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John EM, Koo J, Phipps AI, Longacre TA, Kurian AW, Ingles SA, Wu AH, Hines LM. Reproductive characteristics, menopausal status, race and ethnicity, and risk of breast cancer subtypes defined by ER, PR and HER2 status: the Breast Cancer Etiology in Minorities study. Breast Cancer Res 2024; 26:88. [PMID: 38822357 PMCID: PMC11143591 DOI: 10.1186/s13058-024-01834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/03/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Associations between reproductive factors and risk of breast cancer differ by subtype defined by joint estrogen receptor (ER), progesterone receptor (PR), and HER2 expression status. Racial and ethnic differences in the incidence of breast cancer subtypes suggest etiologic heterogeneity, yet data are limited because most studies have included non-Hispanic White women only. METHODS We analyzed harmonized data for 2,794 breast cancer cases and 4,579 controls, of whom 90% self-identified as African American, Asian American or Hispanic. Questionnaire data were pooled from three population-based studies conducted in California and data on tumor characteristics were obtained from the California Cancer Registry. The study sample included 1,530 luminal A (ER-positive and/or PR-positive, HER2-negative), 442 luminal B (ER-positive and/or PR-positive, HER2-positive), 578 triple-negative (TN; ER-negative, PR-negative, HER2-negative), and 244 HER2-enriched (ER-negative, PR-negative, HER2-positive) cases. We used multivariable unconditional logistic regression models to estimate subtype-specific ORs and 95% confidence intervals associated with parity, breast-feeding, and other reproductive characteristics by menopausal status and race and ethnicity. RESULTS Subtype-specific associations with reproductive factors revealed some notable differences by menopausal status and race and ethnicity. Specifically, higher parity without breast-feeding was associated with higher risk of luminal A and TN subtypes among premenopausal African American women. In contrast, among Asian American and Hispanic women, regardless of menopausal status, higher parity with a breast-feeding history was associated with lower risk of luminal A subtype. Among premenopausal women only, luminal A subtype was associated with older age at first full-term pregnancy (FTP), longer interval between menarche and first FTP, and shorter interval since last FTP, with similar OR estimates across the three racial and ethnic groups. CONCLUSIONS Subtype-specific associations with reproductive factors overall and by menopausal status, and race and ethnicity, showed some differences, underscoring that understanding etiologic heterogeneity in racially and ethnically diverse study samples is essential. Breast-feeding is likely the only reproductive factor that is potentially modifiable. Targeted efforts to promote and facilitate breast-feeding could help mitigate the adverse effects of higher parity among premenopausal African American women.
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Affiliation(s)
- Esther M John
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford University School of Medicine, 3145 Porter Drive, Suite E223, Palo Alto, CA, 94504, USA.
| | - Jocelyn Koo
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Teri A Longacre
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Allison W Kurian
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Sue A Ingles
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90089, USA
| | - Lisa M Hines
- Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, CO, 80918, USA
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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AK N, TUZ Z, AYDIN E, FERHATOĞLU F, SARI M, PAKSOY N, DOĞAN İ, YILDIZ A, DİŞÇİ R, SAİP PM. The effect of parity, breastfeeding history, and duration on clinical and pathological characteristics of breast cancer patients. Turk J Med Sci 2023; 54:229-238. [PMID: 38812646 PMCID: PMC11031182 DOI: 10.55730/1300-0144.5784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 02/15/2024] [Accepted: 11/18/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The study is aimed to determine the relationship between the delivery and breastfeeding history of the patients and the clinicopathological properties of breast cancer. Materials and methods A questionnaire was utilized for the study, which included the age of diagnosis, the number of children at the time of diagnosis, the age of the children, and the breastfeeding period of each child. Results The study included 828 patients. The median age at diagnosis was 47 years for parous women and 42 years for nonparous women (p < 0.001). The tumor size of the patients diagnosed within the breastfeeding period was significantly larger compared to the other patients. Estrogen and progesterone receptor positivity were lower in patients diagnosed during breastfeeding. Additionally, the mean number of positive lymph nodes, dissected lymph nodes, and positive lymph node/dissected lymph node ratio in parous and breastfed patients with a nonmetastatic disease were statistically significantly higher in multivariable analysis than those patients who were nulliparous and have not breastfed. Conclusion Breast cancer is seen at a later age in patients who are parous than those who have never given birth. Patients who are parous and have breastfed tend to present with a higher stage of the disease.
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Affiliation(s)
- Naziye AK
- Department of Medical Oncology, Faculty of Medicine, Demiroğlu Bilim University, İstanbul,
Turkiye
| | - Zeynep TUZ
- Department of Radiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Esra AYDIN
- Department of Medical Oncology, Recep Tayyip Erdogan University, Rize,
Turkiye
| | - Ferhat FERHATOĞLU
- Department of Medical Oncology, Basakşehir Çam ve Sakura City Hospital, İstanbul,
Turkiye
| | - Murat SARI
- Department of Medical Oncology, Marmara Faculty of Medicine, Marmara University, İstanbul,
Turkiye
| | - Nail PAKSOY
- Department of Medical Oncology, Tekirdağ İsmail Fehmi Cumalıoğlu City Hospital, Tekirdağ,
Turkiye
| | - İzzet DOĞAN
- Department of Medical Oncology, Basakşehir Çam ve Sakura City Hospital, İstanbul,
Turkiye
| | - Anıl YILDIZ
- Department of Medical Oncology, İstanbul Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Rian DİŞÇİ
- Faculty of Biostatistical Science, Beykent University, İstanbul,
Turkiye
| | - Pınar Mualla SAİP
- Department of Medical Oncology, İstanbul Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
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Terry MB, Colditz GA. Epidemiology and Risk Factors for Breast Cancer: 21st Century Advances, Gaps to Address through Interdisciplinary Science. Cold Spring Harb Perspect Med 2023; 13:a041317. [PMID: 36781224 PMCID: PMC10513162 DOI: 10.1101/cshperspect.a041317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Research methods to study risk factors and prevention of breast cancer have evolved rapidly. We focus on advances from epidemiologic studies reported over the past two decades addressing scientific discoveries, as well as their clinical and public health translation for breast cancer risk reduction. In addition to reviewing methodology advances such as widespread assessment of mammographic density and Mendelian randomization, we summarize the recent evidence with a focus on the timing of exposure and windows of susceptibility. We summarize the implications of the new evidence for application in risk stratification models and clinical translation to focus prevention-maximizing benefits and minimizing harm. We conclude our review identifying research gaps. These include: pathways for the inverse association of vegetable intake and estrogen receptor (ER)-ve tumors, prepubertal and adolescent diet and risk, early life adiposity reducing lifelong risk, and gaps from changes in habits (e.g., vaping, binge drinking), and environmental exposures.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, Chronic Disease Unit Leader, Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Associate Director, New York, New York 10032, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St Louis, St. Louis, Missouri 63110, USA
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Abubakar M, Klein A, Fan S, Lawrence S, Mutreja K, Henry JE, Pfeiffer RM, Duggan MA, Gierach GL. Host, reproductive, and lifestyle factors in relation to quantitative histologic metrics of the normal breast. Breast Cancer Res 2023; 25:97. [PMID: 37582731 PMCID: PMC10426057 DOI: 10.1186/s13058-023-01692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/29/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Emerging data indicate that variations in quantitative epithelial and stromal tissue composition and their relative abundance in benign breast biopsies independently impact risk of future invasive breast cancer. To gain further insights into breast cancer etiopathogenesis, we investigated associations between epidemiological factors and quantitative tissue composition metrics of the normal breast. METHODS The study participants were 4108 healthy women ages 18-75 years who voluntarily donated breast tissue to the US-based Susan G. Komen Tissue Bank (KTB; 2008-2019). Using high-accuracy machine learning algorithms, we quantified the percentage of epithelial, stromal, adipose, and fibroglandular tissue, as well as the proportion of fibroglandular tissue that is epithelium relative to stroma (i.e., epithelium-to-stroma proportion, ESP) on digitized hematoxylin and eosin (H&E)-stained normal breast biopsy specimens. Data on epidemiological factors were obtained from participants using a detailed questionnaire administered at the time of tissue donation. Associations between epidemiological factors and square root transformed tissue metrics were investigated using multivariable linear regression models. RESULTS With increasing age, the amount of stromal, epithelial, and fibroglandular tissue declined and adipose tissue increased, while that of ESP demonstrated a bimodal pattern. Several epidemiological factors were associated with individual tissue composition metrics, impacting ESP as a result. Compared with premenopausal women, postmenopausal women had lower ESP [β (95% Confidence Interval (CI)) = -0.28 (- 0.43, - 0.13); P < 0.001] with ESP peaks at 30-40 years and 60-70 years among pre- and postmenopausal women, respectively. Pregnancy [β (95%CI) vs nulligravid = 0.19 (0.08, 0.30); P < 0.001] and increasing number of live births (P-trend < 0.001) were positively associated with ESP, while breastfeeding was inversely associated with ESP [β (95%CI) vs no breastfeeding = -0.15 (- 0.29, - 0.01); P = 0.036]. A positive family history of breast cancer (FHBC) [β (95%CI) vs no FHBC = 0.14 (0.02-0.26); P = 0.02], being overweight or obese [β (95%CI) vs normal weight = 0.18 (0.06-0.30); P = 0.004 and 0.32 (0.21-0.44); P < 0.001, respectively], and Black race [β (95%CI) vs White = 0.12 (- 0.005, 0.25); P = 0.06] were positively associated with ESP. CONCLUSION Our findings revealed that cumulative exposure to etiological factors over the lifespan impacts normal breast tissue composition metrics, individually or jointly, to alter their dynamic equilibrium, with potential implications for breast cancer susceptibility and tumor etiologic heterogeneity.
