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Palma D, Thakur N, Loy JC, Margulies BS. Treating bone metastases with local therapy in a breast cancer patient resulted in decreased pain and prevented fracture. Pain Manag 2023; 13:569-577. [PMID: 37795710 DOI: 10.2217/pmt-2023-0069] [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] [Indexed: 10/06/2023] Open
Abstract
Lytic lesions from bone metastases from breast, lung and prostate carcinomas, are associated with a poor prognosis and significant morbidities that include fracture and debilitating pain. Chemotherapeutics, palliative radiation therapy and surgical intervention are routinely used to treat these lesions. The ZetaMet™ Bone Graft is a novel antitumorigenic and osteoinductive graft that offers a potential alternative treatment option. ZetaMet is composed of calcium phosphate salts, type-I collagen and the small molecule N-allyl noroxymorphone dihydrate. Here, we report the case of a stage IV breast cancer patient with multiple lytic metastatic lesions to the spine that were successfully treated, which led to a significant reduction in pain and increased quality of life. This outcome demonstrates that a locally administered therapeutic intervention may represent an important alternative for patients with bone metastases that warrants further study.
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Affiliation(s)
- David Palma
- Mobility Bone & Joint Institute, Andover, MA 01810, USA
| | - Nikhil Thakur
- Mobility Bone & Joint Institute, Andover, MA 01810, USA
- Zetagen Therapeutics, Syracuse, NY 13210, USA
| | - Joe C Loy
- Zetagen Therapeutics, Syracuse, NY 13210, USA
| | - Bryan S Margulies
- Zetagen Therapeutics, Syracuse, NY 13210, USA
- Department of Pathology, College of Medicine, Upstate Medical University, Syracuse, NY 13210, USA
- Department Biological Sciences, University of Notre Dame, Notre Dame, IN 46556, USA
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Castillo C, Camejo N, Etcheverria C, Ferradaz J, Ferreira A, Fontan A, Gabin AS, Herrera G, Artagaveytia N, Parma G, Delgado L. Trastuzumab-induced cardiotoxicity in early breast cancer over a 10-year period in Uruguay. Medicine (Baltimore) 2022; 101:e29927. [PMID: 35905268 PMCID: PMC9333491 DOI: 10.1097/md.0000000000029927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This srudy aimed to estimate the prevalence of trastuzumab-induced cardiotoxicity in Uruguayan women diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer over a 10-year period, who were treated under the financial coverage of the National Resources Fund (Fondo Nacional de Recursos). This was an observational, descriptive study based on the analysis of an anonymized database of Uruguayan women diagnosed with HER2-positive breast cancer who received adjuvant trastuzumab treatment from to 2006 to 2016, provided by the Fondo Nacional de Recursos. Statistical analysis was performed using SPSS Statistics version 25, and variables were assessed using measures of central tendency, dispersion, contingency tables, and proportions. The chi-square test was used to analyze the association between the different variables. The study included 1401 patients diagnosed with stage I to III HER2-positive breast cancer. The mean age at diagnosis was 52 years. The prevalence of cardiotoxicity was 20.3%. Most patients who discontinued treatment owing to cardiotoxicity eventually resumed treatment (92.6%). Moreover, the prevalence of cardiotoxicity was similar among patients who received regimens with and without anthracyclines. No association was observed between prior cardiovascular events or trastuzumab administration (concurrent vs sequential) and the development of cardiotoxicity. In the present study, the prevalence of cardiotoxicity was similar to that reported nationally and internationally. Most patients did not develop cardiotoxicity, while the ones who developed it remained asymptomatic and cardiotoxicity was reversible.
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Affiliation(s)
- Cecilia Castillo
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
- *Correspondence: Cecilia Castillo, Hospital de Clinicas. Av Italia s/n. CP 11600, Montevideo, Uruguay (e-mail: )
| | - Natalia Camejo
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
| | | | | | | | - Analia Fontan
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Ana Sofia Gabin
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Nora Artagaveytia
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
| | - Gabriel Parma
- Unidad de Imagen Cardíaca, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la Rpública
| | - Lucía Delgado
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
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Ding YC, Hurley S, Park JS, Steele L, Rakoff M, Zhu Y, Zhao J, LaBarge M, Bernstein L, Chen S, Reynolds P, Neuhausen SL. Methylation biomarkers of polybrominated diphenyl ethers (PBDEs) and association with breast cancer risk at the time of menopause. ENVIRONMENT INTERNATIONAL 2021; 156:106772. [PMID: 34425644 PMCID: PMC8385228 DOI: 10.1016/j.envint.2021.106772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Exposure to polybrominated diphenyl ethers (PBDEs) may influence risk of developing post-menopausal breast cancer. Although mechanisms are poorly understood, epigenetic regulation of gene expression may play a role. OBJECTIVES To identify DNA methylation (DNAm) changes associated with PBDE serum levels and test the association of these biomarkers with breast cancer risk. METHODS We studied 397 healthy women (controls) and 133 women diagnosed with breast cancer (cases) between ages 40 and 58 years who participated in the California Teachers Study. PBDE levels were measured in blood. Infinium Human Methylation EPIC Bead Chips were used to measure DNAm. Using multivariable linear regression models, differentially methylated CpG sites (DMSs) and regions (DMRs) associated with serum PBDE levels were identified using controls. For top-ranked DMSs and DMRs, targeted next-generation bisulfite sequencing was used to measure DNAm for 133 invasive breast cancer cases and 301 age-matched controls. Conditional logistic regression was used to evaluate associations between DMSs and DMRs and breast cancer risk. RESULTS We identified 15 DMSs and 10 DMRs statistically significantly associated with PBDE levels (FDR < 0.05). Methylation changes in a DMS at BMP8B and DMRs at TP53 and A2M-AS1 were statistically significantly (FDR < 0.05) associated with breast cancer risk. CONCLUSION We show for the first time that serum PBDE levels are associated with differential methylation and that PBDE-associated DNAm changes in blood are associated with breast cancer risk.
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Affiliation(s)
- Yuan Chun Ding
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Susan Hurley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - June-Soo Park
- Environmental Chemistry Laboratory, Department of Toxic Substances Control, Berkeley, CA, USA
| | - Linda Steele
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Michele Rakoff
- Breast Cancer Care and Research Fund, Los Angeles, CA, USA
| | - Yun Zhu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark LaBarge
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Shiuan Chen
- Department of Cancer Biology, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA.
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Camejo N, Castillo C, Alonso R, Correa F, Rivero E, Mezquita C, Rosich A, Dellacasa F, Silveira L, Delgado L. Effectiveness of Trastuzumab for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer in a Real-Life Setting: One Decade of Experience Under National Treatment Coverage Regulations. JCO Glob Oncol 2021; 6:217-223. [PMID: 32045546 PMCID: PMC7051800 DOI: 10.1200/jgo.19.00299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were included: 1,085 women (55.8%) were postmenopausal and 1,240 (63.7%) had HER2 and hormone receptor–positive BC. Trastuzumab was administered as adjuvant therapy to 1,233 patients (63.5%), of whom 154 also received it as a neoadjuvant treatment. Three hundred nineteen patients (16.4%) received trastuzumab for advanced disease. Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months). CONCLUSION Our survival results are not inferior to those reported in clinical trials, in both adjuvant and advanced settings. Importantly, these results support the relevance and the feasibility of treating patients in routine practice, following coverage protocols based on patient selection criteria and methods supported by positive clinical trials. In addition, these results favor quality and appropriate access to BC treatment in our country.
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Affiliation(s)
- Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Rafael Alonso
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Emiliano Rivero
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Camila Mezquita
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Agustin Rosich
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | | | - Lucía Delgado
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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5
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Dai D, Zhong Y, Wang Z, Yousafzai NA, Jin H, Wang X. The prognostic impact of age in different molecular subtypes of breast cancer: a population-based study. PeerJ 2019; 7:e7252. [PMID: 31309004 PMCID: PMC6612417 DOI: 10.7717/peerj.7252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background The aim of current study was to use competing risk model to calculate the potential differences that age played in the prognosis of different breast cancer subtypes. Methods The cohort was selected from Surveillance, Epidemiology, and End Results (SEER) program. The cumulative incidences of death (CID) was assessed for breast cancer caused deaths and other causes of mortality. The multivariate Cox proportional hazards regression model and the multivariate subdistribution hazard (SH) model were used to evaluate the prognostic value of age in different breast cancer subtypes. Results We involved 33,968 breast cancer patients into our cohort. We found older patients had worse overall survival (OS) than young patients in hormone receptor positive and human epidermal growth factor receptor 2 positive breast cancer (HR+/HER2+) (≥40 vs. <40, HR = 2.07, 95% CI [1.28-3.35], p < 0.05). However, when we used competing risk model, we found young age was an independent risk factor only for triple negative breast cancer (TNBC) (≥40 vs. <40, HR = 0.71, 95% CI [0.56-0.89], p < 0.05). No association was found in other groups. Conclusion Our research was currently the largest sample size study and the first competing risk model-based study on the prognostic association between age and different breast cancer subtypes. We found <40 years patients had worse breast cancer specific survival (BCSS) than older patients in the TNBC subtype.
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Affiliation(s)
- Dongjun Dai
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiming Zhong
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhuo Wang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
| | - Neelum Aziz Yousafzai
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hongchuan Jin
- Laboratory of Cancer Biology, Key Lab of Biotherapy, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xian Wang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, Zhejiang, China
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Prevalence and oncologic outcomes of BRCA 1/2 mutations in unselected triple-negative breast cancer patients in Korea. Breast Cancer Res Treat 2018; 173:385-395. [PMID: 30350268 DOI: 10.1007/s10549-018-5015-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) accounts for 10-20% of all diagnosed BCs and it is enriched in BRCA1 mutation. Guidelines for Western countries suggest that BRCA 1/2 genetic testing should be done for patients with TNBC diagnosed less than 60 years, but there is lack of evidence supporting genetic testing in Asian populations. We determined the prevalence of germline BRCA 1/2 mutations among unselected Korean patients with TNBC and analyzed oncologic outcomes. METHODS From among 1628 women with TNBC who underwent surgery at Samsung Medical Center (SMC) between Jul 2008 and Jan 2016, 999 samples were available in the SMC biobank for testing germline BRCA 1/2 mutations using next-generation DNA sequencing. RESULTS Overall, 131 Korean patients (13.1%) had BRCA 1/2 mutations: 97 (9.7%) were in BRCA 1, and 35 (3.5%) were in BRCA 2. One patient had both BRCA 1 and BRCA 2 mutations. Overall, 68 distinct pathologic or likely pathogenic variants (43 BRCA1 and 25 BRCA2) were found. Among those diagnosed at ≤ 60 years, the prevalence of BRCA 1/2 mutation was 14.5%. The mean age of diagnosis of BRCA1/2 mutation carriers was significantly younger than that of non-carriers (45.6 vs. 50.1 years, p < 0.0001). The median follow-up duration was 53.6 months. There were no significant differences in disease-free survival, overall survival, or breast cancer-specific survival (p = 0.799, 0.092, and 0.124, respectively) between BRCA 1/2 carriers and non-carriers, although BRCA 1/2 carriers showed significantly worse contralateral breast cancer-free survival (p < 0.0001) than non-carriers. CONCLUSION In unselected TNBC patients, we found BRCA 1/2 mutations in 13.1% of overall patients and 14.5% of patients ≤ 60 years. We suggest that Korean women with TNBC diagnosed at ≤ 60 years should be tested for BRCA1/2 mutation.
