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Pakzad R, Nedjat S, Salehiniya H, Mansournia N, Etminan M, Nazemipour M, Pakzad I, Mansournia MA. Effect of alcohol consumption on breast cancer: probabilistic bias analysis for adjustment of exposure misclassification bias and confounders. BMC Med Res Methodol 2023; 23:157. [PMID: 37403100 DOI: 10.1186/s12874-023-01978-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/15/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE This study was conducted to evaluate the effect of alcohol consumption on breast cancer, adjusting for alcohol consumption misclassification bias and confounders. METHODS This was a case-control study of 932 women with breast cancer and 1000 healthy control. Using probabilistic bias analysis method, the association between alcohol consumption and breast cancer was adjusted for the misclassification bias of alcohol consumption as well as a minimally sufficient set of adjustment of confounders derived from a causal directed acyclic graph. Population attributable fraction was estimated using the Miettinen's Formula. RESULTS Based on the conventional logistic regression model, the odds ratio estimate between alcohol consumption and breast cancer was 1.05 (95% CI: 0.57, 1.91). However, the adjusted estimates of odds ratio based on the probabilistic bias analysis ranged from 1.82 to 2.29 for non-differential and from 1.93 to 5.67 for differential misclassification. Population attributable fraction ranged from 1.51 to 2.57% using non-differential bias analysis and 1.54-3.56% based on differential bias analysis. CONCLUSION A marked measurement error was in self-reported alcohol consumption so after correcting misclassification bias, no evidence against independence between alcohol consumption and breast cancer changed to a substantial positive association.
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Affiliation(s)
- Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, Iran
| | - Hamid Salehiniya
- Department of Epidemiology and Biostatistics, School of Health, Birjand University of Medical Sciences, South Khorasan, Iran
| | - Nasrin Mansournia
- Department of Endocrinology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mahyar Etminan
- Departments of Ophthalmology and Visual Sciences, Medicine and Pharmacology, University of British Columbia, Vancouver, Canada
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, Iran
| | - Iraj Pakzad
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, PO Box: 14155-6446, Tehran, Iran.
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2
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Pakzad R, Nedjat S, Yaseri M, Salehiniya H, Mansournia N, Nazemipour M, Mansournia MA. Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method. Clin Epidemiol 2020; 12:557-568. [PMID: 32547245 PMCID: PMC7266328 DOI: 10.2147/clep.s252025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to determine the association between smoking and breast cancer after adjusting for smoking misclassification bias and confounders. Methods In this case–control study, 1000 women with breast cancer and 1000 healthy controls were selected. Using a probabilistic bias analysis method, the association between smoking and breast cancer was adjusted for the bias resulting from misclassification of smoking secondary to self-reporting as well as a minimally sufficient adjustment set of confounders derived from a causal directed acyclic graph (cDAG). Population attributable fraction (PAF) for smoking was calculated using Miettinen’s formula. Results While the odds ratio (OR) from the conventional logistic regression model between smoking and breast cancer was 0.64 (95% CI: 0.36–1.13), the adjusted ORs from the probabilistic bias analysis were in the ranges of 2.63–2.69 and 1.73–2.83 for non-differential and differential misclassification, respectively. PAF ranges obtained were 1.36–1.72% and 0.62–2.01% using the non-differential bias analysis and differential bias analysis, respectively. Conclusion After misclassification correction for smoking, the non-significant negative-adjusted association between smoking and breast cancer changed to a significant positive-adjusted association.