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Affiliation(s)
- Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Shady Grove, Bethesda, MD, 20850, USA.
| | - Alyssa Klein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Shady Grove, Bethesda, MD, 20850, USA
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Shady Grove, Bethesda, MD, 20850, USA
| | - Scott Lawrence
- Molecular and Digital Pathology Laboratory, Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, 21702, USA
| | - Karun Mutreja
- Molecular and Digital Pathology Laboratory, Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, 21702, USA
| | - Jill E Henry
- Biospecimen Collection and Banking Core, Susan G. Komen Tissue Bank at the IU Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Shady Grove, Bethesda, MD, 20850, USA
| | - Maire A Duggan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, T2N2Y9, Canada
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Shady Grove, Bethesda, MD, 20850, USA
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Mao X, Omeogu C, Karanth S, Joshi A, Meernik C, Wilson L, Clark A, Deveaux A, He C, Johnson T, Barton K, Kaplan S, Akinyemiju T. Association of reproductive risk factors and breast cancer molecular subtypes: a systematic review and meta-analysis. BMC Cancer 2023; 23:644. [PMID: 37430191 DOI: 10.1186/s12885-023-11049-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes. METHODS Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals. RESULTS A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use. CONCLUSION Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.
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Affiliation(s)
- Xihua Mao
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Shama Karanth
- UF Health Cancer Canter, University of Florida, Gainesville, FL, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Clare Meernik
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Lauren Wilson
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Amy Clark
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Chunyan He
- The Cancer Prevention and Control Research Program, University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Tisha Johnson
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Karen Barton
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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Burchardt NA, Eliassen AH, Shafrir AL, Rosner B, Tamimi RM, Kaaks R, Tworoger SS, Fortner RT. Oral contraceptive use by formulation and breast cancer risk by subtype in the Nurses' Health Study II: a prospective cohort study. Am J Obstet Gynecol 2022; 226:821.e1-821.e26. [PMID: 34921803 DOI: 10.1016/j.ajog.2021.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oral contraceptive use has been associated with a higher breast cancer risk; however, evidence for the associations between different oral contraceptive formulations and breast cancer risk, especially by disease subtype, is limited. OBJECTIVE This study aimed to evaluate the associations between oral contraceptive use by formulation and breast cancer risk by disease subtype. STUDY DESIGN This prospective cohort study included 113,187 women from the Nurses' Health Study II with recalled information on oral contraceptive usage from 13 years of age to baseline (1989) and updated data on usage until 2009 collected via biennial questionnaires. A total of 5799 breast cancer cases were identified until the end of 2017. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals for the associations between oral contraceptive use and breast cancer risk overall and by estrogen and progesterone receptor and human epidermal growth factor receptor 2 status. Oral contraceptive use was evaluated by status of use (current, former, and never), duration of and time since last use independently and cross-classified, and formulation (ie, estrogen and progestin type). RESULTS Current oral contraceptive use was associated with a higher risk for invasive breast cancer (hazard ratio, 1.31; 95% confidence interval, 1.09-1.58) when compared with never use, with stronger associations observed for longer durations of current use (>5 years: hazard ratio, 1.56; 95% confidence interval, 1.23-1.99; ≤5 years: hazard ratio, 1.19; 95% confidence interval, 0.95-1.49). Among former users with >5 years since cessation, the risk was similar to that of never users (eg, >5 to 10 years since cessation: hazard ratio, 0.99; 95% confidence interval, 0.88-1.11). Associations did not differ significantly by tumor subtype. In analyses by formulation, current use of formulations containing levonorgestrel in triphasic (hazard ratio, 2.83; 95% confidence interval, 1.98-4.03) and extended cycle regimens (hazard ratio, 3.49; 95% confidence interval, 1.28-9.53) and norgestrel in monophasic regimens (hazard ratio, 1.91; 95% confidence interval, 1.19-3.06), all combined with ethinyl estradiol, was associated with a higher breast cancer risk when compared with never oral contraceptive use. No association was observed for current use of the other progestin types evaluated (norethindrone, norethindrone acetate, ethynodiol diacetate, desogestrel, norgestimate, and drospirenone), however, sample sizes were relatively small for some of the subgroups, limiting these analyses. CONCLUSION Current oral contraceptive use was associated with a higher risk for invasive breast cancer regardless of disease subtype, however, the risk in former users was comparable with never users 5 years after cessation. In analyses by progestin type, associations were observed for select formulations containing levonorgestrel and norgestrel. Assessment of the associations for newer progestin types (desogestrel, norgestimate, drospirenone) was limited by sample size, and further research on more recently introduced progestins is warranted.
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Barańska A, Dolar-Szczasny J, Kanadys W, Kinik W, Ceglarska D, Religioni U, Rejdak R. Oral Contraceptive Use and Breast Cancer Risk According to Molecular Subtypes Status: A Systematic Review and Meta-Analysis of Case-Control Studies. Cancers (Basel) 2022; 14:cancers14030574. [PMID: 35158842 PMCID: PMC8833678 DOI: 10.3390/cancers14030574] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
We conducted a systematic review and meta-analysis to investigate the effect of oral contraceptives (OCs) on risk of breast cancer (BrCa) by status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). We searched the MEDLINE (PubMed), Embase and the Cochrane Library database and bibliographies of pertinent articles published up to 2020. Therein, we identified nineteen eligible case-control studies which provided data by breast cancer subtypes: ER-positive (ER+), ER-negative (ER−), HER2-positive (HER2+) and Triplet-negative (TN). Summary risk estimates (pooled OR [pOR]) and 95% confidence intervals (CIs) were calculated using fixed/random effects models. The summary meta-analysis showed that over-use of OCs led to significant increased risk of TNBrCa (OR = 1.37, 95% CI; 1.13 to 1.67, p = 0.002), as well as of ER−BrCa (OR = 1.20, 95% CI: 1.03 to 1.40, p = 0.019). There was also a significant reduction in the risk of ER+BrCa (OR = O.92, 95% CI: 0.86 to 0.99, p = 0.026,) and a slight reduction in the risk of HER2+BrCa (OR = 0.95, 95% CI; 0.79 to 1.14, p = 0.561) after taking OCs. Meta-analysis indicated that OC use has different impacts on risk of breast cancer subtypes defined by receptor status. The identified differences between individual subtypes of breast cancer may reflect different mechanisms of carcinogenesis.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland
- Correspondence:
| | - Joanna Dolar-Szczasny
- Department of General and Pediatric Ophtalmology, Medical University of Lublin, 20-070 Lublin, Poland; (J.D.-S.); (R.R.)
| | | | - Wiktoria Kinik
- Science Popularization Centre, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Dorota Ceglarska
- Subunit, Primary Health Care Center Provita, 20-093 Lublin, Poland;
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland;
- National Institute of Public Health-National Institute of Hygiene, Warsaw School of Economics, 02-554 Warsaw, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophtalmology, Medical University of Lublin, 20-070 Lublin, Poland; (J.D.-S.); (R.R.)
