobank prospective study of 273,467 UK females were analyzed. Relative risks (RRs) and 95% confidence intervals (CIs) for each factor were adjusted for age, family history of BC and deprivation score. The analyses were stratified by the menopausal status. RESULTS Over the 9 years of follow up the total number of BC cases were 14,231 with 3,378 (23.7%) incident cases with an incidence rate of 2.09 per 1000 person-years. In pre-menopausal, increase in age, height, having low BMI, low waist to hip ratio, first degree family history of BC, early menarche age, nulliparous, late age at first live birth, high reproductive interval index, and long contraceptive use duration were all significantly associated with an increased BC risk. In post-menopausal, getting older, being taller, having high BMI, first degree BC family history, nulliparous, late age at first live birth, and high reproductive interval index were all significantly associated with an increased risk of BC. The population attributable fraction (PAF) suggested that an early first live birth, lower reproductive interval index and increased number of children can contribute to BC risk reduction up to 50%. CONCLUSIONS This study utilizes the UK Biobank study to confirm associations between anthropometric and reproductive factors and the risk of breast cancer development. Result of attributable fraction of risk contributed by each risk factor suggested that lifetime risk of BC can be reduced by controlling weight, reassessing individual approaches to the timing of childbirth and options for contraception and considering early screening for women with family history in the first degree relative.
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Affiliation(s)
- Kawthar Al-Ajmi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kenneth R. Muir
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Fischer A, Ziogas A, Anton-Culver H. Perception matters: Stressful life events increase breast cancer risk. J Psychosom Res 2018; 110:46-53. [PMID: 29764605 PMCID: PMC7793611 DOI: 10.1016/j.jpsychores.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The relationship between psychological stress and breast cancer risk is unclear. The present study sought to understand how stressfulness appraisal of salient Life Events (LEs) influences breast cancer risk. METHODS A case-control design was used and included 664 female cases identified through the Cancer Surveillance Program of Orange County, CA and 203 female population-based controls. A LE questionnaire determined if events occurred prior to breast cancer diagnosis and if these events were considered to be stressful or not. Multivariate unconditional logistic regression was used to calculate ORs while adjusting for known breast cancer covariates. RESULTS Cumulative adverse LEs perceived as stressful were associated with increased breast cancer risk in a dose response fashion (OR = 1.63, 95% CI = 1.00-2.66, Ptrend = 0.045). Conversely, events perceived as non-stressful did not have a significant impact on breast cancer risk. Previous personal illness was directly related to increased breast cancer risk, whether perceived as stressful (OR = 2.84, 95% CI = 1.96-4.11) or non-stressful (OR = 3.47, 95% CI = 1.34-8.94). Abortion and relocation were observed to have a protective effect on breast cancer risk only when reported as stressful (OR = 0.54, 95% CI = 0.32-0.92; OR = 0.63, 95% CI = 0.43-0.93, respectively). Pre/Peri-menopausal women who were nulliparous or who had their first child at ≥30 years of age were especially prone to the effects of appraised stress on increased breast cancer risk. CONCLUSIONS This study underscores the importance of stressfulness appraisal when determining the effect of major LEs on breast cancer risk. Our results support incorporating assessments of perceived stressfulness in future epidemiological investigation of this topic.
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Affiliation(s)
- Avital Fischer
- University of California Irvine, School of Medicine, United States
| | - Argyrios Ziogas
- University of California Irvine, Department of Epidemiology, School of Medicine, United States
| | - Hoda Anton-Culver
- University of California Irvine, Department of Epidemiology, School of Medicine, United States; Genetic Epidemiology Research Institute, United States.
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Morère JF, Viguier J, Couraud S, Brignoli-Guibaudet L, Lhomel C, Pivot XB, Eisinger F. Awareness and Misconceptions of Breast Cancer Risk Factors Among Laypersons and Physicians. Curr Oncol Rep 2018; 20:15. [DOI: 10.1007/s11912-017-0647-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e30-e66. [PMID: 29437116 PMCID: PMC6722327 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.