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Gaudet MM, Gierach GL, Carter BD, Luo J, Milne RL, Weiderpass E, Giles GG, Tamimi RM, Eliassen AH, Rosner B, Wolk A, Adami HO, Margolis KL, Gapstur SM, Garcia-Closas M, Brinton LA. Pooled Analysis of Nine Cohorts Reveals Breast Cancer Risk Factors by Tumor Molecular Subtype. Cancer Res 2018; 78:6011-6021. [PMID: 30185547 PMCID: PMC6223627 DOI: 10.1158/0008-5472.can-18-0502] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/11/2018] [Accepted: 08/27/2018] [Indexed: 11/16/2022]
Abstract
Various subtypes of breast cancer defined by estrogen receptor (ER), progesterone receptor (PR), and HER2 exhibit etiologic differences in reproductive factors, but associations with other risk factors are inconsistent. To clarify etiologic heterogeneity, we pooled data from nine cohort studies. Multivariable, joint Cox proportional hazards regression models were used to estimate HRs and 95% confidence intervals (CI) for molecular subtypes. Of 606,025 women, 11,741 invasive breast cancers with complete tissue markers developed during follow-up: 8,700 luminal A-like (ER+ or PR+/HER2-), 1,368 luminal B-like (ER+ or PR+/HER2+), 521 HER2-enriched (ER-/PR-/HER2+), and 1,152 triple-negative (ER-/PR-/HER2-) disease. Ever parous compared with never was associated with lower risk of luminal A-like (HR, 0.78; 95% CI, 0.73-0.83) and luminal B-like (HR, 0.74; 95% CI, 0.64-0.87) as well as a higher risk of triple-negative disease (HR, 1.23; 95% CI, 1.02-1.50; P value for overall tumor heterogeneity < 0.001). Direct associations with luminal-like, but not HER2-enriched or triple-negative, tumors were found for age at first birth, years between menarche and first birth, and age at menopause (P value for overall tumor heterogeneity < 0.001). Age-specific associations with baseline body mass index differed for risk of luminal A-like and triple-negative breast cancer (P value for tumor heterogeneity = 0.02). These results provide the strongest evidence for etiologic heterogeneity of breast cancer to date from prospective studies.Significance: These findings comprise the largest study of prospective data to date and contribute to the accumulating evidence that etiological heterogeneity exists in breast carcinogenesis. Cancer Res; 78(20); 6011-21. ©2018 AACR.
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Affiliation(s)
- Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia.
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Brian D Carter
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Community Medicine, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alicja Wolk
- Department of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | | | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Feng F, Wei Y, Zheng K, Li Y, Zhang L, Wang T, Zhang Y, Li H, Ren G, Li F. Comparison of epidemiological features, clinicopathological features, and treatments between premenopausal and postmenopausal female breast cancer patients in western China: a retrospective multicenter study of 15,389 female patients. Cancer Med 2018; 7:2753-2763. [PMID: 29673111 PMCID: PMC6010855 DOI: 10.1002/cam4.1503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/04/2018] [Accepted: 03/20/2018] [Indexed: 12/20/2022] Open
Abstract
Premenopausal and postmenopausal breast cancers are considered different types. Thus, this study aimed to explore differences in risk factors, epidemiological features, clinicopathological features, and treatment modes of premenopausal breast cancer compared to postmenopausal patients in western China. This was a hospital-based, retrospective, multicenter epidemiological study of patients with breast cancer. Using the Western China Clinical Cooperation Group database, we obtained the records of 15,389 female breast cancers between January 2010 and April 2017. These patients were divided into premenopausal and postmenopausal groups, and their risk factors, epidemiological feature, clinicopathological features, and treatment modes were compared. Chi-square tests, t-test, and the multivariate logistic regression analysis were applied for statistical analysis. A total of 8395 patients were categorized as premenopausal, and 6994 patients were categorized as postmenopausal. Their risk factors, epidemiological features, clinicopathological features, and treatment modes were compared. Premenopausal patients with breast cancer had a greater tumor diameter at diagnosis (P = 0.008); higher rates of estrogen receptor (ER) expression (P < 0.0001), progesterone receptor (PR) expression (P < 0.0001), negative human epidermal growth factor receptor 2 (HER2) expression (P = 0.015), and negative P53 expression (P < 0.0001); and higher proportions of receiving breast-conserving surgery and breast reconstruction (P < 0.0001), chemotherapy (P < 0.0001), radiotherapy (P < 0.0001), and endocrine therapy (P < 0.0001). The ethnicity, age at menarche, marital status, number of pregnancies, and number of births were the risk factors for age at diagnosis of breast cancer before or after menopause in western China. We found that the fall in the fertility rate, early menarche age, married, and less breastfeeding might have increased the possibility of premenopausal breast cancer. Significant differences exist in the tumor size, hormone receptor state, HER2 expression, epidemiological features, and treatment modes between premenopausal and postmenopausal female breast cancer patients in western China. Its further implementation requires prospective clinical testing.
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Affiliation(s)
- Fan Feng
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Yuxian Wei
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Ke Zheng
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Yujing Li
- Department of OncologyThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Lu Zhang
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Tielin Wang
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Yanli Zhang
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Hongyuan Li
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Guosheng Ren
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
| | - Fan Li
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of ChongQing Medical UniversityFriendship RoadYu‐Zhong District, ChongQing400016China
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Fallahpour S, Navaneelan T, De P, Borgo A. Breast cancer survival by molecular subtype: a population-based analysis of cancer registry data. CMAJ Open 2017; 5:E734-E739. [PMID: 28951445 PMCID: PMC5621954 DOI: 10.9778/cmajo.20170030] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The relation between breast cancer molecular subtype and survival has been studied in several jurisdictions, but limited information is available for Ontario. The aim of this study was to determine breast cancer survival by molecular subtype and to assess the effect on survival of selected demographic and tumour-based characteristics. METHODS We extracted 29 833 breast cancer cases (in 26 538 girls and women aged ≥ 15 yr) diagnosed between 2010 and 2012 from the Ontario Cancer Registry. Cancers were categorized into 4 molecular subtypes: 1) luminal A (estrogen-receptor-positive and/or progesterone-receptor-positive [ER+ and/or PR+] and negative for human epidermal growth factor receptor 2 [HER2-]), 2) luminal B (ER+ and/or PR+/HER2+), 3) HER2-enriched (ER- and PR-/HER2+) and 4) triple-negative (ER- and PR-/HER2-). We estimated associations with predictor variables (age, stage at diagnosis, histologic type, comorbidity and place of residence [urban or rural]) using a multivariate Cox proportional hazards model. Likelihood ratio testing was used to evaluate differences in risk of death. RESULTS Luminal A was the most commonly diagnosed subtype (59.0%) and had the greatest survival, whereas triple-negative had the poorest survival. For all subtypes, a dose-response effect was observed between the hazard of death and age and stage at diagnosis, with the greatest effect found for the HER2-enriched subtype (age: hazard ratio [HR] 7.87 [95% confidence interval (CI) 3.68-11.81]; stage at diagnosis: HR 37.71 [95% CI 34.64-41.27]). Moderate comorbidity (Charlson Comorbidity Index score 1 or 2) was associated with increased risk of death for triple-negative cancers (HR 2.42 [95% CI 1.36-4.31]), and severe comorbidity (Charlson Comorbidity Index score ≥ 3) increased the risk for all molecular subtypes. INTERPRETATION The results indicate the importance of including molecular subtype, along with age, stage at diagnosis and comorbidity, in assessing breast cancer survival. They highlight the need to address outcomes related to hormone-receptor-negative cancers, for which survival lags behind that for hormone-receptor-positive cancers.
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Affiliation(s)
- Saber Fallahpour
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Tanya Navaneelan
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Prithwish De
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Alessia Borgo
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
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Iwamoto T, Kumamaru H, Miyata H, Tomotaki A, Niikura N, Kawai M, Anan K, Hayashi N, Masuda S, Tsugawa K, Aogi K, Ishida T, Masuoka H, Iijima K, Matsuoka J, Doihara H, Kinoshita T, Nakamura S, Tokuda Y. Distinct breast cancer characteristics between screen- and self-detected breast cancers recorded in the Japanese Breast Cancer Registry. Breast Cancer Res Treat 2016; 156:485-494. [PMID: 27048417 PMCID: PMC4837218 DOI: 10.1007/s10549-016-3770-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 11/12/2022]
Abstract
The rate of breast cancer screening for women of all ages in Japan is increasing. However, little is known about the biological differences between screen- and self-detected tumors. We used data from the Japanese Breast Cancer Registry (JBCR), a nationwide registry of newly diagnosed breast cancer cases in Japan, to investigate patients diagnosed between January 1, 2004 and December 31, 2011. We compared the clinicopathological features of tumors and assessed yearly trends regarding the proportion of screen-detected cases during the study period. We found that 31.8 % (65,358/205,544) of cancers were detected by screening. Asymptomatic tumors detected by screening (asymptomatic) were more likely to have favorable prognostic features than those that were self-detected (ductal carcinoma in situ [DCIS]: 19.8 versus 4.1 %, node-negative: 77.0 versus 61.6 %, and estrogen receptor-positive [ER+]: 82.0 versus 72.9 %, respectively). All these findings were statistically significant (p < .001). The proportion of breast cancers detected by screening among all cases increased from 21.7 % in 2004 to 37.1 % in 2011. During the same time period, the proportion of screen-detected DCIS increased from 41.5 to 66.0 % and that of ER+ cancers increased from 23.2 to 39.7 %. This study demonstrated that low-risk tumors, including DCIS, ER+, and lower TNM stage, account for a substantial proportion of clinical screening-detected cancers. The differences in biological characteristics between screen- and self-detected cancers may account in part for the limited efficacy of breast cancer screening programs aimed at improving breast cancer mortality.
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Affiliation(s)
- Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City, Okayama, 700-8558, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Ai Tomotaki
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masaaki Kawai
- Department of Breast Surgery, Miyagi Cancer Center, Natori, Japan
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Naoki Hayashi
- Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shinobu Masuda
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenjiro Aogi
- Department of Breast Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Takanori Ishida
- Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Kotaro Iijima
- Department of Breast Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Junji Matsuoka
- Department of Palliative and Supportive Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City, Okayama, 700-8558, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, Tokyo, Japan
| | - Yutaka Tokuda
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
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11
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Cadherin-5: a biomarker for metastatic breast cancer with optimum efficacy in oestrogen receptor-positive breast cancers with vascular invasion. Br J Cancer 2016; 114:1019-26. [PMID: 27010749 PMCID: PMC4984911 DOI: 10.1038/bjc.2016.66] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/14/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A glycoproteomic study has previously shown cadherin-5 (CDH5) to be a serological marker of metastatic breast cancer when both protein levels and glycosylation status were assessed. In this study we aimed to further validate the utility of CDH5 as a biomarker for breast cancer progression. METHODS A nested case-control study of serum samples from breast cancer patients, of which n=52 had developed a distant metastatic recurrence within 5 years post-diagnosis and n=60 had remained recurrence-free. ELISAs were used to quantify patient serum CDH5 levels and assess glycosylation by Helix pomatia agglutinin (HPA) binding. Clinicopathological, treatment and lifestyle factors associated with metastasis and elevated biomarker levels were identified. RESULTS Elevated CDH5 levels (P=0.028) and ratios of CDH5:HPA binding (P=0.007) distinguished patients with metastatic disease from those that remained metastasis-free. Multivariate analysis showed that the association between CDH5:HPA ratio and the formation of distant metastases was driven by patients with oestrogen receptor (ER+) positive cancer with vascular invasion (VI+). CONCLUSIONS CDH5 levels and the CDH5 glycosylation represent biomarker tests that distinguish patients with metastatic breast cancer from those that remain metastasis-free. The test reached optimal sensitivity and specificity in ER-positive cancers with vascular invasion.
