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Katuwal S, Tapanainen J, Pukkala E. Multivariate analysis of independent roles of socioeconomic status, occupational physical activity, reproductive factors, and postmenopausal hormonal therapy in risk of breast cancer. Breast Cancer Res Treat 2022; 193:495-505. [PMID: 35366162 PMCID: PMC9090885 DOI: 10.1007/s10549-022-06571-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This case-control study assesses the independent roles of reproductive history, postmenopausal hormonal therapy (HT), socioeconomic status (SES), and occupational physical activity on the risk of breast cancer (BC). METHODS Odds ratios (OR) were estimated from conditional logistic multivariate regression model in a data set of 19,253 Finnish women diagnosed with BC between 1994 and 2013 and 96,265 age-matched population controls. RESULTS Both pre- and postmenopausal white-collar workers had significantly increased risk of ductal and lobular BC as compared to manual workers. Moderate occupational physical activity reduced risk of lobular BC by 14%. There was a transient increase in the risk of BC observed after each birth followed by a protective effect starting some years after the delivery. As the number of children increased, the short-term excess risk was lower and protective effect was observed earlier. Continuous estrogen-progestin therapy (EPT) significantly increased the risk of both ductal and lobular BC and the magnitude of risk was directly proportional to duration of use (OR for 5+ years of use 2.26, 95% confidence interval 2.12-2.42). Monthly EPT for 5+ years increased the risk (OR 1.32, 95% CI 1.20-1.45). Users of estradiol plus levonorgestrel intrauterine system devices showed ORs of 1.56 (95% CI 1.45-1.69) and 2.18 (95% CI 1.81-2.64) for ductal and lobular BC, respectively. CONCLUSION This study concludes that pregnancy has a dual effect on BC risk, with a transient increase in risk followed by a long-term protective effect. The SES and HT have a large effect on BC risk while occupational physical activity has only a small independent effect.
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Affiliation(s)
- Sushmita Katuwal
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Juha Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Lee J, Lee J, Lee D, Kim H, Kang M. Sedentary work and breast cancer risk: A systematic review and meta-analysis. J Occup Health 2021; 63:e12239. [PMID: 34161650 PMCID: PMC8221371 DOI: 10.1002/1348-9585.12239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to assess sedentary work's contribution to breast cancer risk quantitatively using thorough research articles. METHODS We performed a meta-analysis using a registered protocol in PROSPERO (registration number: CRD42020204629). Literature from PubMed, Embase, and Cochrane involving sedentary work and breast cancer risk was reviewed. We calculated the overall pooled risk ratios (RRs) and 95% CI with a random-effect model from the included studies. Furthermore, we performed stratified analyses by characteristics of studies. RESULTS Thirty-one studies (13 cohort studies and 18 case-control studies) were included in the analysis. The overall effect of the pooled analysis was an RR of 1.16 (95% CI 1.08-1.23). The results were 1.20 (95% CI 1.10-1.30) and 1.12 (95% CI 1.02-1.23) for cohort and case-control studies. The effect of sedentary work did not seem to be consistently attenuated by controlling body mass index, menopausal status, or experience of hormone replacement therapy. CONCLUSION The results from this meta-analysis suggest that sedentary behavior within the occupational domain was associated with a 15.5% increased risk of breast cancer. It is essential to reduce the sedentary time spent at work and to secure time for leisure-time physical activity among sedentary workers as a primary preventive measure.
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Affiliation(s)
- Jongin Lee
- Department of Occupational and Environmental MedicineSeoul St. Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - JaeYong Lee
- Department of Occupational and Environmental MedicineSeoul St. Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Dong‐Wook Lee
- Department of Preventive MedicineCollege of MedicineSeoul National UniversitySeoulRepublic of Korea
| | - Hyoung‐Ryoul Kim
- Department of Occupational and Environmental MedicineSeoul St. Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Mo‐Yeol Kang
- Department of Occupational and Environmental MedicineSeoul St. Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Engel CL, Sharima Rasanayagam M, Gray JM, Rizzo J. Work and Female Breast Cancer: The State of the Evidence, 2002-2017. New Solut 2019; 28:55-78. [PMID: 29658425 DOI: 10.1177/1048291118758460] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The authors undertook a scoping review to assess the literature from 2002 to 2017 on the relationship between occupation and female breast cancer. Case-control, cohort, and meta-analytic studies suggest that women working as flight attendants, in medical professions, some production positions, sales and retail, and scientific technical staff are likely to have elevated risk of breast cancer. In addition, occupational exposures to night-shift work, ionizing radiation, some chemicals, job stress, and sedentary work may increase risk of breast cancer. Occupational physical activity appears to decrease risk. Workplace exposures to passive smoke and occupational exposure to nonionizing radiation do not appear to affect breast cancer risk. Some studies of occupational categories and workplace exposures indicate that risk may be modified by duration of exposure, timing of exposure, dose, hormone-receptor subtypes, and menopausal status at diagnosis. The compelling data from this review reveal a substantial need for further research on occupation and breast cancer.