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Bertrand KA, O’Brien KM, Wright LB, Palmer JR, Blot WJ, Eliassen AH, Rosenberg L, Sandin S, Tobias D, Weiderpass E, Zheng W, Swerdlow AJ, Schoemaker MJ, Nichols HB, Sandler DP. Gestational diabetes and risk of breast cancer before age 55 years. Int J Epidemiol 2022; 50:1936-1947. [PMID: 34458915 PMCID: PMC8743115 DOI: 10.1093/ije/dyab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The history of gestational diabetes mellitus (GDM) has been associated with breast cancer risk in some studies, particularly in young women, but results of cohort studies are conflicting. METHODS We pooled data from 257 290 young (age <55 years) women from five cohorts. We used multivariable Cox proportional-hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between GDM history and risk of breast cancer, overall and by oestrogen receptor (ER) status, before age 55 years, adjusted for established breast cancer risk factors. RESULTS Five percent of women reported a history of GDM and 6842 women reported an incident breast-cancer diagnosis (median follow-up = 16 years; maximum = 24 years). Compared with parous women without GDM, women with a history of GDM were not at increased risk of young-onset breast cancer overall (HR = 0.90; 95% CI: 0.78, 1.03) or by ER status (HR = 0.96; 95% CI: 0.79, 1.16 for ER-positive; HR = 1.07; 95% CI: 0.78, 1.47 for ER-negative). Compared with nulliparous women, parous women with a history of GDM had a lower risk of breast cancer overall (HR = 0.79; 95% CI: 0.68, 0.91) and of ER-positive (HR = 0.82; 95% CI: 0.66, 1.02) but not ER-negative (HR = 1.09; 95% CI: 0.76, 1.54) invasive breast cancer. These results were consistent with the HRs comparing parous women without GDM to nulliparous women. CONCLUSIONS Results of this analysis do not support the hypothesis that GDM is a risk factor for breast cancer in young women. Our findings suggest that the well-established protective effect of parity on risk of ER-positive breast cancer persists even for pregnancies complicated by GDM.
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Affiliation(s)
| | - Katie M O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Deirdre Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC)/World Health Organization (WHO), Lyon, France
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
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10
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Palmer JR, Zirpoli G, Bertrand KA, Battaglia T, Bernstein L, Ambrosone CB, Bandera EV, Troester MA, Rosenberg L, Pfeiffer RM, Trinquart L. A Validated Risk Prediction Model for Breast Cancer in US Black Women. J Clin Oncol 2021; 39:3866-3877. [PMID: 34623926 PMCID: PMC8608262 DOI: 10.1200/jco.21.01236] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Breast cancer risk prediction models are used to identify high-risk women for early detection, targeted interventions, and enrollment into prevention trials. We sought to develop and evaluate a risk prediction model for breast cancer in US Black women, suitable for use in primary care settings. METHODS Breast cancer relative risks and attributable risks were estimated using data from Black women in three US population-based case-control studies (3,468 breast cancer cases; 3,578 controls age 30-69 years) and combined with SEER age- and race-specific incidence rates, with incorporation of competing mortality, to develop an absolute risk model. The model was validated in prospective data among 51,798 participants of the Black Women's Health Study, including 1,515 who developed invasive breast cancer. A second risk prediction model was developed on the basis of estrogen receptor (ER)-specific relative risks and attributable risks. Model performance was assessed by calibration (expected/observed cases) and discriminatory accuracy (C-statistic). RESULTS The expected/observed ratio was 1.01 (95% CI, 0.95 to 1.07). Age-adjusted C-statistics were 0.58 (95% CI, 0.56 to 0.59) overall and 0.63 (95% CI, 0.58 to 0.68) among women younger than 40 years. These measures were almost identical in the model based on estrogen receptor-specific relative risks and attributable risks. CONCLUSION Discriminatory accuracy of the new model was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models in White women, suggesting that effective risk stratification for Black women is now possible. This model may be especially valuable for risk stratification of young Black women, who are below the ages at which breast cancer screening is typically begun.
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Affiliation(s)
- Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Gary Zirpoli
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Kimberly A. Bertrand
- Slone Epidemiology Center at Boston University, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | | | | | | | - Melissa A. Troester
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Ruth M. Pfeiffer
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD
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11
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Barańska A, Błaszczuk A, Kanadys W, Malm M, Drop K, Polz-Dacewicz M. Oral Contraceptive Use and Breast Cancer Risk Assessment: A Systematic Review and Meta-Analysis of Case-Control Studies, 2009-2020. Cancers (Basel) 2021; 13:cancers13225654. [PMID: 34830807 PMCID: PMC8616467 DOI: 10.3390/cancers13225654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE), Embase, and the Cochrane Library were searched to identify case-control studies of OC and BrCa published between 2009 and 2020. We used the DerSimonian-Laird method to compute pooled odds ratios (ORs) and confidence intervals (CIs), and the Mantel-Haenszel test to assess the association between OC use and cancer. Forty-two studies were identified that met the inclusion criteria and we included a total of 110,580 women (30,778 into the BrCa group and 79,802 into the control group, of which 15,722 and 38,334 were using OC, respectively). The conducted meta-analysis showed that the use of OC was associated with a significantly increased risk of BrCa in general, OR = 1.15, 95% CI: 1.01 to 1.31, p = 0.0358. Regarding other risk factors for BrCa, we found that increased risk was associated significantly with early menarche, nulliparous, non-breastfeeding, older age at first parity, postmenopause, obesity, smoking, and family history of BrCa. Despite our conclusion that birth control pills increase the cancer risk being supported by extensive previous studies and meta-analyzes, further confirmation is required.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland;
- Correspondence:
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Wiesław Kanadys
- Specialistic Medical Center Czechow, Gynecology Unit, 20-848 Lublin, Poland;
| | - Maria Malm
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Katarzyna Drop
- Department of Language, Rhetoric and Media Law, John Paul II Catholic University, 20-950 Lublin, Poland;
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
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12
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Allouch S, Gupta I, Malik S, Al Farsi HF, Vranic S, Al Moustafa AE. Breast Cancer During Pregnancy: A Marked Propensity to Triple-Negative Phenotype. Front Oncol 2021; 10:580345. [PMID: 33425733 PMCID: PMC7786283 DOI: 10.3389/fonc.2020.580345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022] Open
Abstract
Breast and cervical cancers comprise 50% of all cancers during pregnancy. In particular, gestational breast cancer is considered one of the most aggressive types of cancers, which is a rare but fatal disease. However, the incidence of this type of cancer is increasing over the years and its prevalence is expected to rise further as more women delay childbearing. Breast cancer occurring after pregnancy is generally triple negative with specific characterizations of a poorer prognosis and outcome. On the other hand, it has been pointed out that this cancer is associated with a specific group of genes which can be used as precise targets to manage this deadly disease. Indeed, combination therapies consisting of gene-based agents with other cancer therapeutics is presently under consideration. We herein review recent progress in understanding the development of breast cancer during pregnancy and their unique subtype of triple negative which is the hallmark of this type of breast cancer.