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Hsieh YC, Cho EC, Tu SH, Wu CH, Hung CS, Hsieh MC, Su CT, Liu YR, Lee CH, Ho YS, Chiou HY. MSH2 rs2303425 Polymorphism is Associated with Early-Onset Breast Cancer in Taiwan. Ann Surg Oncol 2016; 24:603-610. [DOI: 10.1245/s10434-016-5168-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Indexed: 11/18/2022]
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13
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Mordukhovich I, Beyea J, Herring AH, Hatch M, Stellman SD, Teitelbaum SL, Richardson DB, Millikan RC, Engel LS, Shantakumar S, Steck SE, Neugut AI, Rossner P, Santella RM, Gammon MD. Vehicular Traffic-Related Polycyclic Aromatic Hydrocarbon Exposure and Breast Cancer Incidence: The Long Island Breast Cancer Study Project (LIBCSP). ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:30-8. [PMID: 26008800 PMCID: PMC4710589 DOI: 10.1289/ehp.1307736] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 05/19/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental pollutants, known human lung carcinogens, and potent mammary carcinogens in laboratory animals. However, the association between PAHs and breast cancer in women is unclear. Vehicular traffic is a major ambient source of PAH exposure. OBJECTIVES Our study aim was to evaluate the association between residential exposure to vehicular traffic and breast cancer incidence. METHODS Residential histories of 1,508 participants with breast cancer (case participants) and 1,556 particpants with no breast cancer (control participants) were assessed in a population-based investigation conducted in 1996-1997. Traffic exposure estimates of benzo[a]pyrene (B[a]P), as a proxy for traffic-related PAHs, for the years 1960-1995 were reconstructed using a model previously shown to generate estimates consistent with measured soil PAHs, PAH-DNA adducts, and CO readings. Associations between vehicular traffic exposure estimates and breast cancer incidence were evaluated using unconditional logistic regression. RESULTS The odds ratio (95% CI) was modestly elevated by 1.44 (0.78, 2.68) for the association between breast cancer and long-term 1960-1990 vehicular traffic estimates in the top 5%, compared with below the median. The association with recent 1995 traffic exposure was elevated by 1.14 (0.80, 1.64) for the top 5%, compared with below the median, which was stronger among women with low fruit/vegetable intake [1.46 (0.89, 2.40)], but not among those with high fruit/vegetable intake [0.92 (0.53, 1.60)]. Among the subset of women with information regarding traffic exposure and tumor hormone receptor subtype, the traffic-breast cancer association was higher for those with estrogen/progesterone-negative tumors [1.67 (0.91, 3.05) relative to control participants], but lower among all other tumor subtypes [0.80 (0.50, 1.27) compared with control participants]. CONCLUSIONS In our population-based study, we observed positive associations between vehicular traffic-related B[a]P exposure and breast cancer incidence among women with comparatively high long-term traffic B[a]P exposures, although effect estimates were imprecise. CITATION Mordukhovich I, Beyea J, Herring AH, Hatch M, Stellman SD, Teitelbaum SL, Richardson DB, Millikan RC, Engel LS, Shantakumar S, Steck SE, Neugut AI, Rossner P Jr., Santella RM, Gammon MD. 2016. Vehicular traffic-related polycyclic aromatic hydrocarbon exposure and breast cancer incidence: the Long Island Breast Cancer Study Project (LIBCSP). Environ Health Perspect 124:30-38; http://dx.doi.org/10.1289/ehp.1307736.
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Affiliation(s)
- Irina Mordukhovich
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
- Address correspondence to I. Mordukhovich, Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Dr., Boston, MA 02215 USA. Telephone: (617) 384-8754. E-mail:
| | - Jan Beyea
- Consulting in the Public Interest, Lambertville, New Jersey, USA
| | - Amy H. Herring
- Department of Biostatistics, and
- Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Steven D. Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Susan L. Teitelbaum
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - David B. Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert C. Millikan
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lawrence S. Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Susan E. Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Alfred I. Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Medicine, and
| | - Pavel Rossner
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
- Laboratory of Genetic Ecotoxicology, Institute of Experimental Medicine AS CR, Prague, Czech Republic
| | - Regina M. Santella
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Marilie D. Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
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McCullough LE, Miller EE, Wang Q, Li JY, Liu L, Li H, Zhang J, Smith JS. Cross-Sectional Associations between Body Size, Circulating Sex-Steroid Hormones and IGF Components among Healthy Chinese Women. PLoS One 2015; 10:e0137686. [PMID: 26352264 PMCID: PMC4564271 DOI: 10.1371/journal.pone.0137686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/19/2015] [Indexed: 01/03/2023] Open
Abstract
The incidence of breast cancer has increased in Asian countries and rates of hormone receptor (HR) negative breast cancer exceed those of Western countries. Epidemiologic data suggest that the association between body size and BC risk may vary by HR status, and could differ geographically. While body size may influence BC risk by moderating the synthesis and metabolism of circulating sex-steroid hormones, insulin-like growth factor (IGF)-1 and related binding proteins, there is a dearth of literature among Asian women. We aimed to examine these specific associations in a sample of Chinese women. In Sichuan Province 143 women aged ≥40 years were recruited through outpatient services (2011–2012). Questionnaires, anthropometric measurements, and blood samples were utilized for data collection and linear regression was applied in data analyses. Among women <50 years we observed a non-monotonic positive association between body mass index (BMI) and 17β-estradiol, and a reversed J-shaped association between BMI and IGF-1 (p ≤0.05). We observed similar associations between waist-to-hip ratio and these markers. Our finding of augmented IGF-1 among women with low body mass may have implications for understanding breast tumor heterogeneity in diverse populations and should be evaluated in larger prospective studies with cancer outcomes.
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Affiliation(s)
- Lauren E. McCullough
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, North Carolina, 27514, United States of America
| | - Erline E. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
| | - Qiong Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
| | - Jia-yuan Li
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
- * E-mail:
| | - Li Liu
- The Comprehensive Guidance Center of Women's Health, Chengdu Women’s and Children’s Central Hospital, Shi Ye Street, Qingyang District, Chengdu, 610015, P.R. China
| | - Hui Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
| | - Jing Zhang
- The Comprehensive Guidance Center of Women's Health, Chengdu Women’s and Children’s Central Hospital, Shi Ye Street, Qingyang District, Chengdu, 610015, P.R. China
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, North Carolina, 27514, United States of America
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15
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Ambrosone CB, Zirpoli G, Hong CC, Yao S, Troester MA, Bandera EV, Schedin P, Bethea TN, Borges V, Park SY, Chandra D, Rosenberg L, Kolonel LN, Olshan AF, Palmer JR. Important Role of Menarche in Development of Estrogen Receptor-Negative Breast Cancer in African American Women. J Natl Cancer Inst 2015; 107:djv172. [PMID: 26085483 DOI: 10.1093/jnci/djv172] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/22/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Menarche is a critical time point for diverging fates of mammary cells of origin. African American women have young age at menarche, which could be associated with their high rates of estrogen receptor-negative (ER-) breast cancer. METHODS In the AMBER Consortium, using harmonized data from 4426 African American women with breast cancer and 17 474 controls, we used polytomous logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for ages at menarche and first live birth (FLB), and the interval between, in relation to ER+ and ER- breast cancer. All statistical tests were two-sided. RESULTS Risk of ER- breast cancer was reduced with later age at menarche among both parous and nulliparous women (≥15 vs <11 years OR = 0.62, 95% CI = 0.48 to 0.81 and OR = 0.56, 95% CI = 0.29 to 1.10, respectively), with no effect of age at FLB. For ER+ breast cancer, the inverse association was weaker among nulliparous women. While longer intervals between menarche and FLB were associated with increased risk of ER+ breast cancer in a dose-response fashion (OR for 20 year interval = 1.39, 95% CI = 1.08 to 1.79, P trend = .003), ER- risk was only increased for intervals up to 14 years and not beyond (P trend = .33). CONCLUSIONS While ER- breast cancer risk was markedly reduced in women with a late age at menarche, there was not a clear pattern of increased risk with longer interval between menarche and FLB, as was observed for ER+ breast cancer. These findings indicate that etiologic pathways involving adolescence and pregnancy may differ for ER- and ER+ breast cancer.
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Affiliation(s)
- Christine B Ambrosone
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK).
| | - Gary Zirpoli
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Chi-Chen Hong
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Song Yao
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Melissa A Troester
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Elisa V Bandera
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Pepper Schedin
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Traci N Bethea
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Virginia Borges
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Song-Yi Park
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Dhyan Chandra
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Lynn Rosenberg
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Laurence N Kolonel
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Andrew F Olshan
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
| | - Julie R Palmer
- Roswell Park Cancer Institute, Buffalo, NY (CBA, GZ, CCH, SY, DC); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Oregon Health & Science University, Portland, OR (PS); Slone Epidemiology Center at Boston University, Boston, MA (TNB, LR, JRP); University of Colorado Denver School of Medicine, Denver, CO (VB); University of Hawaii Cancer Center, Honolulu, HI (SYP, LNK)
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16
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Arendt LM, Kuperwasser C. Form and function: how estrogen and progesterone regulate the mammary epithelial hierarchy. J Mammary Gland Biol Neoplasia 2015; 20:9-25. [PMID: 26188694 PMCID: PMC4596764 DOI: 10.1007/s10911-015-9337-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/08/2015] [Indexed: 12/30/2022] Open
Abstract
The mammary gland undergoes dramatic post-natal growth beginning at puberty, followed by full development occurring during pregnancy and lactation. Following lactation, the alveoli undergo apoptosis, and the mammary gland reverses back to resemble the nonparous gland. This process of growth and regression occurs for multiple pregnancies, suggesting the presence of a hierarchy of stem and progenitor cells that are able to regenerate specialized populations of mammary epithelial cells. Expansion of epithelial cell populations in the mammary gland is regulated by ovarian steroids, in particular estrogen acting through its receptor estrogen receptor alpha (ERα) and progesterone signaling through progesterone receptor (PR). A diverse number of stem and progenitor cells have been identified based on expression of cell surface markers and functional assays. Here we review the current understanding of how estrogen and progesterone act together and separately to regulate stem and progenitor cells within the human and mouse mammary tissues. Better understanding of the hierarchal organization of epithelial cell populations in the mammary gland and how the hormonal milieu affects its regulation may provide important insights into the origins of different subtypes of breast cancer.
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Affiliation(s)
- Lisa M Arendt
- Developmental, Molecular, and Chemical Biology Department, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
- Molecular Oncology Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
- Raymond and Beverly Sackler Laboratory for the Convergence of Biomedical, Physical and Engineering Sciences, Boston, MA, 02111, USA
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI, 53706, USA
| | - Charlotte Kuperwasser
- Developmental, Molecular, and Chemical Biology Department, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA.