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Affiliation(s)
- Connie L Engel
- 1 Breast Cancer Prevention Partners, San Francisco, CA, USA
| | | | - Janet M Gray
- 1 Breast Cancer Prevention Partners, San Francisco, CA, USA
| | - Jeanne Rizzo
- 1 Breast Cancer Prevention Partners, San Francisco, CA, USA
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Lynch BM, Mahmood S, Boyle T. Sedentary Behaviour and Cancer. SEDENTARY BEHAVIOUR EPIDEMIOLOGY 2018. [DOI: 10.1007/978-3-319-61552-3_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol 2017; 18:e457-e471. [PMID: 28759385 PMCID: PMC10441558 DOI: 10.1016/s1470-2045(17)30411-4] [Citation(s) in RCA: 361] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022]
Abstract
The lifestyle factors of physical activity, sedentary behaviour, and diet are increasingly being studied for their associations with cancer. Physical activity is inversely associated with and sedentary behaviour is positively (and independently) associated with an increased risk of more than ten types of cancer, including colorectal cancer (and advanced adenomas), endometrial cancers, and breast cancer. The most consistent dietary risk factor for premalignant and invasive breast cancer is alcohol, whether consumed during early or late adult life, even at low levels. Epidemiological studies show that the inclusion of wholegrain, fibre, fruits, and vegetables within diets are associated with reduced cancer risk, with diet during early life (age <8 years) having the strongest apparent association with cancer incidence. However, randomised controlled trials of diet-related factors have not yet shown any conclusive associations between diet and cancer incidence. Obesity is a key contributory factor associated with cancer risk and mortality, including in dose-response associations in endometrial and post-menopausal breast cancer, and in degree and duration of fatty liver disease-related hepatocellular carcinoma. Obesity produces an inflammatory state, characterised by macrophages clustered around enlarged hypertrophied, dead, and dying adipocytes, forming crown-like structures. Increased concentrations of aromatase and interleukin 6 in inflamed breast tissue and an increased number of macrophages, compared with healthy tissue, are also observed in women with normal body mass index, suggesting a metabolic obesity state. Emerging randomised controlled trials of physical activity and dietary factors and mechanistic studies of immunity, inflammation, extracellular matrix mechanics, epigenetic or transcriptional regulation, protein translation, circadian disruption, and interactions of the multibiome with lifestyle factors will be crucial to advance this field.
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Affiliation(s)
- Jacqueline Kerr
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, USA
| | - Cheryl Anderson
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, USA
| | - Scott M Lippman
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Medicine, University of California, La Jolla, San Diego, CA, USA.
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Johnsson A, Broberg P, Johnsson A, Tornberg ÅB, Olsson H. Occupational sedentariness and breast cancer risk. Acta Oncol 2017; 56:75-80. [PMID: 27919198 DOI: 10.1080/0284186x.2016.1262547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Epidemiological studies have indicated that physical activity reduces the risk of developing breast cancer. More recently, sedentary behavior has been suggested as a risk factor independent of physical activity level. The purpose of the present study was to investigate occupational sedentariness and breast cancer risk in pre- and postmenopausal women. MATERIALS AND METHODS In a population-based prospective cohort study (n = 29 524), working history was assessed by a questionnaire between 1990 and 1992. Participants were classified as having: (1) sedentary occupations only; (2) mixed occupations or (3) non-sedentary occupations only. The association between occupational sedentariness and breast cancer incidence was analyzed by Cox regression, adjusted for known risk factors and participation in competitive sports. RESULTS Women with a working history of occupational sedentariness had a significantly increased risk of breast cancer (adjusted HR 1.20; 95% CI 1.05, 1.37) compared with those with mixed or non-sedentary occupations. The association was stronger among women younger than 55 years (adjusted HR 1.54; 95% CI 1.20, 1.96), whereas no association was seen in women 55 years or older. Adjustment for participation in competitive sports did not change the association. CONCLUSIONS We found that occupational sedentariness was associated with increased breast cancer risk, especially in women younger than 55 years. This may be a modifiable risk factor by planning breaks during the working day. Whether this reduces the risk of breast cancer needs to be further studied.
