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Al-Shami K, Awadi S, Khamees A, Alsheikh AM, Al-Sharif S, Ala’ Bereshy R, Al-Eitan SF, Banikhaled SH, Al-Qudimat AR, Al-Zoubi RM, Al Zoubi MS. Estrogens and the risk of breast cancer: A narrative review of literature. Heliyon 2023; 9:e20224. [PMID: 37809638 PMCID: PMC10559995 DOI: 10.1016/j.heliyon.2023.e20224] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
In female mammals, the development and regulation of the reproductive system and non-reproductive system are significantly influenced by estrogens (oestrogens). In addition, lipid metabolism is another physiological role of estrogens. Estrogens act through different types of receptors to introduce signals to the target cell by affecting many estrogen response elements. Breast cancer is considered mostly a hormone-dependent disease. Approximately 70% of breast cancers express progesterone receptors and/or estrogen receptors, and they are a good marker for cancer prognosis. This review will discuss estrogen metabolism and the interaction of estrogen metabolites with breast cancer. The carcinogenic role of estrogen is discussed in light of both conventional and atypical cancers susceptible to hormones, such as prostate, endometrial, and lung cancer, as we examine how estrogen contributes to the formation and activation of breast cancer. In addition, this review will discuss other factors that can be associated with estrogen-driven breast cancer.
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Affiliation(s)
- Khayry Al-Shami
- Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan
| | - Sajeda Awadi
- Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan
| | - Almu'atasim Khamees
- Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan
- Department of General Surgery, King Hussein Cancer Center, Amman, 11941, Jordan
| | | | - Sumaiya Al-Sharif
- Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan
| | | | - Sharaf F. Al-Eitan
- Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan
| | | | - Ahmad R. Al-Qudimat
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, 2713, Qatar
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, 2713, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
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Mao X, Omeogu C, Karanth S, Joshi A, Meernik C, Wilson L, Clark A, Deveaux A, He C, Johnson T, Barton K, Kaplan S, Akinyemiju T. Association of reproductive risk factors and breast cancer molecular subtypes: a systematic review and meta-analysis. BMC Cancer 2023; 23:644. [PMID: 37430191 DOI: 10.1186/s12885-023-11049-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes. METHODS Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals. RESULTS A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use. CONCLUSION Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.
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Affiliation(s)
- Xihua Mao
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Shama Karanth
- UF Health Cancer Canter, University of Florida, Gainesville, FL, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Clare Meernik
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Lauren Wilson
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Amy Clark
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Chunyan He
- The Cancer Prevention and Control Research Program, University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Tisha Johnson
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Karen Barton
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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Ellingjord-Dale M, Vos L, Vik Hjerkind K, Hjartåker A, Russnes HG, Tretli S, Hofvind S, Dos-Santos-Silva I, Ursin G. Number of Risky Lifestyle Behaviors and Breast Cancer Risk. JNCI Cancer Spectr 2018; 2:pky030. [PMID: 31360858 PMCID: PMC6649737 DOI: 10.1093/jncics/pky030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/03/2018] [Accepted: 06/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Lifestyle factors are associated with overall breast cancer risk, but less is known about their associations, alone or jointly, with risk of specific breast cancer subtypes. Methods We conducted a case-control subjects study nested within a cohort of women who participated in the Norwegian Breast Cancer Screening Program during 2006-2014 to examine associations between risky lifestyle factors and breast cancer risk. In all, 4402 breast cancer cases subjects with information on risk factors and hormone receptor status were identified. Conditional logistic regression was used to estimate odds ratios (ORs), with 95% confidence intervals (CIs), in relation to five risky lifestyle factors: body mass index (BMI) of 25 kg/m² or greater, three or more glasses of alcoholic beverages per week, ever smoking, fewer than four hours of physical activity per week, and ever use of menopausal hormone therapy. Analyses were adjusted for education, age at menarche, number of pregnancies, and menopausal status. All statistical tests were two-sided. Results Compared with women with no risky lifestyle behaviors, those with five had 85% (OR = 1.85, 95% CI = 1.42 to 2.42, P trend < .0001) increased risk of breast cancer overall. This association was limited to luminal A-like (OR = 2.20, 95% CI = 1.55 to 3.12, P trend < .0001) and luminal B-like human epidermal growth factor receptor 2 (HER2)-positive (OR = 1.66, 95% CI = 0.61 to 4.54, P trend < .004) subtypes. Number of risky lifestyle factors was not associated with increased risk of luminal B-like HER2-negative, HER2-positive, or triple-negative subtypes (P trend > .18 for all). Conclusions Number of risky lifestyle factors was positively associated with increased risk for luminal A-like and luminal B-like HER2-positive breast cancer.