- Molecular Oncology Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.
- Raymond and Beverly Sackler Laboratory for the Convergence of Biomedical, Physical and Engineering Sciences, Boston, MA, 02111, USA.
- Developmental, Molecular, and Chemical Biology Department, Tufts University School of Medicine, 800 Washington St, Box 5609, Boston, MA, 02111, USA.
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17
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Martin LJ, Melnichouk O, Huszti E, Connelly PW, Greenberg CV, Minkin S, Boyd NF. Serum lipids, lipoproteins, and risk of breast cancer: a nested case-control study using multiple time points. J Natl Cancer Inst 2015; 107:djv032. [PMID: 25817193 DOI: 10.1093/jnci/djv032] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is strong evidence that breast cancer risk is influenced by environmental factors. Blood lipid and lipoprotein levels are also influenced by environmental factors and are associated with some breast cancer risk factors. We examined whether serial measures of serum lipids and lipoproteins were associated with breast cancer risk. METHODS We carried out a nested case-control study within a randomized long-term dietary intervention trial with 4690 women with extensive mammographic density followed for an average of 10 years for breast cancer incidence. We measured lipids in an average of 4.2 blood samples for 279 invasive breast cancer case subjects and 558 matched control subjects. We calculated subaverages of lipids for each subject based on menopausal status and use of hormone replacement therapy (HRT) at blood collection and analyzed their association with breast cancer using generalized estimating equations. All statistical tests were two-sided. RESULTS High-density lipoprotein-cholesterol (HDL-C) (P = .05) and apoA1 (P = .02) levels were positively associated with breast cancer risk (75(th) vs 25(th) percentile: HDL-C, 23% higher; apoA1, 28% higher) and non-HDL-C (P = .03) and apoB (P = .01) levels were negatively associated (75(th) vs 25(th) percentile: non-HDL-C, 19% lower; apoB, 22% lower). These associations were observed only when lipids were measured when HRT was not used. Total cholesterol and triglyceride levels were not statistically significantly associated with breast cancer risk. CONCLUSIONS These results demonstrate that serum lipids are associated with breast cancer risk in women with extensive mammographic density. The possibility that interventions for heart disease prevention, which aim to reduce non-HDL-C or raise HDL-C, may have effects on breast cancer risk merits examination.
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Affiliation(s)
- Lisa J Martin
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Olga Melnichouk
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Ella Huszti
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Philip W Connelly
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Carolyn V Greenberg
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Salomon Minkin
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC)
| | - Norman F Boyd
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada (LJM, OM, EH, CVG, SM, NFB); Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada (PWC); Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (PWC).
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Aktipis CA, Ellis BJ, Nishimura KK, Hiatt RA. Modern reproductive patterns associated with estrogen receptor positive but not negative breast cancer susceptibility. EVOLUTION MEDICINE AND PUBLIC HEALTH 2014; 2015:52-74. [PMID: 25389105 PMCID: PMC4362290 DOI: 10.1093/emph/eou028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has long been accepted that modern reproductive patterns are likely contributors to breast cancer susceptibility because of their influence on hormones such as estrogen and the importance of these hormones in breast cancer. We conducted a meta-analysis to assess whether this ‘evolutionary mismatch hypothesis’ can explain susceptibility to both estrogen receptor positive (ER-positive) and estrogen receptor negative (ER-negative) cancer. Our meta-analysis includes a total of 33 studies and examines parity, age of first birth and age of menarche broken down by estrogen receptor status. We found that modern reproductive patterns are more closely linked to ER-positive than ER-negative breast cancer. Thus, the evolutionary mismatch hypothesis for breast cancer can account for ER-positive breast cancer susceptibility but not ER-negative breast cancer.
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Affiliation(s)
- C Athena Aktipis
- Center for Evolution and Cancer, University of California San Francisco, 2340 Sutter Street S-341, Box 0128, San Francisco, CA 94143-0128, USA; Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA; Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, Tucson, AZ 85721, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, UCSF, San Francisco, CA 94143, USA Center for Evolution and Cancer, University of California San Francisco, 2340 Sutter Street S-341, Box 0128, San Francisco, CA 94143-0128, USA; Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA; Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, Tucson, AZ 85721, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, UCSF, San Francisco, CA 94143, USA
| | - Bruce J Ellis
- Center for Evolution and Cancer, University of California San Francisco, 2340 Sutter Street S-341, Box 0128, San Francisco, CA 94143-0128, USA; Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA; Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, Tucson, AZ 85721, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, UCSF, San Francisco, CA 94143, USA
| | - Katherine K Nishimura
- Center for Evolution and Cancer, University of California San Francisco, 2340 Sutter Street S-341, Box 0128, San Francisco, CA 94143-0128, USA; Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA; Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, Tucson, AZ 85721, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, UCSF, San Francisco, CA 94143, USA
| | - Robert A Hiatt
- Center for Evolution and Cancer, University of California San Francisco, 2340 Sutter Street S-341, Box 0128, San Francisco, CA 94143-0128, USA; Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA; Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, Tucson, AZ 85721, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, UCSF, San Francisco, CA 94143, USA
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Escarela G, Pérez-Ruiz LC, Núñez-Antonio G. Temporal trend, clinicopathologic and sociodemographic characterization of age at diagnosis of breast cancer among US women diagnosed from 1990 to 2009. SPRINGERPLUS 2014; 3:626. [PMID: 25392796 PMCID: PMC4226808 DOI: 10.1186/2193-1801-3-626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022]
Abstract
This paper investigates the distribution of age at diagnosis of female breast cancer and its association with temporal trend, clinicopathologic and sociodemographic variables in the presence of two latent clusters that are directly unobservable. Such clusters help to identify two subpopulations of either young or old patients whose etiologies are thought to be different. A large sample drawn from registry data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program from 1990 to 2009 was analyzed using a two-component Gaussian mixture model. Evidence of a steady delay of age at diagnosis and an increasing proportion of young patients being diagnosed during the 20-year period was found. Histopathologic effects indicate that duct and lobular carcinomas differ significantly in regard to subpopulation membership, which confirms that they represent different etiologies. While the presence of estrogen receptor status in the model overlaps the effects of other important variables it is highly correlated with, it is found that the grade, extension and size of the tumor along with lymph node involvement status, race and marital status are important predictors of age at diagnosis. The results highlight the significant impacts that such features can have on breast cancer control efforts, and point to the importance of ensuring that medical decision making should use them along with an indicator of the age subpopulation a patient may belong to.
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Affiliation(s)
- Gabriel Escarela
- Departement of Mathematics, Universidad Autónoma Metropolitana - Iztapalapa, AT-351 UAM-I Av. San Rafael Atlixco No. 186 Col. Vicentina, Mexico City, DF 09340 Mexico
| | - Luis Carlos Pérez-Ruiz
- Departement of Mathematics, Universidad Autónoma Metropolitana - Iztapalapa, AT-351 UAM-I Av. San Rafael Atlixco No. 186 Col. Vicentina, Mexico City, DF 09340 Mexico
| | - Gabriel Núñez-Antonio
- Departement of Mathematics, Universidad Autónoma Metropolitana - Iztapalapa, AT-351 UAM-I Av. San Rafael Atlixco No. 186 Col. Vicentina, Mexico City, DF 09340 Mexico
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20
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Anderson WF, Rosenberg PS, Prat A, Perou CM, Sherman ME. How many etiological subtypes of breast cancer: two, three, four, or more? J Natl Cancer Inst 2014; 106:dju165. [PMID: 25118203 PMCID: PMC4148600 DOI: 10.1093/jnci/dju165] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 05/01/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is a heterogeneous disease, divisible into a variable number of clinical subtypes. A fundamental question is how many etiological classes underlie the clinical spectrum of breast cancer? An etiological subtype reflects a grouping with a common set of causes, whereas a clinical subtype represents a grouping with similar prognosis and/or prediction. Herein, we review the evidence for breast cancer etiological heterogeneity. We then evaluate the etiological evidence with mRNA profiling data. A bimodal age distribution at diagnosis with peak frequencies near ages 50 and 70 years is a fundamental characteristic of breast cancer for important tumor features, clinical characteristics, risk factor profiles, and molecular subtypes. The bimodal peak frequencies at diagnosis divide breast cancer overall into a "mixture" of two main components in varying proportions in different cancer populations. The first breast cancer tends to arise early in life with modal age-at-diagnosis near 50 years and generally behaves aggressively. The second breast cancer occurs later in life with modal age near 70 years and usually portends a more indolent clinical course. These epidemiological and molecular data are consistent with a two-component mixture model and compatible with a hierarchal view of breast cancers arising from two main cell types of origin. Notwithstanding the potential added value of more detailed categorizations for personalized breast cancer treatment, we suggest that the development of better criteria to identify the two proposed etiologic classes would advance breast cancer research and prevention.
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Affiliation(s)
- William F Anderson
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP).
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Aleix Prat
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Charles M Perou
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
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22
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Breast cancer: trends in international incidence in men and women. Br J Cancer 2014; 110:1891-7. [PMID: 24518595 PMCID: PMC3974084 DOI: 10.1038/bjc.2014.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 12/29/2022] Open
Abstract
Background: The age-standardised incidence of breast cancer varies geographically, with rates in the highest-risk countries more than five times those in the lowest-risk countries. Methods: We investigated the correlation between male (MBC) and female breast cancer (FBC) incidence stratified by female age-group (<50 years, and ⩾50 years) and used Poisson regression to examine male incidence rate ratios according to female incidence rates. Results: Age-adjusted breast cancer incidence rates for males and females share a similar geographic distribution (Spearman's correlation=0.51; P<0.0001). A correlation with male incidence rates was found for the entire female population and for women aged 50 years and over. Breast cancer incidence rates in males aged <50 years were not associated with FBC incidence, whereas those in males aged ⩾50 years were. MBC incidence displays a small ‘hook' similar to the Clemmesen's hook for FBC, but at a later age than the female hook. Interpretation: Further investigation of possible explanations for these patterns is warranted. Although the incidence of breast cancer is much lower in men than in women, it may be possible to identify a cause common to both men and women.
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23
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Begg CB, Zabor EC, Bernstein JL, Bernstein L, Press MF, Seshan VE. A conceptual and methodological framework for investigating etiologic heterogeneity. Stat Med 2013; 32:5039-52. [PMID: 23857589 PMCID: PMC4104361 DOI: 10.1002/sim.5902] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 06/13/2013] [Indexed: 01/24/2023]
Abstract
Cancer has traditionally been studied using the disease site of origin as the organizing framework. However, recent advances in molecular genetics have begun to challenge this taxonomy, as detailed molecular profiling of tumors has led to discoveries of subsets of tumors that have profiles that possess distinct clinical and biological characteristics. This is increasingly leading to research that seeks to investigate whether these subtypes of tumors have distinct etiologies. However, research in this field has been opportunistic and anecdotal, typically involving the comparison of distributions of individual risk factors between tumors classified on the basis of candidate tumor characteristics. The purpose of this article is to place this area of investigation within a more general conceptual and analytic framework, with a view to providing more efficient and practical strategies for designing and analyzing epidemiologic studies to investigate etiologic heterogeneity. We propose a formal definition of etiologic heterogeneity and show how classifications of tumor subtypes with larger etiologic heterogeneities inevitably possess greater disease risk predictability overall. We outline analytic strategies for estimating the degree of etiologic heterogeneity among a set of subtypes and for choosing subtypes that optimize the heterogeneity, and we discuss technical challenges that require further methodologic research. We illustrate the ideas by using a pooled case-control study of breast cancer classified by expression patterns of genes known to define distinct tumor subtypes.