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Affiliation(s)
- Soumaya Allouch
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ishita Gupta
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
| | - Shaza Malik
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ala-Eddin Al Moustafa
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
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13
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John EM, Phipps AI, Hines LM, Koo J, Ingles SA, Baumgartner KB, Slattery ML, Wu AH. Menstrual and reproductive characteristics and breast cancer risk by hormone receptor status and ethnicity: The Breast Cancer Etiology in Minorities study. Int J Cancer 2020; 147:1808-1822. [PMID: 32064598 PMCID: PMC8784189 DOI: 10.1002/ijc.32923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
We pooled multiethnic data from four population-based studies and examined associations of menstrual and reproductive characteristics with breast cancer (BC) risk by tumor hormone receptor (HR) status [defined by estrogen receptor (ER) and progesterone receptor (PR)]. We estimated odds ratios and 95% confidence intervals using multivariable logistic regression, stratified by age (<50, ≥50 years) and ethnicity, for 5,186 HR+ (ER+ or PR+) cases, 1,365 HR- (ER- and PR-) cases and 7,480 controls. For HR+ BC, later menarche and earlier menopause were associated with lower risk in non-Hispanic whites (NHWs) and Hispanics, and higher parity and longer breast-feeding were associated with lower risk in Hispanics and Asian Americans, and suggestively in NHWs. Positive associations with later first full-term pregnancy (FTP), longer interval between menarche and first FTP and shorter time since last FTP were limited to younger Hispanics and Asian Americans. Except for nulliparity, reproductive characteristics were not associated with risk in African Americans. For HR- BC, lower risk was associated with later menarche, except in African Americans and older Asian Americans and with longer breast-feeding in Hispanics and Asian Americans only. In younger African Americans, HR- BC risk associated with higher parity (≥3 vs. 1 FTP) was increased fourfold in women who never breast-fed, but not in those with a breast-feeding history, suggesting that breast-feeding may mitigate the adverse effect of higher parity in younger African American women. Further work needs to evaluate why menstrual and reproductive risk factors vary in importance according to age and ethnicity.
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Affiliation(s)
- Esther M. John
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, CA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa M. Hines
- Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, CO
| | - Jocelyn Koo
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Sue A. Ingles
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Kathy B. Baumgartner
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | | | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
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14
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Figueroa JD, Davis Lynn BC, Edusei L, Titiloye N, Adjei E, Clegg-Lamptey JN, Yarney J, Wiafe-Addai B, Awuah B, Duggan MA, Wiafe S, Nyarko K, Aitpillah F, Ansong D, Hewitt SM, Ahearn T, Garcia-Closas M, Brinton LA. Reproductive factors and risk of breast cancer by tumor subtypes among Ghanaian women: A population-based case-control study. Int J Cancer 2020; 147:1535-1547. [PMID: 32068253 DOI: 10.1002/ijc.32929] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/09/2020] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Abstract
Higher proportions of early-onset and estrogen receptor (ER) negative cancers are observed in women of African ancestry than in women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status may explain this disparity. We analyzed data from 1,126 cases (aged 18-74 years) with invasive breast cancer and 2,106 controls recruited from a population-based case-control study in Ghana. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for menstrual and reproductive factors using polytomous logistic regression models adjusted for potential confounders. Among controls, medians for age at menarche, parity, age at first birth, and breastfeeding/pregnancy were 15 years, 4 births, 20 years and 18 months, respectively. For women ≥50 years, parity and extended breastfeeding were associated with decreased risks: >5 births vs. nulliparous, OR 0.40 (95% CI 0.20-0.83) and 0.71 (95% CI 0.51-0.98) for ≥19 vs. <13 breastfeeding months/pregnancy, which did not differ by ER. In contrast, for earlier onset cases (<50 years) parity was associated with increased risk for ER-negative tumors (p-heterogeneity by ER = 0.02), which was offset by extended breastfeeding. Similar associations were observed by intrinsic-like subtypes. Less consistent relationships were observed with ages at menarche and first birth. Reproductive risk factor distributions are different from European populations but exhibited etiologic heterogeneity by age at diagnosis and ER status similar to other populations. Differences in reproductive patterns and subtype heterogeneity are consistent with racial disparities in subtype distributions.
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Affiliation(s)
- Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Brittny C Davis Lynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | - Maire A Duggan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, CA
| | | | | | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen M Hewitt
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Thomas Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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15
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Cheng TYD, Yao S, Omilian AR, Khoury T, Buas MF, Payne-Ondracek R, Sribenja S, Bshara W, Hong CC, Bandera EV, Davis W, Higgins MJ, Ambrosone CB. FOXA1 Protein Expression in ER + and ER - Breast Cancer in Relation to Parity and Breastfeeding in Black and White Women. Cancer Epidemiol Biomarkers Prev 2019; 29:379-385. [PMID: 31871111 DOI: 10.1158/1055-9965.epi-19-0787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/28/2019] [Accepted: 12/12/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Forkhead box protein A1 (FOXA1) promotes luminal differentiation, and hypermethylation of the gene can be a mechanism of developing estrogen receptor-negative (ER-) breast cancer. We examined FOXA1 in breast tumor and adjacent normal tissue in relation to reproductive factors, particularly higher parity and no breastfeeding, that are associated with ER- tumors. METHODS We performed IHC for FOXA1 in breast tumors (n = 1,329) and adjacent normal tissues (n = 298) in the Women's Circle of Health Study (949 Blacks and 380 Whites). Protein expression levels were summarized by histology (H) scores. Generalized linear models were used to assess FOXA1 protein expression in relation to reproductive factors by ER status. RESULTS ER-positive (ER+) versus ER- tumors had higher FOXA1 protein expression (P < 0.001). FOXA1 expression was higher in tumor versus paired adjacent normal tissue in women with ER+ or non-triple-negative cancer (both P < 0.001), but not in those with ER- or triple-negative cancer. Higher number of births (1, 2, and 3+) was associated with lower FOXA1 protein expression in ER+ tumors [differences in H score, or β = -8.5; 95% confidence interval (CI), -15.1 to -2.0], particularly among parous women who never breastfed (β = -10.4; 95% CI, -19.7 to -1.0), but not among those who breastfed (β = -7.5; 95% CI, -16.9 to 1.8). The associations for ER- tumors were similar, although they were not statistically significant. CONCLUSIONS In this tumor-based study, higher parity was associated with lower FOXA1 expression in ER+ tumors, and breastfeeding may ameliorate the influence. IMPACT These findings contribute to our understanding of FOXA1 methylation and breast cancer etiology.
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Affiliation(s)
- Ting-Yuan David Cheng
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida. .,Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Angela R Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Thaer Khoury
- Department of Pathology & Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Matthew F Buas
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rochelle Payne-Ondracek
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sirinapa Sribenja
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Wiam Bshara
- Department of Pathology & Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, The State University of New Jersey, New Brunswick, New Jersey
| | - Warren Davis
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael J Higgins
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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16
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Sangaramoorthy M, Hines LM, Torres-Mejía G, Phipps AI, Baumgartner KB, Wu AH, Koo J, Ingles SA, Slattery ML, John EM. A Pooled Analysis of Breastfeeding and Breast Cancer Risk by Hormone Receptor Status in Parous Hispanic Women. Epidemiology 2019; 30:449-457. [PMID: 30964816 PMCID: PMC6472273 DOI: 10.1097/ede.0000000000000981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on breastfeeding and breast cancer risk are sparse and inconsistent for Hispanic women. METHODS Pooling data for nearly 6,000 parous Hispanic women from four population-based studies conducted between 1995 and 2007 in the United States and Mexico, we examined the association of breastfeeding with risk of breast cancer overall and subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status, and the joint effects of breastfeeding, parity, and age at first birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. RESULTS Among parous Hispanic women, older age at first birth was associated with increased breast cancer risk, whereas parity was associated with reduced risk. These associations were found for hormone receptor positive (HR+) breast cancer only and limited to premenopausal women. Age at first birth and parity were not associated with risk of ER- and PR- breast cancer. Increasing duration of breastfeeding was associated with decreasing breast cancer risk (≥25 vs. 0 months: OR = 0.73; 95% CI = 0.60, 0.89; Ptrend = 0.03), with no heterogeneity by menopausal status or subtype. At each parity level, breastfeeding further reduced HR+ breast cancer risk. Additionally, breastfeeding attenuated the increase in risk of HR+ breast cancer associated with older age at first birth. CONCLUSIONS Our findings suggest that breastfeeding is associated with reduced risk of both HR+ and ER- and PR- breast cancer among Hispanic women, as reported for other populations, and may attenuate the increased risk in women with a first pregnancy at older ages.