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Affiliation(s)
| | - Linda Vos
- Department of research, Cancer Registry of Norway, Oslo, Norway
| | | | - Anette Hjartåker
- Department of nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hege G Russnes
- Department of Pathology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Steinar Tretli
- Department of research, Cancer Registry of Norway, Oslo, Norway
| | - Solveig Hofvind
- Department of research, Cancer Registry of Norway, Oslo, Norway.,Department of radiography and dental technology, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Giske Ursin
- Department of research, Cancer Registry of Norway, Oslo, Norway.,Division of epidemiology, University of Southern California, Los Angeles, CA
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Ellingjord-Dale M, Vos L, Tretli S, Hofvind S, Dos-Santos-Silva I, Ursin G. Parity, hormones and breast cancer subtypes - results from a large nested case-control study in a national screening program. Breast Cancer Res 2017; 19:10. [PMID: 28114999 PMCID: PMC5259848 DOI: 10.1186/s13058-016-0798-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 12/29/2022] Open
Abstract
Background Breast cancer comprises several molecular subtypes with different prognoses and possibly different etiology. Reproductive and hormonal factors are associated with breast cancer overall, and with luminal subtypes, but the associations with other subtypes are unclear. We used data from a national screening program to conduct a large nested case-control study. Methods We conducted a nested case-control study on participants in the Norwegian Breast Cancer Screening Program in 2006 − 2014. There was information on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) for 4748 cases of breast cancer. Breast cancer subtypes were defined as luminal A-like (ER+ PR+ HER2-), luminal B-like (ER+ PR- HER2- or ER+ PR+/PR-HER2+), HER2-positive (ER- PR- HER2+) and triple-negative (ER- PR- HER2-). Conditional logistic regression was used to estimate odds ratios (ORs) of breast cancer associated with age at first birth, number of pregnancies, oral contraceptive use, intrauterine devices and menopausal hormone therapy. Analyses were adjusted for age, body mass index, education, age at menarche, number of pregnancies and menopausal status. Results Number of pregnancies was inversely associated with relative risk of luminal-like breast cancers (p-trend ≤0.02), and although not statistically significant, with HER2-positive (OR = 0.60, 95% CI 0.31–1.19) and triple-negative cancer (OR = 0.70, 95% CI 0.41–1.21). Women who had ≥4 pregnancies were at >40% lower risk of luminal-like and HER2-positive cancers than women who had never been pregnant. However, there was a larger discrepancy between tumor subtypes with menopausal hormone use. Women who used estrogen and progesterone therapy (EPT) had almost threefold increased risk of luminal A-like cancer (OR = 2.92, 95% CI 2.36–3.62) compared to never-users, but were not at elevated risk of HER2-positive (OR = 0.88, 95% CI 0.33–2.30) or triple-negative (OR = 0.92, 95% CI 0.43 − 1.98) subtypes. Conclusions Reproductive factors were to some extent associated with all subtypes; the strongest trends were with luminal-like subtypes. Hormone therapy use was strongly associated with risk of luminal-like breast cancer, and less so with risk of HER2-positive or triple-negative cancer. There are clearly some, but possibly limited, etiologic differences between subtypes, with the greatest contrast between luminal A-like and triple-negative subtypes. Trial registration Not applicable.
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Affiliation(s)
| | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | | | | | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway. .,University of Oslo, Oslo, Norway. .,University of Southern California, Los Angeles, CA, USA.
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