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Affiliation(s)
- Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, U.S.A
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Ritte R, Tikk K, Lukanova A, Tjønneland A, Olsen A, Overvad K, Dossus L, Fournier A, Clavel-Chapelon F, Grote V, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Berrino F, Mattiello A, Tumino R, Sacerdote C, Quirós JR, Buckland G, Molina-Montes E, Chirlaque MD, Ardanaz E, Amiano P, Bueno-de-Mesquita HB, van Gils CH, Peeters PH, Wareham N, Khaw KT, Key TJ, Travis RC, Weiderpass E, Dumeaux V, Lund E, Sund M, Andersson A, Romieu I, Rinaldi S, Vineis P, Merritt MA, Riboli E, Kaaks R. Reproductive factors and risk of hormone receptor positive and negative breast cancer: a cohort study. BMC Cancer 2013; 13:584. [PMID: 24321460 PMCID: PMC3866571 DOI: 10.1186/1471-2407-13-584] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/15/2013] [Indexed: 01/10/2023] Open
Abstract
Background The association of reproductive factors with hormone receptor (HR)-negative breast tumors remains uncertain. Methods Within the EPIC cohort, Cox proportional hazards models were used to describe the relationships of reproductive factors (menarcheal age, time between menarche and first pregnancy, parity, number of children, age at first and last pregnancies, time since last full-term childbirth, breastfeeding, age at menopause, ever having an abortion and use of oral contraceptives [OC]) with risk of ER-PR- (n = 998) and ER+PR+ (n = 3,567) breast tumors. Results A later first full-term childbirth was associated with increased risk of ER+PR+ tumors but not with risk of ER-PR- tumors (≥35 vs. ≤19 years HR: 1.47 [95% CI 1.15-1.88] ptrend < 0.001 for ER+PR+ tumors; ≥35 vs. ≤19 years HR: 0.93 [95% CI 0.53-1.65] ptrend = 0.96 for ER-PR- tumors; Phet = 0.03). The risk associations of menarcheal age, and time period between menarche and first full-term childbirth with ER-PR-tumors were in the similar direction with risk of ER+PR+ tumors (phet = 0.50), although weaker in magnitude and statistically only borderline significant. Other parity related factors such as ever a full-term birth, number of births, age- and time since last birth were associated only with ER+PR+ malignancies, however no statistical heterogeneity between breast cancer subtypes was observed. Breastfeeding and OC use were generally not associated with breast cancer subtype risk. Conclusion Our study provides possible evidence that age at menarche, and time between menarche and first full-term childbirth may be associated with the etiology of both HR-negative and HR-positive malignancies, although the associations with HR-negative breast cancer were only borderline significant.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Bertrand KA, Tamimi RM, Scott CG, Jensen MR, Pankratz V, Visscher D, Norman A, Couch F, Shepherd J, Fan B, Chen YY, Ma L, Beck AH, Cummings SR, Kerlikowske K, Vachon CM. Mammographic density and risk of breast cancer by age and tumor characteristics. Breast Cancer Res 2013; 15:R104. [PMID: 24188089 PMCID: PMC3978749 DOI: 10.1186/bcr3570] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/29/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction Understanding whether mammographic density (MD) is associated with all breast tumor subtypes and whether the strength of association varies by age is important for utilizing MD in risk models. Methods Data were pooled from six studies including 3414 women with breast cancer and 7199 without who underwent screening mammography. Percent MD was assessed from digitized film-screen mammograms using a computer-assisted threshold technique. We used polytomous logistic regression to calculate breast cancer odds according to tumor type, histopathological characteristics, and receptor (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2)) status by age (<55, 55–64, and ≥65 years). Results MD was positively associated with risk of invasive tumors across all ages, with a two-fold increased risk for high (>51%) versus average density (11-25%). Women ages <55 years with high MD had stronger increased risk of ductal carcinoma in situ (DCIS) compared to women ages 55–64 and ≥65 years (Page-interaction = 0.02). Among all ages, MD had a stronger association with large (>2.1 cm) versus small tumors and positive versus negative lymph node status (P’s < 0.01). For women ages <55 years, there was a stronger association of MD with ER-negative breast cancer than ER-positive tumors compared to women ages 55–64 and ≥65 years (Page-interaction = 0.04). MD was positively associated with both HER2-negative and HER2-positive tumors within each age group. Conclusion MD is strongly associated with all breast cancer subtypes, but particularly tumors of large size and positive lymph nodes across all ages, and ER-negative status among women ages <55 years, suggesting high MD may play an important role in tumor aggressiveness, especially in younger women.
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Kurbel S. Model of tumor-associated epigenetic changes of HER2, ER, and PgR expression in invasive breast cancer phenotypes. Tumour Biol 2013; 34:2011-7. [PMID: 23640060 DOI: 10.1007/s13277-013-0809-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/16/2013] [Indexed: 11/24/2022] Open
Abstract
This theoretic paper is an attempt to apply the epigenetic progenitor model of human cancer origin, proposed by Feinberg et al. (Nat Rev Genet 7:21-33, 2006), to the reported phenotype features of invasive breast cancer. The model is based on the idea that expression of estrogen receptors (ER), progesterone receptors (PgR), and HER2 molecules in breast tumors is either remnants of the tissue stem cell from which the tumor has developed or a newly acquired tumor-associated epigenetic feature. HER2 overexpression is considered as an example of the tumor-associated epigenetic changes. The model makes a simple distinction regarding the possible types of ER and PgR expression: the "functional" steroid hormone receptors are inherited from pretumoral tissue stem cells, while the "dysfunctional" steroid hormone receptors are acquired during tumorigenesis from initially ER-PgR-negative cells. In the former, estrogen binding increases the PgR expression while progesterone binding decreases the expression of ER and PgR. Since the estrogen-dependent PgR expression works only in cells with functional ERs, the expected share of tumors with functional ER and PgR receptors is in the model calculated as the squared probability of expressing the PgRs. Reported data from various trials are pooled together to find out phenotype shares (ER+PgR+ makes 62.03 %, ER+PgR- 16.43 %, ER-PgR+ 3.06, and ER-PgR- 18.48 %). By applying the model on these shares, the proposed share of tumors with the functional ER+PgR+ phenotype was 38.48 %, while the share of tumors with the dysfunctional ER+PgR+ was 23.55 %. The presented model suggests that both luminal A and luminal B tumor types are heterogeneous regarding the steroid receptor expression. Some tumors have functional and some have dysfunctional steroid receptors. If these predicted subgroups exist, their detection in the clinical practice might substantially improve treatment options, particularly in the premenopausal setting.
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Affiliation(s)
- Sven Kurbel
- Department of Physiology, Osijek Medical Faculty, J Huttlera 4, 31000, Osijek, Croatia.
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27
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White AJ, Teitelbaum SL, Wolff MS, Stellman SD, Neugut AI, Gammon MD. Exposure to fogger trucks and breast cancer incidence in the Long Island Breast Cancer Study Project: a case-control study. Environ Health 2013; 12:24. [PMID: 23497110 PMCID: PMC3639887 DOI: 10.1186/1476-069x-12-24] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/19/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND Few studies have supported an association between breast cancer and DDT, usually assessed with biomarkers that cannot discern timing of exposure, or differentiate between the accumulation of chronic low-dose versus acute high-dose exposures in the past. Previous studies suggest that an association may be evident only among women exposed to DDT during biologically susceptible windows, or among those diagnosed with estrogen receptor/progesterone receptor-positive (ER+PR+) breast cancer subtypes. Self-reported acute exposure to a fogger truck, which sprayed DDT prior to 1972, was hypothesized to increase the risk of breast cancer, particularly among women exposed at a young age or diagnosed with ER+PR+ breast cancer. METHODS We examined these possibilities in the Long Island Breast Cancer Study Project (LIBCSP) (1,508 cases, 1,556 controls), which included exposure assessment by structured questionnaire and serum samples collected between 1996-1998, using adjusted logistic and polytomous regression to estimate ORs and 95% CIs. RESULTS Women with ER+PR+ breast cancer had a 44% increased odds of ever seeing a pre-1972 fogger truck compared to other subtypes (OR = 1.44; 95% CI 1.08-1.93). However, there was little variation in the observed increase in breast cancer risk when considering all women who reported seeing a pre-1972 fogger truck at their residence (OR = 1.16; 95% CI 0.98, 1.37), or during hypothesized susceptible windows. Self-reported acute exposure was not correlated with serum concentrations, a biomarker of long-term exposure. CONCLUSIONS These findings support the hypothesis that seeing a fogger truck, a proxy measure for acute DDT exposure, may be associated with ER+PR+ tumors, the most commonly diagnosed breast cancer subtype among American women.
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Affiliation(s)
- Alexandra J White
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan L Teitelbaum
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Mary S Wolff
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Steven D Stellman
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Alfred I Neugut
- Department of Epidemiology, Columbia University, New York, New York, USA
- Department of Medicine, Columbia University, New York, New York, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Jung S, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, van den Brandt PA, Buring JE, Cerhan JR, Gaudet MM, Giles GG, Goodman G, Hakansson N, Hankinson SE, Helzlsouer K, Horn-Ross PL, Inoue M, Krogh V, Lof M, McCullough ML, Miller AB, Neuhouser ML, Palmer JR, Park Y, Robien K, Rohan TE, Scarmo S, Schairer C, Schouten LJ, Shikany JM, Sieri S, Tsugane S, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Zhang SM, Zhang X, Ziegler RG, Smith-Warner SA. Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst 2013; 105:219-36. [PMID: 23349252 DOI: 10.1093/jnci/djs635] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Estrogen receptor-negative (ER(-)) breast cancer has few known or modifiable risk factors. Because ER(-) tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER(-) breast cancer. METHODS Among 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER(+)) and 4821 ER(-) breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided. RESULTS Total fruit and vegetable intake was statistically significantly inversely associated with risk of ER(-) breast cancer but not with risk of breast cancer overall or of ER(+) tumors. The inverse association for ER(-) tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER(-) breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER(+) breast cancer (P (common-effects) by ER status < .001). Total fruit consumption was non-statistically significantly associated with risk of ER(-) breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04). CONCLUSIONS We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER(-) breast cancer in our large pooled analyses.
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Affiliation(s)
- Seungyoun Jung
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Longwood Avenue, Boston, MA 02115, USA.