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Affiliation(s)
| | - Lisa M. Hines
- Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, CO 80918
| | - Gabriela Torres-Mejía
- Instituto Nacional de Salud Puública, Population Health Research Center, Cuernavaca Morelos,
Mexico
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA 98195
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
98109
| | - Kathy B. Baumgartner
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, James
Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center,
University of Southern California, Los Angeles, CA 90089
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA 94538
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94304
| | - Sue A. Ingles
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center,
University of Southern California, Los Angeles, CA 90089
| | | | - Esther M. John
- Cancer Prevention Institute of California, Fremont, CA 94538
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94304
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA
94304
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17
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Fortner RT, Sisti J, Chai B, Collins LC, Rosner B, Hankinson SE, Tamimi RM, Eliassen AH. Parity, breastfeeding, and breast cancer risk by hormone receptor status and molecular phenotype: results from the Nurses' Health Studies. Breast Cancer Res 2019; 21:40. [PMID: 30867002 PMCID: PMC6416887 DOI: 10.1186/s13058-019-1119-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/13/2019] [Indexed: 01/02/2023] Open
Abstract
Background Epidemiologic data suggest that parity increases risk of hormone receptor-negative breast cancer and that breastfeeding attenuates this association. Prospective data, particularly on the joint effects of higher parity and breastfeeding, are limited. Methods We investigated parity, breastfeeding, and breast cancer risk by hormone-receptor (estrogen (ER) and progesterone receptor (PR)) and molecular subtypes (luminal A, luminal B, HER2-enriched, and basal-like) in the Nurses’ Health Study (NHS; 1976–2012) and NHSII (1989–2013). A total of 12,452 (ER+ n = 8235; ER− n = 1978) breast cancers were diagnosed among 199,514 women. We used Cox proportional hazards models, adjusted for breast cancer risk factors, to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results Parous women had lower risk of ER+ breast cancer (vs. nulliparous, HR = 0.82 [0.77–0.88]); no association was observed for ER− disease (0.98 [0.84–1.13]; Phet = 0.03). Among parous women, breastfeeding was associated with lower risk of ER− (vs. never 0.82 [0.74–0.91]), but not ER+, disease (0.99 [0.94–1.05]; Phet < 0.001). Compared to nulliparous women, higher parity was inversely associated with luminal B breast cancer regardless of breastfeeding (≥ 3 children: ever breastfed, 0.78 [0.62–0.98]; never breastfed, 0.76 [0.58–1.00]) and luminal A disease only among women who had breastfed (≥ 3 children, 0.84 [0.71–0.99]). Basal-like breast cancer risk was suggestively higher among women with higher parity who never breastfed; associations were null among those who ever breastfed. Conclusions This study provides evidence that breastfeeding is inversely associated with hormone receptor-negative breast cancers, representing an accessible and cost-effective risk-reduction strategy for aggressive disease subtypes. Electronic supplementary material The online version of this article (10.1186/s13058-019-1119-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Julia Sisti
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Boyang Chai
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Susan E Hankinson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St., Amherst, MA, 01003, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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18
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Nichols HB, Schoemaker MJ, Cai J, Xu J, Wright LB, Brook MN, Jones ME, Adami HO, Baglietto L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kitahara CM, Larsson SC, Linet M, Merritt MA, Milne RL, Pala V, Palmer JR, Peeters PH, Riboli E, Sund M, Tamimi RM, Tjønneland A, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Wolk A, Zheng W, Weinberg CR, Swerdlow AJ, Sandler DP. Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. Ann Intern Med 2019; 170:22-30. [PMID: 30534999 PMCID: PMC6760671 DOI: 10.7326/m18-1323] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective To characterize breast cancer risk in relation to recent childbirth. Design Pooled analysis of individual-level data from 15 prospective cohort studies. Setting The international Premenopausal Breast Cancer Collaborative Group. Participants Women younger than 55 years. Measurements During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women. Primary Funding Source The Avon Foundation, the National Institute of Environmental Health Sciences, Breast Cancer Now and the UK National Health Service, and the Institute of Cancer Research.
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Affiliation(s)
- Hazel B. Nichols
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Jianwen Cai
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jiawei Xu
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Mark N. Brook
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | - William J. Blot
- Vanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marie-Christine Boutron-Ruault
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Institut Gustave Roussy Centre for Research in Epidemiology and Population Health, University Paris-Saclay, and University Paris-Sud, Villejuif, France
| | - Miren Dorronsoro
- Public Health Direction and Biodonostia Research Institute and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Basque Regional Health Department, San Sebastian, Spain
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - A. Heather Eliassen
- Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Graham G. Giles
- Cancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Inger T. Gram
- University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Susan E. Hankinson
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | | | - Rudolf Kaaks
- German Cancer Research Center, Heidelberg, Germany
| | | | - Cari M. Kitahara
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Susanna C. Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martha Linet
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Melissa A. Merritt
- School of Public Health, Imperial College London, London, United Kingdom
| | - Roger L. Milne
- Cancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Valeria Pala
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, and University of Oslo, Oslo, Norway, and University of Southern California, Los Angeles, California
| | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | | | - Rulla M. Tamimi
- Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Giske Ursin
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Vatten
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisabete Weiderpass
- Karolinska Institutet, Stockholm, Sweden; University of Tromsø, The Arctic University of Norway, Tromsø, Norway; and Folkhälsan Research Center, Helsinki, Finland
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wei Zheng
- Vanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Clarice R. Weinberg
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
| | | | - Dale P. Sandler
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
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19
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Terry MB, Liao Y, Kast K, Antoniou AC, McDonald JA, Mooij TM, Engel C, Nogues C, Buecher B, Mari V, Moretta-Serra J, Gladieff L, Luporsi E, Barrowdale D, Frost D, Henderson A, Brewer C, Evans DG, Eccles D, Cook J, Ong KR, Izatt L, Ahmed M, Morrison PJ, Dommering CJ, Oosterwijk JC, Ausems MGEM, Kriege M, Buys SS, Andrulis IL, John EM, Daly M, Friedlander M, McLachlan SA, Osorio A, Caldes T, Jakubowska A, Simard J, Singer CF, Tan Y, Olah E, Navratilova M, Foretova L, Gerdes AM, Roos-Blom MJ, Arver B, Olsson H, Schmutzler RK, Hopper JL, van Leeuwen FE, Goldgar D, Milne RL, Easton DF, Rookus MA, Andrieu N. The Influence of Number and Timing of Pregnancies on Breast Cancer Risk for Women With BRCA1 or BRCA2 Mutations. JNCI Cancer Spectr 2018; 2:pky078. [PMID: 30873510 PMCID: PMC6405439 DOI: 10.1093/jncics/pky078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/08/2018] [Accepted: 12/08/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Full-term pregnancy (FTP) is associated with a reduced breast cancer (BC) risk over time, but women are at increased BC risk in the immediate years following an FTP. No large prospective studies, however, have examined whether the number and timing of pregnancies are associated with BC risk for BRCA1 and BRCA2 mutation carriers. METHODS Using weighted and time-varying Cox proportional hazards models, we investigated whether reproductive events are associated with BC risk for mutation carriers using a retrospective cohort (5707 BRCA1 and 3525 BRCA2 mutation carriers) and a prospective cohort (2276 BRCA1 and 1610 BRCA2 mutation carriers), separately for each cohort and the combined prospective and retrospective cohort. RESULTS For BRCA1 mutation carriers, there was no overall association with parity compared with nulliparity (combined hazard ratio [HRc] = 0.99, 95% confidence interval [CI] = 0.83 to 1.18). Relative to being uniparous, an increased number of FTPs was associated with decreased BC risk (HRc = 0.79, 95% CI = 0.69 to 0.91; HRc = 0.70, 95% CI = 0.59 to 0.82; HRc = 0.50, 95% CI = 0.40 to 0.63, for 2, 3, and ≥4 FTPs, respectively, P trend < .0001) and increasing duration of breastfeeding was associated with decreased BC risk (combined cohort P trend = .0003). Relative to being nulliparous, uniparous BRCA1 mutation carriers were at increased BC risk in the prospective analysis (prospective hazard ration [HRp] = 1.69, 95% CI = 1.09 to 2.62). For BRCA2 mutation carriers, being parous was associated with a 30% increase in BC risk (HRc = 1.33, 95% CI = 1.05 to 1.69), and there was no apparent decrease in risk associated with multiparity except for having at least 4 FTPs vs. 1 FTP (HRc = 0.72, 95% CI = 0.54 to 0.98). CONCLUSIONS These findings suggest differential associations with parity between BRCA1 and BRCA2 mutation carriers with higher risk for uniparous BRCA1 carriers and parous BRCA2 carriers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nadine Andrieu