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Affiliation(s)
- Reza Pakzad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Salehiniya
- School of Public Health, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
| | - Nasrin Mansournia
- Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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3
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Arthur R, Wassertheil-Smoller S, Manson JE, Luo J, Snetselaar L, Hastert T, Caan B, Qi L, Rohan T. The Combined Association of Modifiable Risk Factors with Breast Cancer Risk in the Women's Health Initiative. Cancer Prev Res (Phila) 2018; 11:317-326. [PMID: 29483073 DOI: 10.1158/1940-6207.capr-17-0347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of selected modifiable risk factors (diet, alcohol, physical activity, BMI, and smoking) with risk of invasive breast cancer in the Women's Health Initiative (WHI). This study comprised 131,833 postmenopausal women, of whom 8,168 had breast cancer, who were enrolled in the WHI Observational Study or the WHI clinical trials. Cox proportional hazards regression was used to estimate the HRs and 95% confidence intervals (CI) for the association of the score with the risk of developing breast cancer overall and according to specific breast cancer clinicopathologic characteristics. There was a 4% reduction in the risk of breast cancer per unit increase in the HLI score. Compared with those with an HLI score in the lowest quintile level, those in the highest quintile level had 30%, 37%, and 30% lower risk for overall, ER+/PR+, and HER2+ breast cancer, respectively (HR = 0.70; 95% CI, 0.64-0.76; 0.63, 0.57-0.69; and 0.70; 0.55-0.90, respectively). We also observed inverse associations between the score and risk of breast cancer irrespective of nodal status, tumor grade, and stage of the disease. Most individual lifestyle factors were independently associated with the risk of breast cancer. Our findings support the view that promoting healthy lifestyle practices may be beneficial with respect to lowering risk of breast cancer among postmenopausal women. Cancer Prev Res; 11(6); 317-26. ©2018 AACRSee related editorial by Friedenreich and McTiernan, p. 313.
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Affiliation(s)
- Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | - Linda Snetselaar
- Department of Epidemiology, School of Public Health, University of Iowa, Iowa City, Iowa
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Bette Caan
- Division of Research, Kaiser Permanente, Oakland, California
| | - Lihong Qi
- Department of Public Health Science, School of Medicine, UC Davis, Davis, California
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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4
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Brenner DR, Poirier AE, Grundy A, Khandwala F, McFadden A, Friedenreich CM. Cancer incidence attributable to excess body weight in Alberta in 2012. CMAJ Open 2017; 5:E330-E336. [PMID: 28455439 PMCID: PMC5510285 DOI: 10.9778/cmajo.20160039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Excess body weight has been consistently associated with colorectal, breast, endometrial, esophageal, gall bladder, pancreatic and kidney cancers. The objective of this analysis was to estimate the proportion of total and site-specific cancers attributable to excess body weight in adults in Alberta in 2012. METHODS We estimated the proportions of attributable cancers using population attributable risk. Risk estimates were obtained from recent meta-analyses, and exposure prevalence estimates were obtained from the Canadian Community Health Survey. People with a body mass index of 25.00-29.99 kg/m2 and of 30 kg/m2 or more were categorized as overweight and obese, respectively. RESULTS About 14%-47% of men and 9%-35% of women in Alberta were classified as either overweight or obese; the proportion increased with increasing age for both sexes. We estimate that roughly 17% and 12% of obesity-related cancers among men and women, respectively, could be attributed to excess body weight in Alberta in 2012. The heaviest absolute burden in terms of number of cases was seen for breast cancer among women and for colorectal cancer among men. Overall, about 5% of all cancers in adults in Alberta in 2012 were estimated to be attributable to excess body weight in 2000-2003. INTERPRETATION Excess body weight contributes to a substantial proportion of cases of cancers associated with overweight and obesity annually in Alberta. Strategies to improve energy imbalance and reduce the proportion of obese and overweight Albertans may have a notable impact on cancer incidence in the future.