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Hajiebrahimi MH, Bahmanyar S, Lambe M, Adolfsson J, Fornander T, Wärnberg F, Cnattingius S. Placental weight and mortality in premenopausal breast cancer by tumor characteristics. Breast Cancer Res Treat 2012; 137:297-305. [PMID: 23149466 DOI: 10.1007/s10549-012-2337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022]
Abstract
Placental weight may be regarded as an indirect marker of hormone exposures during pregnancy. There is epidemiological evidence that breast cancer mortality in premenopausal women increases with placental weight in the most recent pregnancy. We investigated if this association differs by tumor characteristics, including expression of estrogen and progesterone receptors. In a Swedish population-based cohort, we followed 1,067 women with premenopausal breast cancer diagnosed from 1992 to 2006. Using Cox regression models, we estimated hazard ratios for the association between placental weight and risk of premenopausal breast cancer mortality. In stratified analyses, we estimated mortality risks in subjects with different tumor stages, estrogen receptor (ER) or progesterone receptor (PR) status. Compared with women with placental weight less than 600 g, women with a placental weight between 600 and 699 g were at a 50 % increased risk of mortality, however, not significant change in risk was observed for women with placental weight ≥ 700 g. Mortality risks associated with higher placental weight were more pronounced among ER(-) and PR(-) breast cancer tumors, where both a placental weight 600-699 g and ≥ 700 g were associated with a more than doubled mortality risks compared with tumors among women with placental weight less than 600 g. Moreover, stratified analyses for joint receptor status revealed that a consistent increased mortality risk by placental weight was only apparent in women with ER(-)/PR(-) breast cancer. The increased mortality risk in premenopausal breast cancer associated with higher placental weight was most pronounced among ER(-) and PR(-) tumors.
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Ritte R, Lukanova A, Tjønneland A, Olsen A, Overvad K, Mesrine S, Fagherazzi G, Dossus L, Teucher B, Steindorf K, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Grioni S, Mattiello A, Tumino R, Sacerdote C, Quirós JR, Buckland G, Molina-Montes E, Chirlaque MD, Ardanaz E, Amiano P, Bueno-de-Mesquita B, van Duijnhoven F, van Gils CH, Peeters PH, Wareham N, Khaw KT, Key TJ, Travis RC, Krum-Hansen S, Gram IT, Lund E, Sund M, Andersson A, Romieu I, Rinaldi S, McCormack V, Riboli E, Kaaks R. Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: a cohort study. Int J Cancer 2012; 132:2619-29. [PMID: 23090881 DOI: 10.1002/ijc.27913] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/17/2012] [Indexed: 12/18/2022]
Abstract
Associations of breast cancer overall with indicators of exposures during puberty are reasonably well characterized; however, uncertainty remains regarding the associations of height, leg length, sitting height and menarcheal age with hormone receptor-defined malignancies. Within the European Prospective Investigation into Cancer and Nutrition cohort, Cox proportional hazards models were used to describe the relationships of adult height, leg length and sitting height and age at menarche with risk of estrogen and progesterone receptor negative (ER-PR-) (n = 990) and ER+PR+ (n = 3,524) breast tumors. Height as a single risk factor was compared to a model combining leg length and sitting height. The possible interactions of height, leg length and sitting height with menarche were also analyzed. Risk of both ER-PR- and ER+PR+ malignancies was positively associated with standing height, leg length and sitting height and inversely associated with increasing age at menarche. For ER+PR+ disease, sitting height (hazard ratios: 1.14[95% confidence interval: 1.08-1.20]) had a stronger risk association than leg length (1.05[1.00-1.11]). In comparison, for ER-PR- disease, no distinct differences were observed between leg length and sitting height. Women who were tall and had an early menarche (≤13 years) showed an almost twofold increase in risk of ER+PR+ tumors but no such increase in risk was observed for ER-PR- disease. Indicators of exposures during rapid growth periods were associated with risks of both HR-defined breast cancers. Exposures during childhood promoting faster development may establish risk associations for both HR-positive and -negative malignancies. The stronger associations of the components of height with ER+PR+ tumors among older women suggest possible hormonal links that could be specific for postmenopausal women.
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Affiliation(s)
- Rebecca Ritte
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Ritte R, Lukanova A, Berrino F, Dossus L, Tjønneland A, Olsen A, Overvad TF, Overvad K, Clavel-Chapelon F, Fournier A, Fagherazzi G, Rohrmann S, Teucher B, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Quirós JR, Buckland G, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Sund M, Lenner P, Bueno-de-Mesquita B, van Gils CH, Peeters PH, Krum-Hansen S, Gram IT, Lund E, Khaw KT, Wareham N, Allen NE, Key TJ, Romieu I, Rinaldi S, Siddiq A, Cox D, Riboli E, Kaaks R. Adiposity, hormone replacement therapy use and breast cancer risk by age and hormone receptor status: a large prospective cohort study. Breast Cancer Res 2012; 14:R76. [PMID: 22583394 PMCID: PMC3446339 DOI: 10.1186/bcr3186] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/12/2012] [Accepted: 05/14/2012] [Indexed: 12/15/2022] Open
Abstract
Introduction Associations of hormone-receptor positive breast cancer with excess adiposity are reasonably well characterized; however, uncertainty remains regarding the association of body mass index (BMI) with hormone-receptor negative malignancies, and possible interactions by hormone replacement therapy (HRT) use. Methods Within the European EPIC cohort, Cox proportional hazards models were used to describe the relationship of BMI, waist and hip circumferences with risk of estrogen-receptor (ER) negative and progesterone-receptor (PR) negative (n = 1,021) and ER+PR+ (n = 3,586) breast tumors within five-year age bands. Among postmenopausal women, the joint effects of BMI and HRT use were analyzed. Results For risk of ER-PR- tumors, there was no association of BMI across the age bands. However, when analyses were restricted to postmenopausal HRT never users, a positive risk association with BMI (third versus first tertile HR = 1.47 (1.01 to 2.15)) was observed. BMI was inversely associated with ER+PR+ tumors among women aged ≤49 years (per 5 kg/m2 increase, HR = 0.79 (95%CI 0.68 to 0.91)), and positively associated with risk among women ≥65 years (HR = 1.25 (1.16 to 1.34)). Adjusting for BMI, waist and hip circumferences showed no further associations with risks of breast cancer subtypes. Current use of HRT was significantly associated with an increased risk of receptor-negative (HRT current use compared to HRT never use HR: 1.30 (1.05 to 1.62)) and positive tumors (HR: 1.74 (1.56 to 1.95)), although this risk increase was weaker for ER-PR- disease (Phet = 0.035). The association of HRT was significantly stronger in the leaner women (BMI ≤22.5 kg/m2) than for more overweight women (BMI ≥25.9 kg/m2) for, both, ER-PR- (HR: 1.74 (1.15 to 2.63)) and ER+PR+ (HR: 2.33 (1.84 to 2.92)) breast cancer and was not restricted to any particular HRT regime. Conclusions An elevated BMI may be positively associated with risk of ER-PR- tumors among postmenopausal women who never used HRT. Furthermore, postmenopausal HRT users were at an increased risk of ER-PR- as well as ER+PR+ tumors, especially among leaner women. For hormone-receptor positive tumors, but not for hormone-receptor negative tumors, our study confirms an inverse association of risk with BMI among young women of premenopausal age. Our data provide evidence for a possible role of sex hormones in the etiology of hormone-receptor negative tumors.
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Affiliation(s)
- Rebecca Ritte
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld TP4, Heidelberg, 69120, Germany.
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Abstract
Triple negative (TN) breast cancers fail to express the three most common breast cancer receptors; i.e., estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). Accumulating data demonstrate that epidemiological risk factor profiles also vary between TN (ER-PR-HER2-) and other breast cancers, especially the so-called Luminal A breast cancers (ER+PR ± HER2-) [1]. A more comprehensive understanding of the epidemiology of TN breast cancers has important public health implications for risk assessment [2], prevention and treatment. The epidemiology of TN breast cancers can be first understood in the age-related reproductive risk factor patterns for ER, PR, and HER2. For example, there is a clear and strong association between older age at diagnosis (and therefore postmenopausal status) and the development of ER positive, PR positive, and HER2 negative breast cancers. On the other hand, younger age at diagnosis (and premenopausal status) is related to the development of ER negative, PR negative, and HER2 positive breast cancers. This gives rise to the somewhat counterintuitive suggestion that menopause has a greater relative impact upon hormone receptor negative than positive breast cancers [3,4]. Throughout this review, we will primarily contrast ER-PR-HER2- (TN) with ER+PR ± HER2- (Luminal A) breast cancers. We will first summarize the population-based age-specific incidence rate patterns and clinical outcomes, and then will review the available analytical studies. Information sources for this review included the National Cancer Institute's Surveillance, Epidemiology, and End Results 13 Registries Public-Use Database [5], CANCERLIT, Index Medicus, and PubMed.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, DHHS/NIH/NCI/Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892-7244, USA
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Kricker A, Disipio T, Stone J, Goumas C, Armes JE, Gertig DM, Armstrong BK. Bodyweight and other correlates of symptom-detected breast cancers in a population offered screening. Cancer Causes Control 2011; 23:89-102. [PMID: 22020871 DOI: 10.1007/s10552-011-9858-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 10/12/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the factors associated with symptom-detected breast cancers in a population offered screening. METHODS We interviewed 1,459 Australian women aged 40-69, 946 with symptom-detected and 513 with mammogram-detected invasive breast cancers ≥ 1.1 cm in diameter about their personal, mammogram, and breast histories before diagnosis and reviewed medical records for tumor characteristics and mammogram dates, calculating ORs and 95% confidence intervals (CIs) for symptom- versus mammogram-detected cancers in logistic regression models. RESULTS Lack of regular mammograms (<2 mammograms in the 4.5 years before diagnosis) was the strongest correlate of symptom-detected breast cancer (OR = 3.04 for irregular or no mammograms). In women who had regular mammograms (≥ 2 mammograms in the 4.5 years before diagnosis), the independent correlates of symptom-detected cancers were low BMI (OR < 25 kg/m(2) vs. ≥ 30 kg/m(2) = 2.18, 95% CI 1.23-3.84; p = 0.008), increased breast density (available in 498 women) (OR highest quarter vs. lowest = 3.50, 95% CI 1.76-6.97; p (trend) = 0.004), high-grade cancer, and a larger cancer (each p < 0.01). In women who did not have regular mammograms, the independent correlates were age <50 years, a first cancer, and a ≥ 2-cm cancer. Smoking appeared to modify the association of symptom-detected cancer with low BMI (higher ORs for low BMI in current smokers) and estrogen receptor (ER) status (higher ORs for low BMI in ER cancers). CONCLUSION Women with low BMI may benefit from a tailored approach to breast cancer detection, particularly if they smoke.
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Affiliation(s)
- Anne Kricker
- Sydney School of Public Health, University of Sydney, QEII Building D02, Sydney, NSW 2006, Australia.
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Martin LJ, Li Q, Melnichouk O, Greenberg C, Minkin S, Hislop G, Boyd NF. A randomized trial of dietary intervention for breast cancer prevention. Cancer Res 2011; 71:123-33. [PMID: 21199800 DOI: 10.1158/0008-5472.can-10-1436] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiologic data and animal experiments suggest that dietary fat may influence risk of breast cancer. To determine whether intervention with a low-fat, high-carbohydrate diet would reduce breast cancer incidence in women at increased risk of the disease, we carried out a randomized controlled trial in Canada. We recruited 4,690 women with extensive mammographic density and randomized them to an intervention group or a comparison group. The intervention group received intensive dietary counseling to reduce fat intake to a target of 15% of calories and increase carbohydrate to 65% of calories. Dietary intakes were assessed throughout using food records. Subjects were followed for at least 7 years and for an average of 10 years. The main outcome was invasive breast cancer. Percentage of calories from fat in the intervention group decreased from 30% at baseline to 20% after randomization and remained 9% to 10% lower than the comparison group throughout. There were 118 invasive breast cancers in the intervention group and 102 in the comparison group [adjusted hazard ratio = 1.19 (95% CI: 0.91-1.55)]. Analysis of food records showed that fat intake at baseline and after randomization was not associated with total breast cancer incidence. Greater weight and lower carbohydrate intake at baseline and after randomization were associated with an increased risk of estrogen receptor (ER)-positive breast cancer. Our findings suggest that a sustained reduction in dietary fat intake did not reduce risk of breast cancer in women with extensive mammographic density. Weight and carbohydrate intakes were associated with risk of ER-positive breast cancer.