- Correspondence to: Nadine Andrieu, PhD, Cancer Genetic Epidemiology Team, INSERM Unit 900, Institut Curie, 26 rue d’Ulm, 75005 Paris, France (e-mail: )
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20
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Clinical subtypes and prognosis in breast cancer according to parity: a nationwide study in Korean Breast Cancer Society. Breast Cancer Res Treat 2018; 173:679-691. [DOI: 10.1007/s10549-018-5032-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 12/20/2022]
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21
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Ellingjord-Dale M, Vos L, Vik Hjerkind K, Hjartåker A, Russnes HG, Tretli S, Hofvind S, Dos-Santos-Silva I, Ursin G. Number of Risky Lifestyle Behaviors and Breast Cancer Risk. JNCI Cancer Spectr 2018; 2:pky030. [PMID: 31360858 PMCID: PMC6649737 DOI: 10.1093/jncics/pky030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/03/2018] [Accepted: 06/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Lifestyle factors are associated with overall breast cancer risk, but less is known about their associations, alone or jointly, with risk of specific breast cancer subtypes. Methods We conducted a case-control subjects study nested within a cohort of women who participated in the Norwegian Breast Cancer Screening Program during 2006-2014 to examine associations between risky lifestyle factors and breast cancer risk. In all, 4402 breast cancer cases subjects with information on risk factors and hormone receptor status were identified. Conditional logistic regression was used to estimate odds ratios (ORs), with 95% confidence intervals (CIs), in relation to five risky lifestyle factors: body mass index (BMI) of 25 kg/m² or greater, three or more glasses of alcoholic beverages per week, ever smoking, fewer than four hours of physical activity per week, and ever use of menopausal hormone therapy. Analyses were adjusted for education, age at menarche, number of pregnancies, and menopausal status. All statistical tests were two-sided. Results Compared with women with no risky lifestyle behaviors, those with five had 85% (OR = 1.85, 95% CI = 1.42 to 2.42, P trend < .0001) increased risk of breast cancer overall. This association was limited to luminal A-like (OR = 2.20, 95% CI = 1.55 to 3.12, P trend < .0001) and luminal B-like human epidermal growth factor receptor 2 (HER2)-positive (OR = 1.66, 95% CI = 0.61 to 4.54, P trend < .004) subtypes. Number of risky lifestyle factors was not associated with increased risk of luminal B-like HER2-negative, HER2-positive, or triple-negative subtypes (P trend > .18 for all). Conclusions Number of risky lifestyle factors was positively associated with increased risk for luminal A-like and luminal B-like HER2-positive breast cancer.
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Affiliation(s)
| | - Linda Vos
- Department of research, Cancer Registry of Norway, Oslo, Norway
| | | | - Anette Hjartåker
- Department of nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hege G Russnes
- Department of Pathology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Steinar Tretli
- Department of research, Cancer Registry of Norway, Oslo, Norway
| | - Solveig Hofvind
- Department of research, Cancer Registry of Norway, Oslo, Norway.,Department of radiography and dental technology, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Giske Ursin
- Department of research, Cancer Registry of Norway, Oslo, Norway.,Division of epidemiology, University of Southern California, Los Angeles, CA
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22
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John EM, Hines LM, Phipps AI, Koo J, Longacre TA, Ingles SA, Baumgartner KB, Slattery ML, Wu AH. Reproductive history, breast-feeding and risk of triple negative breast cancer: The Breast Cancer Etiology in Minorities (BEM) study. Int J Cancer 2018; 142:2273-2285. [PMID: 29330856 PMCID: PMC5893409 DOI: 10.1002/ijc.31258] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 02/03/2023]
Abstract
Few risk factors have been identified for triple negative breast cancer (TNBC) which lacks expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). This more aggressive subtype disproportionately affects some racial/ethnic minorities and is associated with lower survival. We pooled data from three population-based studies (558 TNBC and 5,111 controls) and examined associations of TNBC risk with reproductive history and breast-feeding. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression. For younger women, aged <50 years, TNBC risk was increased two-fold for parous women who never breast-fed compared to nulliparous women (OR = 2.02, 95% CI = 1.12-3.63). For younger parous women, longer duration of lifetime breast-feeding was associated with a borderline reduced risk (≥24 vs. 0 months: OR = 0.52, 95% CI = 0.26-1.04, Ptrend = 0.06). Considering the joint effect of parity and breast-feeding, risk was increased two-fold for women with ≥3 full-term pregnancies (FTPs) and no or short-term (<12 months) breast-feeding compared to women with 1-2 FTPs and breast-feeding ≥12 months (OR = 2.56, 95% CI = 1.22-5.35). None of these associations were observed among older women (≥50 years). Differences in reproductive patterns possibly contribute to the ethnic differences in TNBC incidence. Among controls aged <50 years, the prevalence of no or short-term breast-feeding and ≥3 FTPs was highest for Hispanics (22%), followed by African Americans (18%), Asian Americans (15%) and non-Hispanic whites (6%). Breast-feeding is a modifiable behavioral factor that may lower TNBC risk and mitigate the effect of FTPs in women under age 50 years.
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Affiliation(s)
- Esther M. John
- Cancer Prevention Institute of California, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Lisa M. Hines
- University of Colorado at Colorado Springs, Department of Biology, Colorado Springs, CO 80918
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA 98195
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA 94538
| | - Teri A. Longacre
- Department of Pathology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Sue A. Ingles
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
| | - Kathy B. Baumgartner
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | | | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
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23
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The Impact of Hormonal Contraceptives on Breast Cancer Pathology. Discov Oncol 2018; 9:240-253. [PMID: 29687205 DOI: 10.1007/s12672-018-0332-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/11/2018] [Indexed: 01/04/2023] Open
Abstract
This retrospective case series study, using data obtained through questionnaires and histopathological diagnoses from 656 patients enrolled in the Department of Defense (DoD) Clinical Breast Care Project (CBCP), evaluated associations between hormonal contraceptive use and breast cancer pathology including benign breast pathologies. Three combination hormonal contraceptive agents (COCs) Lo Ovral (LO), Ortho Novum (ON), and Ortho Tri-Cyclen (OTC) were evaluated as they represented the most commonly used hormonal contraceptives in our cohort. The results of this study suggest that the ever use of LO + ON + OTC does not influence the overall incidence of benign breast condition or malignant disease compared to other COCs; however, patients that have used OTC had an association with a diagnosis of benign or luminal A pathologies whereas ON was associated with a diagnosis of benign and DCIS; LO showed no association with any diagnosis-benign or malignant. Patients that have used LO or ON were more likely to be diagnosed with breast cancer at age ≥ 40 years whereas patients that had ever used OTC were likely to be diagnosed before the age of 40. Caucasians were less likely to have used OTC and more likely to have used ON; however, use of either hormonal agent positively correlated with premenopausal status at diagnosis and having a benign condition. Age at diagnosis, ethnicity, BMI, family history, menstruation status, and duration of use were all independent predictors of different histopathological subtypes. We conclude that patient-specific variables should be considered when deciding on which type of hormonal contraceptive to use to minimize the risk of developing breast cancer or a breast-related pathology.