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Ekwueme DU, Allaire BT, Parish WJ, Thomas CC, Poehler D, Guy GP, Aldridge AP, Lahoti SR, Fairley TL, Trogdon JG. Estimation of Breast Cancer Incident Cases and Medical Care Costs Attributable to Alcohol Consumption Among Insured Women Aged <45 Years in the U.S. Am J Prev Med 2017; 53:S47-S54. [PMID: 28818245 PMCID: PMC5854476 DOI: 10.1016/j.amepre.2017.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION This study estimated the percentage of breast cancer cases, total number of incident cases, and total annual medical care costs attributable to alcohol consumption among insured younger women (aged 18-44 years) by type of insurance and stage at diagnosis. METHODS The study used the 2012-2013 National Survey on Drug Use and Health, cancer incidence data from two national registry programs, and published relative risk measures to estimate the: (1) alcohol-attributable fraction of breast cancer cases among younger women by insurance type; (2) total number of breast cancer incident cases attributable to alcohol consumption by stage at diagnosis and insurance type among younger women; and (3) total annual medical care costs of treating breast cancer incident cases attributable to alcohol consumption among younger women. Analyses were conducted in 2016; costs were expressed in 2014 U.S. dollars. RESULTS Among younger women enrolled in Medicaid, private insurance, and both groups, 8.7% (95% CI=7.4%, 10.0%), 13.8% (95% CI=13.3%, 14.4%), and 12.3% (95% CI=11.4%, 13.1%) of all breast cancer cases, respectively, were attributable to alcohol consumption. Localized stage was the largest proportion of estimated attributable incident cases. The estimated total number of breast cancer incident alcohol-attributable cases was 1,636 (95% CI=1,570, 1,703) and accounted for estimated total annual medical care costs of $148.4 million (95% CI=$140.6 million, $156.1 million). CONCLUSIONS Alcohol-attributable breast cancer has estimated medical care costs of nearly $150 million per year. The current findings could be used to support evidence-based interventions to reduce alcohol consumption in younger women.
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Affiliation(s)
- Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Poehler
- RTI International, Research Triangle Park, North Carolina
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sejal R Lahoti
- RTI International, Research Triangle Park, North Carolina
| | - Temeika L Fairley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Justin G Trogdon
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Gassama M, Bénichou J, Dartois L, Thiébaut ACM. Comparison of methods for estimating the attributable risk in the context of survival analysis. BMC Med Res Methodol 2017; 17:10. [PMID: 28114895 PMCID: PMC5259851 DOI: 10.1186/s12874-016-0285-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background The attributable risk (AR) measures the proportion of disease cases that can be attributed to an exposure in the population. Several definitions and estimation methods have been proposed for survival data. Methods Using simulations, we compared four methods for estimating AR defined in terms of survival functions: two nonparametric methods based on Kaplan-Meier’s estimator, one semiparametric based on Cox’s model, and one parametric based on the piecewise constant hazards model, as well as one simpler method based on estimated exposure prevalence at baseline and Cox’s model hazard ratio. We considered a fixed binary exposure with varying exposure probabilities and strengths of association, and generated event times from a proportional hazards model with constant or monotonic (decreasing or increasing) Weibull baseline hazard, as well as from a nonproportional hazards model. We simulated 1,000 independent samples of size 1,000 or 10,000. The methods were compared in terms of mean bias, mean estimated standard error, empirical standard deviation and 95% confidence interval coverage probability at four equally spaced time points. Results Under proportional hazards, all five methods yielded unbiased results regardless of sample size. Nonparametric methods displayed greater variability than other approaches. All methods showed satisfactory coverage except for nonparametric methods at the end of follow-up for a sample size of 1,000 especially. With nonproportional hazards, nonparametric methods yielded similar results to those under proportional hazards, whereas semiparametric and parametric approaches that both relied on the proportional hazards assumption performed poorly. These methods were applied to estimate the AR of breast cancer due to menopausal hormone therapy in 38,359 women of the E3N cohort. Conclusion In practice, our study suggests to use the semiparametric or parametric approaches to estimate AR as a function of time in cohort studies if the proportional hazards assumption appears appropriate. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0285-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malamine Gassama
- Université Paris-Saclay, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, 25 rue du Dr. Roux, Paris Cedex 15, 75724, France
| | - Jacques Bénichou
- University of Rouen, Inserm, U 1219, 1 rue de Germont, Rouen Cedex, 76031, France.,Rouen University Hospital, Department of Biostatistics, 1 rue de Germont, Rouen Cedex, 76031, France
| | - Laureen Dartois
- Université Paris-Saclay, CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, 114 rue Edouard Vaillant, Villejuif Cedex, 94805, France.,Gustave Roussy, 114 rue Edouard Vaillant, Villejuif Cedex, 94805, France
| | - Anne C M Thiébaut
- Université Paris-Saclay, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, 25 rue du Dr. Roux, Paris Cedex 15, 75724, France.