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Affiliation(s)
- Darren R Brenner
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Abbey E Poirier
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Anne Grundy
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Farah Khandwala
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Alison McFadden
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Christine M Friedenreich
- Affiliations: Department of Cancer Epidemiology and Prevention Research (Brenner, Poirier, Grundy, Khandwala, McFadden, Friedenreich), CancerControl Alberta, Alberta Health Services; Department of Oncology (Brenner, Friedenreich), Cumming School of Medicine; Department of Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Grevers X, Grundy A, Poirier AE, Khandwala F, Feldman M, Friedenreich CM, Brenner DR. Cancer incidence attributable to the use of oral contraceptives and hormone therapy in Alberta in 2012. CMAJ Open 2016; 4:E754-E759. [PMID: 28018891 PMCID: PMC5173458 DOI: 10.9778/cmajo.20160046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hormonal contraceptives and hormone replacement therapies are classified as carcinogenic to humans (group 1) by the International Agency for Research on Cancer. We sought to estimate the proportion and total number of cancers attributable to the use of oral contraceptives and hormone therapy in Alberta in 2012. METHODS Population attributable risks were used to estimate the proportion of attributable cases for each associated cancer site. Relative risk estimates were obtained from the most relevant and recent epidemiologic literature. Prevalences of the use of oral contraceptives and hormone therapy in Alberta were collected from Alberta's Tomorrow Project. Specific cancer incidence data were obtained from the Alberta Cancer Registry for the year 2012. RESULTS Overall, 6.3% of breast cancers (n = 135) diagnosed in Alberta in 2012 were estimated to be attributable to the use of oral contraceptives, and the exposure potentially prevented about 57.3% of endometrial cancers (n = 276) and 29.1% of ovarian cancers (n = 52). About 15.5% of breast cancers (n = 258) and 8.9% of ovarian cancers (n = 13) were estimated to be attributable to the use of hormone therapy, whereas 11.3% of endometrial cancers (n = 48) were possibly prevented by the exposure. INTERPRETATION Based on our estimates, oral contraceptive use resulted in a net protective effect among the cancer sites studied, thus reducing the cancer burden in Alberta in 2012. The use of hormone therapy was estimated to increase the cancer burden in the province, therefore the risk and benefit of hormone therapy should be carefully considered before use.
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Affiliation(s)
- Xin Grevers
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Anne Grundy
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Farah Khandwala
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Matthew Feldman
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta
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6
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Whiteman DC, Wilson LF. The fractions of cancer attributable to modifiable factors: A global review. Cancer Epidemiol 2016; 44:203-221. [PMID: 27460784 DOI: 10.1016/j.canep.2016.06.013] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/13/2022]
Abstract
Worldwide, the burden of cancer is rising, stimulating efforts to develop strategies to control these diseases. Primary prevention, a key control strategy, aims to reduce cancer incidence through programs directed towards reducing population exposure to known causal factors. Before enacting such strategies, it is necessary to estimate the likely effect on cancer incidence if exposures to known causal factors were reduced or eliminated. The population attributable fraction (PAF) is the epidemiological measure which quantifies this potential reduction in incidence. We surveyed the literature to document and summarise the proportions of cancers across the globe attributable to modifiable causes, specifically tobacco smoke, alcohol, overweight/obesity, insufficient physical activity, solar ultraviolet (UV) radiation and dietary factors (insufficient fruit, non-starchy vegetables and fibre; red/processed meat; salt). In total, we identified 55 articles that presented PAF estimates for one or more causes. Information coverage was not uniform, with many articles reporting cancer PAFs due to overweight/obesity, alcohol and tobacco, but fewer reporting PAFs for dietary factors or solar UV radiation. At all cancer sites attributable to tobacco and alcohol, median PAFs were markedly lower for women than men. Smoking contributed to very high median PAFs (>50%) for cancers of the lung and larynx. Median PAFs for men, attributable to alcohol, were high (25-50%) for cancers of the oesophagus, oral cavity/pharynx, larynx and liver. For cancers causally associated with overweight/obesity, high median PAFs were reported for oesophageal adenocarcinoma (men 29%, women 37%), gallbladder (men 11%, women 42%) and endometrium (36%). The cancer PAF literature is growing rapidly. Repeating this survey in the future should lead to more precise estimates of the potentially preventable fractions of cancer.