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Ghiasvand R, Maram ES, Tahmasebi S, Tabatabaee SHR. Risk factors for breast cancer among young women in southern Iran. Int J Cancer 2010; 129:1443-9. [PMID: 21064105 DOI: 10.1002/ijc.25748] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 09/28/2010] [Indexed: 11/07/2022]
Abstract
Age standardized incidence rates of breast cancer in developed countries is nearly threefold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the last four decades increasing incidence rates of breast cancer made it the most prevalent cancer in Iranian women. After adjustment for age, Iranian young women are at relatively higher risk of breast cancer than their counterparts in developed countries. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian young women. A hospital-based case control study comprising 521 women with histologically confirmed, incident breast cancer and 521 controls frequency-matched by age and province of residence was conducted. Logistic regression performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. In multivariate analysis, family history [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.07-2.42], oral contraceptives (OC) usage (OR: 1.52; 95% CI: 1.11-2.08), low parity (OR parity ≥ 3 vs. 1-2: 0.33; 95% CI: 0.23-0.49), employment (OR: 1.83; 95% CI: 1.05-3.23) and shorter period of breast feeding (OR ≥ 37 months vs. < 37: 0.61; 95% CI: 0.44-0.84) were related to a higher risk of breast cancer in young women. This was the first study focusing on risk factors of breast cancer in Iranian young women. The trend of decreasing parity and shortened duration of breast feeding along with OC usage might partly explain the rapid rising of breast cancer incidence in Iranian young women.
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Affiliation(s)
- Reza Ghiasvand
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran.
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Leong SPL, Shen ZZ, Liu TJ, Agarwal G, Tajima T, Paik NS, Sandelin K, Derossis A, Cody H, Foulkes WD. Is breast cancer the same disease in Asian and Western countries? World J Surg 2010; 34:2308-24. [PMID: 20607258 PMCID: PMC2936680 DOI: 10.1007/s00268-010-0683-1] [Citation(s) in RCA: 379] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
UNLABELLED A mini-symposium was held in Montreal, Canada, at the International Surgical Week for the Breast Surgical International in 2007 addressing the question whether breast cancer is the same disease in Asian and Western countries. Numerous investigators from Asian and Western countries presented the epidemiologic and clinical outcome data of women with breast cancer. Although there are significant similarities, the striking difference is that the peak age for breast cancer is between 40 and 50 years in the Asian countries, whereas the peak age in the Western countries is between 60 and 70 years. Also, the incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is increasing, the mortality rate is definitely decreasing. Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries. BACKGROUND Whether breast cancer is the same disease in Asian and Western countries was the topic of a 2007 Breast Surgery International symposium at International Surgical Week. METHODS Participating investigators from China, Taiwan, India, Japan, South Korea, Sweden, Canada, and the United States were asked beforehand to provide data on the epidemiology and treatment outcome of women in their countries. RESULTS Comparisons of the epidemiologic and clinical outcome data of women with breast cancer showed significant similarities, but the striking difference is that the peak age is between 40 and 50 years in Asian countries, but is between 60 and 70 years in Western countries. The incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is also increasing, the mortality rate is definitely decreasing. DISCUSSION Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries.
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Affiliation(s)
- Stanley P L Leong
- Department of Surgery, California Pacific Medical Center and Sutter Pacific Medical Foundation, 2340 Clay Street, 2nd Floor, San Francisco, CA 94115, USA.
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Shin HR, Boniol M, Joubert C, Hery C, Haukka J, Autier P, Nishino Y, Sobue T, Chen CJ, You SL, Ahn SH, Jung KW, Law SCK, Mang O, Chia KS. Secular trends in breast cancer mortality in five East Asian populations: Hong Kong, Japan, Korea, Singapore and Taiwan. Cancer Sci 2010; 101:1241-6. [PMID: 20219071 PMCID: PMC11159515 DOI: 10.1111/j.1349-7006.2010.01519.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Breast cancer risk is increasing in most Asian female populations, but little is known about the long-term mortality trend of the disease among these populations. We extracted data for Hong Kong (1979-2005), Japan (1963-2006), Korea (1985-2006), and Singapore (1963-2006) from the World Health Organization (WHO) mortality database and for Taiwan (1964-2007) from the Taiwan cancer registry. The annual age-standardized, truncated (to > or =20 years) breast cancer death rates for 11 age groups were estimated and joinpoint regression was applied to detect significant changes in breast cancer mortality. We also compared age-specific mortality rates for three calendar periods (1975-1984, 1985-1994, and 1995-2006). After 1990, breast cancer mortality tended to decrease slightly in Hong Kong and Singapore except for women aged 70+. In Taiwan and Japan, in contrast, breast cancer death rates increased throughout the entire study period. Before the 1990s, breast cancer death rates were almost the same in Taiwan and Japan; thereafter, up to 1996, they rose more steeply in Taiwan and then they began rising more rapidly in Japan than in Taiwan after 1996. The most rapid increases in breast cancer mortality, and for all age groups, were in Korea. Breast cancer mortality trends are expected to maintain the secular trend for the next decade mainly as the prevalence of risk factors changes and population ages in Japan, Korea, and Taiwan. Early detection and treatment improvement will continue to reduce the mortality rates in Hong Kong and Singapore as observed in Western countries.
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Affiliation(s)
- Hai-Rim Shin
- International Agency for Research on Cancer, Lyon, France.
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Shin A, Kim J, Lim SY, Kim G, Sung MK, Lee ES, Ro J. Dietary Mushroom Intake and the Risk of Breast Cancer Based on Hormone Receptor Status. Nutr Cancer 2010; 62:476-83. [DOI: 10.1080/01635580903441212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pezzin LE, O'Niel MB, Nattinger AB. The economic consequences of breast cancer adjuvant hormonal treatments. J Gen Intern Med 2009; 24 Suppl 2:S446-50. [PMID: 19838848 PMCID: PMC2763163 DOI: 10.1007/s11606-009-1079-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE Adjuvant hormone therapy (HT) based on tamoxifen (TX) or aromatase inhibitors (AIs) has become the standard of care for treating hormone receptor -positive (HR+) breast cancer (BC) over the past 20 years. Based on clinical trial results, AI use is recommended by the American Society of Clinical Oncology for treatment of postmenopausal women with HR+ breast cancer. AIs, however, are significantly more expensive than TX, raising concerns about access and use of effective treatment among women of lower socio-economic status. OBJECTIVES To examine the relationship between adjuvant HT modality and experience of financial hardship among a cohort of older BC survivors. Also, to examine the extent to which financial concerns affect the probability of switching between adjuvant HT modalities. DESIGN Population-based, prospective survey study. PARTICIPANTS Elderly (65+) women who had an incident BC surgery in 2003 and who reported receiving adjuvant HT during the first 12 months post-surgery. METHODS Multivariate regression models. RESULTS Use of AIs was associated with a significantly higher probability of financial hardship. Women who had taken only an AI were more likely to experience financial difficulty than women who took only TX (OR = 1.4; 95% CI: 1.1-1.7), but women who switched between TX and AI were not more likely to experience financial difficulty. Breast cancer survivors with no drug coverage (OR = 4.5; 95% CI: 3.3-5.9) or partial drug coverage (OR = 3.6; 95% CI: 2.8-4.5) were more likely to experience financial difficulty compared to those with full coverage. Lack of drug coverage was also the main factor associated with the likelihood that BC survivors did not switch adjuvant HT modalities. CONCLUSIONS Adjuvant HTs have important economic consequences for BC survivors. These consequences are ameliorated by full, but not partial, drug coverage.
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Affiliation(s)
- Liliana E Pezzin
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Mosley JD, Keri RA. Intrinsic bias in breast cancer gene expression data sets. BMC Cancer 2009; 9:214. [PMID: 19563679 PMCID: PMC2711113 DOI: 10.1186/1471-2407-9-214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 06/29/2009] [Indexed: 01/05/2023] Open
Abstract
Background While global breast cancer gene expression data sets have considerable commonality in terms of their data content, the populations that they represent and the data collection methods utilized can be quite disparate. We sought to assess the extent and consequence of these systematic differences with respect to identifying clinically significant prognostic groups. Methods We ascertained how effectively unsupervised clustering employing randomly generated sets of genes could segregate tumors into prognostic groups using four well-characterized breast cancer data sets. Results Using a common set of 5,000 randomly generated lists (70 genes/list), the percentages of clusters with significant differences in metastasis latencies (HR p-value < 0.01) was 62%, 15%, 21% and 0% in the NKI2 (Netherlands Cancer Institute), Wang, TRANSBIG and KJX64/KJ125 data sets, respectively. Among ER positive tumors, the percentages were 38%, 11%, 4% and 0%, respectively. Few random lists were predictive among ER negative tumors in any data set. Clustering was associated with ER status and, after globally adjusting for the effects of ER-α gene expression, the percentages were 25%, 33%, 1% and 0%, respectively. The impact of adjusting for ER status depended on the extent of confounding between ER-α gene expression and markers of proliferation. Conclusion It is highly probable to identify a statistically significant association between a given gene list and prognosis in the NKI2 dataset due to its large sample size and the interrelationship between ER-α expression and markers of proliferation. In most respects, the TRANSBIG data set generated similar outcomes as the NKI2 data set, although its smaller sample size led to fewer statistically significant results.
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Affiliation(s)
- Jonathan D Mosley
- Department of Pharmacology, Division of General Medical Sciences-Oncology, Case Western Reserve University School of Medicine, Cleveland, USA.
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Is red meat intake a risk factor for breast cancer among premenopausal women? Breast Cancer Res Treat 2009; 117:1-8. [DOI: 10.1007/s10549-009-0441-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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Dey S, Soliman AS, Merajver SD. Xenoestrogens may be the cause of high and increasing rates of hormone receptor positive breast cancer in the world. Med Hypotheses 2009; 72:652-6. [PMID: 19155145 DOI: 10.1016/j.mehy.2008.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 10/03/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
Breast cancer rates are higher in the Western or industrialized world when compared to Africa or Asia. Within the developing world, breast cancer rates are higher in urban areas where people have a more Westernized lifestyle. In addition, there has been a steady increase in the breast cancer incidence across the world. It is already a known fact that the proportion of hormone receptor positive breast cancer cases is higher in the developed world. Evidence from developed countries also shows that most of the increase in breast cancer incidence has been due to an increase in hormone receptor positive breast cancer. Most of the breast cancer incidence can be explained by environmental factors and genetic causes. However, all known risk factors of breast cancer can explain only 30-50% of breast cancer incidence. In the past decade, a number of compounds that affect female hormone homeostasis have been discovered. These xenoestrogens have been shown to cause breast cancer and also induce the expression of hormone receptors in vitro and in vivo. Given the high use of substances containing xenoestrogens in developed regions of the world and their increasing use in urban parts of the developing world, xenoestrogens could be the important cause of high and increasing rates of hormone receptor positive breast cancer across the world. New research in the area of mammary stem cells provides added indication of the probable time period of exposure to xenoestrogens with chronic exposure later in life leading to hormone receptor positive breast cancer and most probable reason behind increasing breast cancer incidence.