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Coughlin SS, Besenyi GM, Bowen D, De Leo G. Development of the Physical activity and Your Nutrition for Cancer (PYNC) smartphone app for preventing breast cancer in women. Mhealth 2017; 3:5. [PMID: 28293621 PMCID: PMC5344121 DOI: 10.21037/mhealth.2017.02.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/20/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In the U.S., breast cancer accounts for more cancer deaths in women than any site other than lung cancer. Based upon attributable risks, about 30-35% of breast cancers could potentially be prevented by addressing obesity, physical inactivity, increased alcohol consumption, and carcinogenic exposures such as hormone replacement therapy (HRT). We need methods of reducing women's risks of this disease that are attractive and easy to use, widely accessible to diverse women, and able to be easily amended to account for new research. METHODS The overall objective of this 12-month project is to develop and test a smartphone app to provide women with information about how they can reduce their risk of breast cancer through healthy behaviors such as physical activity, weight management, restricting caloric intake, consuming a healthy diet and proper nutrition, engaging in regular physical activity, and avoiding carcinogenic exposures such as HRT and alcohol. The specific aims are: (I) to develop a smartphone app for breast cancer prevention using a behavioral framework; (II) to ensure interconnectivity with commercially available products (Fitbit device for monitoring physical activity and the LoseIt! smartphone app for monitoring and tracking diet and nutrition); and (III) to ensure that the mHealth intervention is suitable for women with varying levels of health literacy and eHealth literacy. RESULTS The app, referred to as Physical activity and Your Nutrition for Cancer (PYNC), is being coded on an iOS platform. Users will be able to access the breast cancer prevention app using their smartphone or tablet. The app's design will ensure interconnectivity with commercially available products for monitoring and tracking physical activity, caloric intake, diet and nutrition. Using the app, it will be feasible for users to connect and sync their Fitbit and LoseIt! accounts so that information collected about physical activity, caloric intake, diet, and nutrition can be conveniently assessed from one portal. The Fitbit device and app provides reminders and allows users to set physical activity goals. Users will be able to access health education information about breast cancer risk-reduction with attractive graphics and visual displays. CONCLUSIONS Future directions will include testing the efficacy of the mHealth intervention in increasing physical activity, improving diet and nutrition, and weight management through a randomized controlled trial, and widespread dissemination and implementation research.
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Affiliation(s)
- Steven S. Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Gina M. Besenyi
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Deborah Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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Surpoids, obésité : quel impact sur la récidive du cancer du sein ? PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0585-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Coughlin SS, Thind H, Liu B, Wilson LCC. Towards research-tested smartphone applications for preventing breast cancer. Mhealth 2016; 2:26. [PMID: 27390745 PMCID: PMC4933519 DOI: 10.21037/mhealth.2016.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/03/2016] [Indexed: 01/07/2023] Open
Abstract
Efforts to prevent breast cancer and other chronic illnesses have focused on promoting physical activity, healthy diet and nutrition, and avoidance of excessive alcohol consumption. Smartphone applications (apps) offer a low-cost, effective strategy for breast cancer prevention in women through behavioral change. However, there are currently no research-tested smartphone apps for breast cancer prevention that are suitable for women with varying levels of health literacy and eHealth literacy. In this perspective, we consider modifiable risk factors for breast cancer in women in relation to the development of smartphone apps to promote healthy behaviors associated with breast cancer-risk reduction. First, we provide a summary of breast cancer risk factors that are modifiable through behavioral change including their corresponding relative risk. Second, we discuss scientific issues related to the development of smartphone apps for the primary prevention of breast cancer and offer suggestions for further research. Smartphone apps for preventing breast cancer should be tailored for women at different life stages (e.g., young women, women who are post-menopausal, and older women). Topics such as breastfeeding and oral contraceptives are appropriate for younger women. Weight management, physical activity, avoiding cigarette smoking, and dispelling breast cancer myths are appropriate for women of all ages. As women age, topics such as hormone replacement therapy or comorbid health conditions become more important to address. Apps for breast cancer prevention should be grounded in a behavioral theory or framework and should be suitable for people with varying levels of health literacy. Future developments in smartphone apps for breast cancer prevention should include apps that are tailored for specific cultural, racial, and ethnic groups.
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Affiliation(s)
- Steven S. Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Herpreet Thind
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA, USA
| | - Benyuan Liu
- Department of Computer Sciences, University of Massachusetts, Lowell, MA, USA
| | - Lt Col Candy Wilson
- Malcolm Grow Medical Clinics and Surgery Center at JB-Andrews, Joint Base Andrews, MD, USA
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