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Affiliation(s)
- David C Whiteman
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia; The University of Queensland, School of Public Health, Herston Road, Herston, QLD 4006, Australia.
| | - Louise F Wilson
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
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Grundy A, Friedenreich CM, Poirier AE, Khandwala F, Brenner DR. A methodologic framework to evaluate the number of cancers attributable to lifestyle and environment in Alberta. CMAJ Open 2016; 4:E471-E478. [PMID: 27730111 PMCID: PMC5047844 DOI: 10.9778/cmajo.20150068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Previous research to estimate population attributable risks for cancer in Alberta has been limited. Attributable burden estimates are important for planning and implementing population-based cancer prevention strategies. This article describes a methodologic framework to estimate the number of incident cancers attributable to modifiable lifestyle and environmental risk factors in Alberta. METHODS We estimated population attributable risks for cancer for exposures to 24 established cancer risk factors including tobacco consumption and environmental tobacco exposure, environmental factors, infectious agents, hormone therapies, dietary intake, obesity and physical inactivity. We used risk estimates to quantify the association between individual exposures and cancer sites as well as prevalence estimates for individual exposures in Alberta to estimate the proportion of cancer in Alberta that could be attributed to each exposure. These estimations were conducted in the context of a theoretical minimum risk principle, whereby exposures corresponding to the lowest levels of population risk were used as the comparisons for alternative exposure levels. INTE RPRETATION We outline the main methodologic principles for the protocol used in evaluating population attributable risks for modifiable lifestyle and environmental risk factors for cancer in Alberta. The data produced by this project will provide important information concerning which known cancer risk factors are responsible for the largest proportions of cancer in Alberta and could inform future cancer prevention strategies.
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Affiliation(s)
- Anne Grundy
- Department of Cancer Epidemiology and Prevention Research (Grundy, Friedenreich, Poirier, Khandwala, Brenner) Alberta Health Services-Cancer Control; Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine (Friedenreich, Brenner), University of Calgary, Calgary, Alta
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research (Grundy, Friedenreich, Poirier, Khandwala, Brenner) Alberta Health Services-Cancer Control; Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine (Friedenreich, Brenner), University of Calgary, Calgary, Alta
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research (Grundy, Friedenreich, Poirier, Khandwala, Brenner) Alberta Health Services-Cancer Control; Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine (Friedenreich, Brenner), University of Calgary, Calgary, Alta
| | - Farah Khandwala
- Department of Cancer Epidemiology and Prevention Research (Grundy, Friedenreich, Poirier, Khandwala, Brenner) Alberta Health Services-Cancer Control; Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine (Friedenreich, Brenner), University of Calgary, Calgary, Alta
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research (Grundy, Friedenreich, Poirier, Khandwala, Brenner) Alberta Health Services-Cancer Control; Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine (Friedenreich, Brenner), University of Calgary, Calgary, Alta
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8
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Dartois L, Fagherazzi G, Baglietto L, Boutron-Ruault MC, Delaloge S, Mesrine S, Clavel-Chapelon F. Proportion of premenopausal and postmenopausal breast cancers attributable to known risk factors: Estimates from the E3N-EPIC cohort. Int J Cancer 2016; 138:2415-27. [DOI: 10.1002/ijc.29987] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/10/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Laureen Dartois
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP); U1018, Team 9 Villejuif F-94805 France
- Université Paris-Sud; UMRS 1018 Villejuif F-94805 France
- Gustave Roussy; Villejuif F-94805 France
| | - Guy Fagherazzi
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP); U1018, Team 9 Villejuif F-94805 France
- Université Paris-Sud; UMRS 1018 Villejuif F-94805 France
- Gustave Roussy; Villejuif F-94805 France
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council of Victoria; Melbourne, Victoria Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health; University of Melbourne; Victoria Australia
| | - Marie-Christine Boutron-Ruault
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP); U1018, Team 9 Villejuif F-94805 France
- Université Paris-Sud; UMRS 1018 Villejuif F-94805 France
- Gustave Roussy; Villejuif F-94805 France