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Affiliation(s)
- Subhojit Dey
- Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109, USA
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Hennis AJ, Hambleton IR, Wu SY, Leske MC, Nemesure B. Breast cancer incidence and mortality in a Caribbean population: comparisons with African-Americans. Int J Cancer 2009; 124:429-33. [PMID: 18844211 DOI: 10.1002/ijc.23889] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe breast cancer incidence and mortality in the predominantly African-origin population of Barbados, which shares an ancestral origin with African-Americans. Age-standardized incidence rates were calculated from histologically confirmed breast cancer cases identified during a 45-month period (July 2002-March 2006). Mortality rates were estimated from death registrations over 10-years starting January 1995. There were 396 incident cases of breast cancer for an incidence rate of 78.1 (95% confidence interval (CI) 70.5-86.3), standardized to the US population. Breast cancer incidence in African-Americans between 2000 and 2004 was 143.7 (142.0-145.5) per 100,000. Incidence peaked at 226.6 (174.5-289.4) per 100,000 among Barbadian women aged 50-54 years, and declined thereafter, a pattern in marked contrast to trends in African-American women, whose rates continued to increase to a peak of 483.5 per 100,000 in those aged 75-79 years. Incidence rate ratios comparing Barbadian and African-American women showed no statistically significant differences among women aged>or=55 years (p<or=0.001 at all older ages). The age-standardized mortality rate in Barbados was 32.9 (29.9-36.0) per 100,000; similar to reported US rates. The pattern of diverging breast cancer incidence between Barbadian and African-American women may suggest a greater contribution from genetic factors in younger women, and from environmental factors in older women. Studies in intermediate risk populations, such as Barbados, may assist the understanding of racial disparities in breast cancer.
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Affiliation(s)
- Anselm J Hennis
- Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados, West Indies.
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Pinheiro RL, Sarian LO, Pinto-Neto AM, Morais S, Costa-Paiva L. Relationship between body mass index, waist circumference and waist to hip ratio and the steroid hormone receptor status in breast carcinoma of pre- and postmenopausal women. Breast 2008; 18:8-12. [PMID: 19041243 DOI: 10.1016/j.breast.2008.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/03/2008] [Accepted: 09/05/2008] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess whether body mass index (BMI), waist circumference (WC) and waist to hip ratio (WRH) are associated to the steroid receptor status in breast carcinomas. METHODS Four hundred and seventy three women with breast malignancies stage I-III were included. Weight, height, the waist and hip circumferences (WC), body mass index (BMI), and the waist to hip ratio (WHR) were determined. The expression of estrogen (ER) and progesterone (PR) receptors was determined with immunohistochemistry. RESULTS Most women had central obesity (WC>or=88 and WHR>or=0.85 in 64.3 and 73.4%, respectively). The majority (78.1%) of the women had tumors that expressed at least one of the HR. BMI, WC and WHP were not related to the HR status in neither the pre- or postmenopausal women. Multivariate analysis confirmed these findings. CONCLUSIONS BMI, WC or WHR may not be good predictors of HR status in breast malignancies in either pre- or postmenopausal women.
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Affiliation(s)
- Rosilene Lima Pinheiro
- Section of Nutrition and Dietetics, National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Chen JH, Baek HM, Nalcioglu O, Su MY. Estrogen receptor and breast MR imaging features: a correlation study. J Magn Reson Imaging 2008; 27:825-33. [PMID: 18383260 DOI: 10.1002/jmri.21330] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the MRI features between estrogen receptor (ER) positive and negative breast cancers. MATERIALS AND METHODS Breast MRI of 90 consecutive patients confirmed with invasive ductal carcinoma (IDC), 51 ER positive and 39 ER negative, were analyzed. The tumor morphology and dynamic contrast-enhanced (DCE) kinetics were evaluated based on the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon and compared. Enlarged axillary lymph nodes on MRI and choline (Cho) detection using MR spectroscopy (MRS) were also analyzed and compared. For patients receiving axillary node dissection the pathological nodal status was also compared. RESULTS ER negative breast cancer had bigger tumors compared to ER positive cancer (3.6 +/- 2.0 cm vs. 1.8 +/- 1.3 cm, P < 0.00005). ER negative cancer was more likely to exhibit nonmass type enhancements compared to ER positive cancer (P < 0.005). Enlarged axillary lymph nodes were more frequently identified on MRI in ER negative compared to ER positive patients (P < 0.05). After excluding patients undergoing neoadjuvant chemotherapy, auxiliary lymph node status did not show significant difference between ER positive and ER negative cancer on MRI and pathology. ER negative cancer was more likely to show the malignant type enhancement kinetics (P = 0.15), rim enhancement (P = 0.15), and Cho detection on MRS (P = 0.23) compared to ER positive cancer, but it did not reach a level of statistical significance. CONCLUSION ER negative breast cancer was more aggressive, with larger tumor size, more non-mass-type enhancement lesions, and a higher percentage showing enlarged axillary nodes on MRI. These features might be related to its poorer cellular differentiation and/or a higher angiogenesis.
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Affiliation(s)
- Jeon-Hor Chen
- Center for Functional Onco-Imaging, School of Medicine, University of California, Irvine, California 92697, USA.
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Bågeman E, Ingvar C, Rose C, Jernström H. Coffee consumption and CYP1A2*1F genotype modify age at breast cancer diagnosis and estrogen receptor status. Cancer Epidemiol Biomarkers Prev 2008; 17:895-901. [PMID: 18398030 DOI: 10.1158/1055-9965.epi-07-0555] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CYP1A2 plays a key role in the metabolism of both estrogen and coffee. Women with higher coffee intake and the CYP1A2*1F A/A genotype have a ratio of high 2-hydroxyestrone (2-OHE1) to 16alpha-OHE1. 2-OHE1 is a weak estrogen and may even block the estrogen receptor (ER), whereas 16alpha-OHE1 is procarcinogenic. We hypothesized that moderate to high coffee consumption (> or =2 cups per day) combined with the CYP1A2*1F A/A genotype would be associated with a later age at diagnosis and a greater proportion of ER-negative (ER-) tumors among patients with breast cancer. We genotyped 458 patients with breast cancer (age, 25-99 years) in Lund, Sweden, for CYP1A2*1F. Information on lifestyle factors and tumor characteristics were obtained from preoperative questionnaires and pathology reports. Among patients with CYP1A2*1F A/A (51.3%), moderate to high consumption was associated with a later age at diagnosis compared with low coffee consumption (59.8 versus 52.6 years, P = 0.0004). These patients were also more likely to have ER- tumors than patients with low consumption (14.7% versus 0%, P = 0.018). Coffee was not associated with ER status or age at diagnosis in patients with at least one C allele. Age at diagnosis was not associated with ER status in patients with CYP1A2*1F A/A, but younger patients (<50 years) with at least one C allele were more likely to have ER- tumors compared with older patients (odds ratio, 4.2; 95% confidence interval, 1.9-9.3; P = 0.0002). These findings raise the hypothesis that coffee slows the growth of ER-positive tumors in patients with CYP1A2*1F A/A and may have implications for breast cancer if confirmed.
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Affiliation(s)
- Erika Bågeman
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
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Tumor dormancy and surgery-driven interruption of dormancy in breast cancer: learning from failures. ACTA ACUST UNITED AC 2007; 4:699-710. [PMID: 18037874 DOI: 10.1038/ncponc0999] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 06/14/2007] [Indexed: 11/09/2022]
Abstract
Primary tumor removal, usually considered intrinsically beneficial, can perturb metastatic homeostasis, and for some patients results in the acceleration of metastatic cancer. The continuous-growth model is required to yield to an interrupted-growth model, the implications of which are episodes of tumor dormancy. This Review analyzes the recent evolution of two paradigms related to the development of breast cancer metastases. The evolution of the paradigms described herein is supported by a growing body of findings from experimental models, and is required to explain breast cancer recurrence dynamics for patients undergoing surgery with or without adjuvant chemotherapy.
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Gail MH, Anderson WF, Garcia-Closas M, Sherman ME. Absolute risk models for subtypes of breast cancer. J Natl Cancer Inst 2007; 99:1657-9. [PMID: 18000214 DOI: 10.1093/jnci/djm228] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chen WY, Colditz GA. Risk factors and hormone-receptor status: epidemiology, risk-prediction models and treatment implications for breast cancer. ACTA ACUST UNITED AC 2007; 4:415-23. [PMID: 17597706 DOI: 10.1038/ncponc0851] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 02/27/2007] [Indexed: 11/09/2022]
Abstract
It is increasingly being recognized that breast cancer does not represent a single homogeneous disease; instead, the hormone-receptor status defines important clinical and etiologic differences. We review the epidemiologic data on differences in risk-factor associations by hormone-receptor status and highlight major trends in the literature. We discuss the development and evaluation of breast cancer risk models, with a focus on the Rosner and Colditz model, which can separately estimate the risk of hormone-receptor-positive and hormone-receptor-negative breast cancers. We also discuss the clinical implications of accounting for hormone-receptor status in breast cancer risk-prediction models.
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Affiliation(s)
- Wendy Y Chen
- Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Sasser AK, Sullivan NJ, Studebaker AW, Hendey LF, Axel AE, Hall BM. Interleukin-6 is a potent growth factor for ER-alpha-positive human breast cancer. FASEB J 2007; 21:3763-70. [PMID: 17586727 DOI: 10.1096/fj.07-8832com] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bone is the primary anatomical site of breast cancer metastasis, and bone metastasis is associated with increased morbidity and mortality. Mesenchymal stem cells (MSC) are a predominant fibroblast cell population within the bone marrow, and metastatic breast cancer cells that seed within bone would predictably encounter MSC or their soluble factors. Therefore, we examined the impact of primary human MSC on a panel of estrogen receptor-alpha (ERalpha)-positive (MCF-7, T47D, BT474, and ZR-75-1) and ERalpha-negative (MDA-MB-231 and MDA-MB-468) human breast tumor cell lines. All ERalpha-positive breast tumor cell lines displayed low basal activation of signal transducer and activator of transcription 3 (STAT3) until exposed to MSC, which induced chronic phosphorylation of STAT3 on tyrosine-705. Paracrine IL-6 was found to be the principal mediator of STAT3 phosphorylation in coculture studies, and MSC induction of STAT3 phosphorylation was lost when IL-6 was depleted from MSC conditioned media or the IL-6 receptor was blocked on tumor cells. Enhanced tumor cell growth rates were observed in the ERalpha-positive mammary tumor cell line MCF-7 after paracrine and autocrine IL-6 exposure, where MCF-7 growth rates were enhanced by >2-fold when cocultured with MSC in vitro and even more pronounced in vivo with autocrine IL-6 production.
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Affiliation(s)
- A Kate Sasser
- Integrated Biomedical Science Graduate Program, Department of Pediatrics, School of Medicine & Public Health, The Ohio State University, Columbus, Ohio, USA
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