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Affiliation(s)
- Anna Johnsson
- Department of Clinical Sciences and Cancer Epidemiology, Lund University, Lund, Sweden
| | - Per Broberg
- Department of Clinical Sciences and Cancer Epidemiology, Lund University, Lund, Sweden
| | - Anders Johnsson
- Department of Clinical Sciences and Oncology, Lund University, Lund, Sweden
| | - Åsa B. Tornberg
- Department of Health Sciences, Lund University, Lund, Sweden
- Lund University Diabetes Centre (LUDC), Genetic and Molecular Epidemiology (GAME) Unit, Clinical Research Centre, Skåne University Hospital, Lund, Sweden
| | - Håkan Olsson
- Department of Clinical Sciences and Cancer Epidemiology, Lund University, Lund, Sweden
- Department of Clinical Sciences and Oncology, Lund University, Lund, Sweden
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Boyle T, Fritschi L, Kobayashi LC, Heyworth JS, Lee DG, Si S, Aronson KJ, Spinelli JJ. Sedentary work and the risk of breast cancer in premenopausal and postmenopausal women: a pooled analysis of two case-control studies. Occup Environ Med 2016; 73:735-741. [PMID: 27540104 DOI: 10.1136/oemed-2015-103537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/01/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES There is limited research on the association between sedentary behaviour and breast cancer risk, particularly whether sedentary behaviour is differentially associated with premenopausal and postmenopausal breast cancer. We pooled data from 2 case-control studies from Australia and Canada to investigate this association. METHODS This pooled analysis included 1762 incident breast cancer cases and 2532 controls. Participants in both studies completed a lifetime occupational history and self-rated occupational physical activity level. A job-exposure matrix (JEM) was also applied to job titles to assess sedentary work. Logistic regression analyses (6 pooled and 12 study-specific) were conducted to estimate associations between both self-reported and JEM-assessed sedentary work and breast cancer risk among premenopausal and postmenopausal women. RESULTS No association was observed in the 6 pooled analyses, and 10 of the study-specific analyses also showed null results. 2 study-specific analyses provided inconsistent and contradictory results, with 1 showing statistically significant increased risk of breast cancer for self-reported sedentary work among premenopausal women cancer in the Canadian study, and the other a non-significant inverse association between JEM-assessed sedentary work and breast cancer risk among postmenopausal women in the Australian study. CONCLUSIONS While a suggestion of increased risk was seen for premenopausal women in the Canadian study when using the self-reported measure, overall this pooled study does not provide evidence that sedentary work is associated with breast cancer risk.
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Affiliation(s)
- Terry Boyle
- Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Lindsay C Kobayashi
- Department of Epidemiology and Public Health, University College London, London, UK Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Jane S Heyworth
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Derrick G Lee
- Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Si Si
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Kristan J Aronson
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - John J Spinelli
- Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Association of sedentary behavior with the risk of breast cancer in women: update meta-analysis of observational studies. Ann Epidemiol 2015; 25:687-97. [DOI: 10.1016/j.annepidem.2015.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022]
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Schmid D, Leitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst 2014; 106:dju098. [PMID: 24935969 DOI: 10.1093/jnci/dju098] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sedentary behavior is emerging as an independent risk factor for chronic disease and mortality. However, the evidence relating television (TV) viewing and other sedentary behaviors to cancer risk has not been quantitatively summarized. METHODS We performed a comprehensive electronic literature search in Cochrane, EMBASE, Medline, and SciSearch databases through February 2014 for published articles investigating sedentary behavior in relation to cancer incidence. Because randomized controlled trials are difficult to perform on this topic, we focused on observational studies that met uniform inclusion criteria. Data were extracted independently by both authors and summarized using random-effects meta-analysis and meta-regression. All statistical tests were two-sided. RESULTS Data from 43 observational studies including a total of 68936 cancer cases were analyzed. Comparing the highest vs lowest levels of sedentary time, the relative risks (RRs) for colon cancer were 1.54 (95% confidence interval [CI] = 1.19 to 1.98) for TV viewing time, 1.24 (95% CI = 1.09 to 1.41) for occupational sitting time, and 1.24 (95% CI = 1.03 to 1.50) for total sitting time. For endometrial cancer, the relative risks were 1.66 (95% CI = 1.21 to 2.28) for TV viewing time and 1.32 (95% CI = 1.08 to 1.61) for total sitting time. A positive association with overall sedentary behavior was also noted for lung cancer (RR = 1.21; 95% CI = 1.03 to 1.43). Sedentary behavior was unrelated to cancers of the breast, rectum, ovaries, prostate, stomach, esophagus, testes, renal cell, and non-Hodgkin lymphoma. CONCLUSIONS Prolonged TV viewing and time spent in other sedentary pursuits is associated with increased risks of certain types of cancer.
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Affiliation(s)
- Daniela Schmid
- Affiliation of authors: Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (DS, MFL).
| | - Michael F Leitzmann
- Affiliation of authors: Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (DS, MFL)
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Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis 2013; 5 Suppl 1:S2-8. [PMID: 23819024 DOI: 10.3978/j.issn.2072-1439.2013.05.24] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/25/2013] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most common malignancy in women with 6.6% of cases diagnosed in young women below the age of 40. Despite variances in risk factors, Age Standardized Incidence Rates of breast cancer in young women vary little between different countries. Review of modifiable risk factors shows that long-term use of oral contraceptives, low body mass index (BMI) and high animal fat diet consumption are associated with increased risk of premenopausal breast cancer. Decreased physical activity and obesity increase risks of breast cancer in postmenopausal women, but data on premenopausal women rather shows that high BMI is associated with decreased risk of breast cancer. Non-modifiable risk factors such as family history and genetic mutations do account for increased risks of breast cancer in premenopausal women. Breast cancer in young women is associated with adverse pathological factors, including high grade tumors, hormone receptor negativity, and HER2 overexpression. This has a significant negative impact on the rate of local recurrence and overall survival. Moreover, younger women often tend to present with breast cancer at a later stage than their older counterparts, which further explains worse outcome. Despite these factors, age per se is still being advocated as an independent role player in the prognosis. This entails more aggressive treatment modalities and the need for closer monitoring and follow-up.
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Affiliation(s)
- Hussein A Assi
- Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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