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24
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Zolfaroli I, Tarín JJ, Cano A. Hormonal contraceptives and breast cancer: Clinical data. Eur J Obstet Gynecol Reprod Biol 2018; 230:212-216. [PMID: 29631794 DOI: 10.1016/j.ejogrb.2018.03.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022]
Abstract
The endocrine background of breast cancer has raised questions about the increase in risk that might bear the use of hormonal contraceptives. This has been a particular issue in the case of young women, who constitute the population of contraceptive consumers. Observational studies have been the main source of evidence, which has mainly limited to the combined estrogen-progestogen preparations, the popular pill. Studies in the 80's and 90's of the past century found a small, around a 20%, increase in risk. The translation in absolute number of excess cases has been exiguous because the prevalence of the disease is relatively small in premenopausal women. Moreover, the risk slowly seemed to disappear after 5-10 years of use. The more sophisticated analyses provided by new technologies, together with the powerful central registries in some countries, has confirmed increased risk of similar size. Recent preparations, with lower doses of estrogens and new progestogenic molecules, have not substantially modified the risk size. The impact of progestogen only alternatives, either pills or progestogen-loaded intrauterine devices, seems to be similar, but the evidence is still insufficient. Whether there is a preferential effect on histological or molecular subtypes of breast tumours is being debated yet. The data on women at higher risk, either with mutations of the BRCA1/2 genes or with familial weight, have not found specific response patterns, but the experience is still meagre. It is of interest that long-term follow up data on women who enrolled in the initial cohorts, like that of the Royal College of General Practitioners', have shown a considerable protection against cancer of the ovary (relative risk, RR 0.67), endometrium (RR 0.66), or colorectum (RR 0.81).
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Affiliation(s)
- Irene Zolfaroli
- Service of Obstetrics and Gynecology, Hospital Clínico Universitario-INCLIVA, Av Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Juan J Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, University of Valencia, C/Doctor Moliner, 50, 46100, Burjassot, Spain
| | - Antonio Cano
- Service of Obstetrics and Gynecology, Hospital Clínico Universitario-INCLIVA, Av Blasco Ibáñez 17, 46010, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Av. Blasco Ibáñez, 15, 46010, Valencia, Spain.
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25
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Multi-institutional Evaluation of Women at High Risk of Developing Breast Cancer. Clin Breast Cancer 2017; 17:427-432. [DOI: 10.1016/j.clbc.2017.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/02/2017] [Accepted: 04/06/2017] [Indexed: 01/10/2023]
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26
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VoPham T, DuPré N, Tamimi RM, James P, Bertrand KA, Vieira V, Laden F, Hart JE. Environmental radon exposure and breast cancer risk in the Nurses' Health Study II. Environ Health 2017; 16:97. [PMID: 28882148 PMCID: PMC5590193 DOI: 10.1186/s12940-017-0305-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/03/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Radon and its decay products, a source of ionizing radiation, are primarily inhaled and can deliver a radiation dose to breast tissue, where they may continue to decay and emit DNA damage-inducing particles. Few studies have examined the relationship between radon and breast cancer. METHODS The Nurses' Health Study II (NHSII) includes U.S. female registered nurses who completed biennial questionnaires since 1989. Self-reported breast cancer was confirmed from medical records. County-level radon exposures were linked with geocoded residential addresses updated throughout follow-up. Time-varying Cox regression models adjusted for established breast cancer risk factors were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS From 1989 to 2013, 3966 invasive breast cancer cases occurred among 112,639 participants. Increasing radon exposure was not associated with breast cancer risk overall (adjusted HR comparing highest to lowest quintile = 1.06, 95% CI: 0.94, 1.21, p for trend = 0.30). However, women in the highest quintile of exposure (≥74.9 Bq/m3) had a suggested elevated risk of ER-/PR- breast cancer compared to women in the lowest quintile (<27.0 Bq/m3) (adjusted HR = 1.38, 95% CI: 0.97, 1.96, p for trend = 0.05). No association was observed for ER+/PR+ breast cancer. CONCLUSIONS Although we did not find an association between radon exposure and risk of overall or ER+/PR+ breast cancer, we observed a suggestive association with risk of ER-/PR- breast cancer.
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Affiliation(s)
- Trang VoPham
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Landmark Center 3rd Floor West (HSPH/BWH), 401 Park Drive, Boston, MA 02215 USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Natalie DuPré
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Landmark Center 3rd Floor West (HSPH/BWH), 401 Park Drive, Boston, MA 02215 USA
| | - Rulla M. Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Landmark Center 3rd Floor West (HSPH/BWH), 401 Park Drive, Boston, MA 02215 USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Peter James
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Landmark Center 3rd Floor West (HSPH/BWH), 401 Park Drive, Boston, MA 02215 USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Veronica Vieira
- Program in Public Health, University of California, Irvine, CA USA
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Landmark Center 3rd Floor West (HSPH/BWH), 401 Park Drive, Boston, MA 02215 USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
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27
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Nichols HB, Schoemaker MJ, Wright LB, McGowan C, Brook MN, McClain KM, Jones ME, Adami HO, Agnoli C, Baglietto L, Bernstein L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Butler L, Chen Y, Doody MM, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh WP, Larsson SC, Lund E, Ma H, Merritt MA, Milne RL, Navarro C, Overvad K, Ozasa K, Palmer JR, Peeters PH, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Vatten L, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Zheng W, Sandler DP, Swerdlow AJ. The Premenopausal Breast Cancer Collaboration: A Pooling Project of Studies Participating in the National Cancer Institute Cohort Consortium. Cancer Epidemiol Biomarkers Prev 2017; 26:1360-1369. [PMID: 28600297 PMCID: PMC5581673 DOI: 10.1158/1055-9965.epi-17-0246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/28/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
Breast cancer is a leading cancer diagnosis among premenopausal women around the world. Unlike rates in postmenopausal women, incidence rates of advanced breast cancer have increased in recent decades for premenopausal women. Progress in identifying contributors to breast cancer risk among premenopausal women has been constrained by the limited numbers of premenopausal breast cancer cases in individual studies and resulting low statistical power to subcategorize exposures or to study specific subtypes. The Premenopausal Breast Cancer Collaborative Group was established to facilitate cohort-based analyses of risk factors for premenopausal breast cancer by pooling individual-level data from studies participating in the United States National Cancer Institute Cohort Consortium. This article describes the Group, including the rationale for its initial aims related to pregnancy, obesity, and physical activity. We also describe the 20 cohort studies with data submitted to the Group by June 2016. The infrastructure developed for this work can be leveraged to support additional investigations. Cancer Epidemiol Biomarkers Prev; 26(9); 1360-9. ©2017 AACR.