| | - Suzette Delaloge
- Department of Medical Oncology; Gustave Roussy; Villejuif F-94805 France
| | - Sylvie Mesrine
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP); U1018, Team 9 Villejuif F-94805 France
- Université Paris-Sud; UMRS 1018 Villejuif F-94805 France
- Gustave Roussy; Villejuif F-94805 France
| | - Françoise Clavel-Chapelon
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP); U1018, Team 9 Villejuif F-94805 France
- Université Paris-Sud; UMRS 1018 Villejuif F-94805 France
- Gustave Roussy; Villejuif F-94805 France
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9
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Krieger N, Habel LA, Waterman PD, Shabani M, Ellison-Loschmann L, Achacoso NS, Acton L, Schnitt SJ. Analyzing historical trends in breast cancer biomarker expression: a feasibility study (1947-2009). NPJ Breast Cancer 2016; 1. [PMID: 26807440 PMCID: PMC4721558 DOI: 10.1038/npjbcancer.2015.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background/Objectives: Determining long-term trends in tumor biomarker expression is essential for understanding aspects of tumor biology amenable to change. Limiting the availability of such data, currently used assays for biomarkers are relatively new. For example, assays for the estrogen receptor (ER), which are the oldest, extend back only to the 1970s. Methods: To extend scant knowledge about the feasibility of obtaining long-term data on tumor biomarkers, we randomly selected 60 breast cancer cases (10 per decade) diagnosed between 1947–2009 among women members of the Kaiser Permanente Northern California health plan to obtain and analyze their formalin-fixed paraffin-embedded (FFPE) tumor specimens. For each tumor specimen, we created duplicate tissue microarrays for analysis. Results: We located tumor blocks and pathology reports for 50 of the 60 cases (83%), from which we randomly sampled 5 cases per decade for biomarker analysis (n=30). All 30 cases displayed excellent morphology and exhibited biomarkers compatible with histologic type and grade. Test–retest reliability was also excellent: 100% for ER; 97% for human epidermal growth factor receptor 2 and epidermal growth factor receptor; 93% for progesterone receptor and cytokeratin 5/6; and 90% for Ki67 and molecular phenotype; the kappa statistic was excellent (>0.9) for 4 of the 7 biomarkers, strong (0.6–0.8) for 2, and fair for only 1 (owing to low prevalence). Conclusions: These results indicate immunostaining for biomarkers commonly used to evaluate breast cancer biology and assign surrogate molecular phenotypes can reliably be employed on archival FFPE specimens up to 60 years old.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laurel A Habel
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Melina Shabani
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Luana Acton
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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van Gemert WA, Lanting CI, Goldbohm RA, van den Brandt PA, Grooters HG, Kampman E, Kiemeney LALM, van Leeuwen FE, Monninkhof EM, de Vries E, Peeters PH, Elias SG. The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors. Breast Cancer Res Treat 2015; 152:155-162. [PMID: 26044369 PMCID: PMC4469298 DOI: 10.1007/s10549-015-3447-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/23/2015] [Indexed: 11/23/2022]
Abstract
We aimed to estimate the proportion of Dutch postmenopausal breast cancer cases in 2010 that is attributable to lifestyle-related risk factors. We calculated population attributable fractions (PAFs) of potentially modifiable risk factors for postmenopausal breast cancer in Dutch women aged >50 in 2010. First, age-specific PAFs were calculated for each risk factor, based on their relative risks for postmenopausal breast cancer (from meta-analyses) and age-specific prevalence in the population (from national surveys) around the year 2000, assuming a latency period of 10 years. To obtain the overall PAF, age-specific PAFs were summed in a weighted manner, using the age-specific breast cancer incidence rates (2010) as weights. 95 % confidence intervals for PAF estimates were derived by Monte Carlo simulations. Of Dutch women >40 years, in 2000, 51 % were overweight/obese, 55 % physically inactive (<5 days/week 30 min activity), 75 % regularly consumed alcohol, 42 % ever smoked cigarettes and 79 % had a low-fibre intake (<3.4 g/1000 kJ/day). These factors combined had a PAF of 25.7 % (95 % CI 24.2–27.2), corresponding to 2,665 Dutch postmenopausal breast cancer cases in 2010. PAFs were 8.8 % (95 % CI 6.3–11.3) for overweight/obesity, 6.6 % (95 % CI 5.2–8.0) for alcohol consumption, 5.5 % (95 % CI 4.0–7.0) for physical inactivity, 4.6 % (95 % CI 3.3–6.0) for smoking and 3.2 % (95 % CI 1.6–4.8) for low-fibre intake. Our findings imply that modifiable risk factors are jointly responsible for approximately one out of four Dutch postmenopausal breast cancer cases. This suggests that incidence rates can be lowered substantially by living a more healthy lifestyle.
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Affiliation(s)
- W A van Gemert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands.
| | - C I Lanting
- Netherlands Organisation for Applied Scientific Research, TNO, P.O. Box 2215, 2301 CE, Leiden, Netherlands
| | - R A Goldbohm
- Netherlands Organisation for Applied Scientific Research, TNO, PO Box 360, 3700 AJ, Zeist, Netherlands
| | - P A van den Brandt
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, Netherlands
| | - H G Grooters
- The Dutch Cancer Society (KWF), P.O. Box 75508, 1070 AM, Amsterdam, Netherlands
| | - E Kampman
- Division of Human Nutrition, Wageningen University, P.O. Box 9101, 6700 HB, Wageningen, Netherlands
| | - L A L M Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, the Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, Netherlands
| | - E M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
| | - E de Vries
- Department of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands.,Comprehensive Cancer Centre South, PO Box 231, 5600 AE, Eindhoven, Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
| | - S G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
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Cancer incidence due to excess body weight and leisure-time physical inactivity in Canada: implications for prevention. Prev Med 2014; 66:131-9. [PMID: 24967956 DOI: 10.1016/j.ypmed.2014.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This analysis aimed to estimate the number of incident cases of various cancers attributable to excess body weight (overweight, obesity) and leisure-time physical inactivity annually in Canada. METHODS The number of attributable cancers was estimated using the population attributable fraction (PAF), risk estimates from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (2000). Age-sex-site-specific cancer incidence was obtained from Statistics Canada tables for the most up-to-date year with full national data, 2007. Where the evidence for association has been deemed sufficient, we estimated the number of incident cases of the following cancers attributable to obesity: colon, breast, endometrium, esophagus (adenocarcinomas), gallbladder, pancreas and kidney; and to physical inactivity: colon, breast, endometrium, prostate, lung and/or bronchus, and ovarian. RESULTS Overall, estimates of all cancer incidence in 2007 suggest that at least 3.5% (n=5771) and 7.9% (n=12,885) are attributed to excess body weight and physical inactivity respectively. For both risk factors the burden of disease was greater among women than among men. CONCLUSION Thousands of incident cases of cancer could be prevented annually in Canada as good evidence exists for effective interventions to reduce these risk factors in the population.
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Uyeturk U, Tatli AM, Gucuk S, Oksuzoglu B, Ulas A, Avci N, Ozbay MF, Gunduz S, Akinci MB, Salim DK, Sonmez OU, Akdag F, Ergenc H. Risk Factors for Stage IV Breast Cancer at the Time of Presentation in Turkey. Asian Pac J Cancer Prev 2013; 14:7445-9. [DOI: 10.7314/apjcp.2013.14.12.7445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Population attributable risk of modifiable risk factors associated with invasive breast cancer in women aged 45–69 years in Queensland, Australia. Maturitas 2013; 76:370-6. [DOI: 10.1016/j.maturitas.2013.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/09/2013] [Accepted: 09/03/2013] [Indexed: 11/20/2022]
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Hayes J, Richardson A, Frampton C. Population attributable risks for modifiable lifestyle factors and breast cancer in New Zealand women. Intern Med J 2013; 43:1198-204. [DOI: 10.1111/imj.12256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. Hayes
- Department of Applied Science and Allied Health; Christchurch Polytechnic Institute of Technology; Christchurch New Zealand
| | - A. Richardson
- Wayne Francis Cancer Epidemiology Research Group; University of Canterbury; Christchurch New Zealand
| | - C. Frampton
- Department of Biostatistics; University of Otago; Christchurch New Zealand
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A Statistical Perspective on Prevention Trials: A View from the Women’s Health Initiative. STATISTICS IN BIOSCIENCES 2013. [DOI: 10.1007/s12561-013-9079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Antoine C, Ameye L, Paesmans M, Rozenberg S. Systematic review about breast cancer incidence in relation to hormone replacement therapy use. Climacteric 2013; 17:116-32. [PMID: 23909434 DOI: 10.3109/13697137.2013.829812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several studies report a decrease in breast cancer incidence subsequent to the decrease in hormone replacement therapy (HRT) use. But its magnitude and the time-lag may vary between countries. This may reflect differences in populations, previous type and prevalence of HRT use and breast cancer screening. AIM To review systematically studies assessing the relation between breast cancer incidence and change of HRT use. MATERIAL AND METHOD Descriptive analysis of the methodology of the studies including design limitations and presence of confounding factors, data sources for breast cancer and HRT and regimens of HRT used. RESULTS AND DISCUSSION Eighteen articles were selected. Most studies were ecological and confounding factors such as mammography screening and changes in reproductive and lifestyle habits could not be excluded. Sources of data on breast cancer and HRT were heterogeneous and only few data on HRT regimens used were available. Most studies concluded that the decrease in HRT use during the last decade was probably associated with a decrease in breast cancer incidence, especially for women aged 50 years or more. CONCLUSIONS Data, mostly from epidemiological studies, suggest that the decrease in breast cancer incidence can be partly attributed to the drop in HRT use. Nevertheless, available studies are hampered by a number of limitations and it remains difficult to evaluate the exact impact of the drop in HRT use on the decrease in breast cancer incidence. Especially, the studies are seldom based on detailed individual data and do not provide information on regimens used, type of cancers and possible confounding factors.
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Affiliation(s)
- C Antoine
- Department of Obstetrics and Gynaecology, Université Libre de Bruxelles (ULB) , CHU Saint-Pierre, Brussels
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Neutel CI, Skurtveit S, Berg C. What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population. Sleep Med 2012; 13:893-7. [DOI: 10.1016/j.sleep.2011.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 11/30/2011] [Accepted: 12/09/2011] [Indexed: 11/28/2022]
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Chlebowski RT, Anderson GL. Changing concepts: Menopausal hormone therapy and breast cancer. J Natl Cancer Inst 2012; 104:517-27. [PMID: 22427684 PMCID: PMC3317878 DOI: 10.1093/jnci/djs014] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/20/2011] [Accepted: 01/02/2012] [Indexed: 12/13/2022] Open
Abstract
Hormone therapy is still used by millions of women for menopausal symptoms. Concerns regarding hormone therapy and breast cancer were initially based on case reports and retrospective case-control studies. However, recent results from large prospective cohort studies and the Women's Health Initiative (WHI) randomized placebo-controlled hormone therapy trials have substantially changed concepts regarding how estrogen alone and estrogen plus progestin influence breast cancer. The preponderance of observational studies suggested that estrogen alone and estrogen plus progestin both increased the risk of breast cancer, with cancers commonly diagnosed at an early stage. However, substantially different results emerged from the WHI randomized hormone therapy trials. In the WHI trial evaluating estrogen plus progestin in postmenopausal women with an intact uterus, combined hormone therapy statistically significantly increased the risk of breast cancer and hindered breast cancer detection, leading to delayed diagnosis and a statistically significant increase in breast cancer mortality. By contrast, estrogen alone use by postmenopausal women with prior hysterectomy in the WHI trial did not substantially interfere with breast cancer detection and statistically significantly decreased the risk of breast cancer. Differential mammography usage patterns may explain differences between observational study and randomized trial results. In clinical practice, hormone therapy users have mammograms more frequently than nonusers, leading to more and earlier stage cancer detection. By contrast, in the WHI randomized trials, mammogram frequency was protocol mandated and balanced between comparison groups. Currently, the different effects of estrogen plus progestin vs estrogen alone on breast cancer are not completely understood.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, 1124 W. Carson St, Torrance, CA 90502, USA.
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