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Affiliation(s)
- Hazel B Nichols
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lauren B Wright
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Craig McGowan
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Mark N Brook
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Kathleen M McClain
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Hans-Olov Adami
- Karolinska Institutet, MEB, University of Oslo Institute of Health and Society, Sweden, Norway
| | - Claudia Agnoli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Italy, France
| | - Laura Baglietto
- Centre for Research in Epidemiology and Population Health (CESP), France
| | - Leslie Bernstein
- Beckman Research Institute of City of Hope, Monrovia, California
| | | | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Lesley Butler
- University of Pittsburgh Graduate School of Public Health, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Yu Chen
- NYU School of Medicine, New York, New York
| | - Michele M Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Laure Dossus
- International Agency for Research on Cancer, France
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | - Graham G Giles
- Cancer Council Victoria, University of Melbourne, Melbourne, Australia
| | - Inger T Gram
- University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Boston, Massachusetts
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, DKFZ, Heidelberg, Germany
| | | | - Victoria A Kirsh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | | | - Susanna C Larsson
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Eiliv Lund
- UiT (University of Tromsø), Tromsø, Norway
| | - Huiyan Ma
- Beckman Research Institute of City of Hope, Monrovia, California
| | | | - Roger L Milne
- Cancer Council Victoria, University of Melbourne, Melbourne, Australia
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kotaro Ozasa
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Elio Riboli
- School of Public Health, Imperial College London, United Kingdom
| | | | | | | | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | | | - Lars Vatten
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisabete Weiderpass
- Karolinska Institutet, Department of Epidemiology and Biostatistics, Oslo, Norway
- Department of Research, Head, Group of Etiological Cancer Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Walter C Willett
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alicja Wolk
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | | | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
- Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
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FOXA1 hypermethylation: link between parity and ER-negative breast cancer in African American women? Breast Cancer Res Treat 2017; 166:559-568. [PMID: 28756535 DOI: 10.1007/s10549-017-4418-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reproductive factors, particularly parity, have differential effects on breast cancer risk according to estrogen receptor (ER) status, especially among African American (AA) women. One mechanism could be through DNA methylation, leading to altered expression levels of genes important in cell fate decisions. METHODS Using the Illumina 450K BeadChip, we compared DNA methylation levels in paraffin-archived tumor samples from 383 AA and 350 European American (EA) women in the Women's Circle of Health Study (WCHS). We combined 450K profiles with RNA-seq data and prioritized genes based on differential methylation by race, correlation between methylation and gene expression, and biological function. We measured tumor protein expression and assessed its relationship to DNA methylation. We evaluated associations between reproductive characteristics and DNA methylation using linear regression. RESULTS 410 loci were differentially methylated by race, with the majority unique to ER- tumors. FOXA1 was hypermethylated in tumors from AA versus EA women with ER- cancer, and increased DNA methylation correlated with reduced RNA and protein expression. Importantly, parity was positively associated with FOXA1 methylation among AA women with ER- tumors (P = 0.022), as was number of births (P = 0.026), particularly among those who did not breastfeed (P = 0.008). These same relationships were not observed among EA women, although statistical power was more limited. CONCLUSIONS Methylation and expression of FOXA1 is likely impacted by parity and breastfeeding. Because FOXA1 regulates a luminal gene expression signature in progenitor cells and represses the basal phenotype, this could be a mechanism that links these reproductive exposures with ER- breast cancer.
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Jerônimo AFDA, Weller M. Differential Association of the Lifestyle-Related Risk Factors Smoking and Obesity with Triple Negative Breast Cancer in a Brazilian Population. Asian Pac J Cancer Prev 2017; 18:1585-1593. [PMID: 28669172 PMCID: PMC6373799 DOI: 10.22034/apjcp.2017.18.6.1585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: A longer lifespan and changing lifestyle-related and reproductive risk factors have led to an increased incidence of breast cancer in Brazil. There have been few studies about associations of specific risk factors with molecular subtypes of the disease. The aim of the present study was to identify factors that modulate the risk of triple negative breast cancer. Materials and Methods: A case-case analysis was performed. Data for 236 breast cancer patients from two reference centres in North-eastern Brazil were applied to assess the association of risk factors with triple negative breast cancer relative to the luminal A subtype. Molecular subtypes were defined by expression status of hormone receptors and amplification of HER2. Nominal logistic regression was used to estimate odds ratios and to generate a model of independent variables. Results: Smoking and body mass index were differentially associated with likelihood of triple negative breast cancer compared to the Luminal A subtype (p= 0.013; p= 0.004): Women who ever smoked some time in their lives were 4.016 (OR= 0.249; CI 95%: 0.09- 0.71) times less likely to have triple negative breast cancer. Obese and overweight patients, respectively, were 4.489 (CI 95%: 1.32- 15.28) and 1.340 (CI 95%: 0.38- 4.69) times more likely to have triple negative breast cancer. Conclusions: Case-case analysis with the Luminal A subtype as the reference group indicated that smoking and body mass index are differentially associated with risk of triple negative breast cancer.
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Unar-Munguía M, Torres-Mejía G, Colchero MA, González de Cosío T. Breastfeeding Mode and Risk of Breast Cancer: A Dose-Response Meta-Analysis. J Hum Lact 2017; 33:422-434. [PMID: 28196329 DOI: 10.1177/0890334416683676] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Breastfeeding reduces women's risk of breast cancer. Since exclusive breastfeeding has a stronger hormonal effect, it could theoretically result in a greater reduction in breast cancer risk than any breastfeeding mode. No meta-analysis has examined breast cancer risk by breastfeeding mode. Research aim: The authors conducted a meta-analysis for breast cancer risk in parous women who breastfed exclusively or in any mode versus parous women who formula fed their infants, and they estimated the summary dose-response association by the accumulated duration of any breastfeeding mode. METHODS A systematic review of studies published between 2005 and 2015 analyzing breastfeeding and breast cancer risk in women was conducted in PubMed and EBSCOhost. A meta-analysis ( n = 65 studies) with fixed effects (or random effects, if heterogeneity existed) was carried out stratified by breastfeeding mode and menopausal and parity status. A summary dose-response association was estimated using the generalized least-squares method. RESULTS The summary relative risk (SRR) for breast cancer in parous women who breastfed exclusively was 0.72, 95% confidence interval (CI) [0.58, 0.90], versus parous women who had never breastfed. For parous women who breastfed in any mode, the SRR was lower in both premenopausal women (0.86, 95% CI [0.80, 0.93]) and postmenopausal women (0.89, 95% CI [0.83, 0.95]). There was no heterogeneity or publication bias. There is weak evidence of a difference between exclusive and any breastfeeding mode ( p = .08). The summary dose-response curve was nonlinear ( p < .001). CONCLUSION Exclusive breastfeeding among parous women reduces the risk of breast cancer compared with parous women who do not breastfeed exclusively.
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Affiliation(s)
- Mishel Unar-Munguía
- 1 Center for Research on Health and Nutrition, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Gabriela Torres-Mejía
- 2 Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - M Arantxa Colchero
- 3 Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Shackshaft L, Van Hemelrijck M, Garmo H, Malmström H, Lambe M, Hammar N, Walldius G, Jungner I, Wulaningsih W. Circulating gamma-glutamyl transferase and development of specific breast cancer subtypes: findings from the Apolipoprotein Mortality Risk (AMORIS) cohort. Breast Cancer Res 2017; 19:22. [PMID: 28264697 PMCID: PMC5339947 DOI: 10.1186/s13058-017-0816-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Different etiological pathways may precede development of specific breast cancer subtypes and impact prevention or treatment strategies. We investigated the association between gamma-glutamyl transferase (GGT) and development of specific breast cancer subtypes based on oestrogen receptor (ER), progesterone receptor (PR) and HER2 status. METHODS We included 231,283 cancer-free women in a Swedish cohort. Associations between GGT and breast cancer subtypes were investigated with nested case-control and case-case analyses. We used logistic regression models to assess serum GGT in relation to breast cancer subtype, based on individual and combined receptor status. RESULTS Positive associations were found between serum GGT and development of ER+, ER- and PR+ breast cancers compared to controls (odds ratio (OR) 1.14 (95% confidence interval (CI) 1.08-1.19), 1.11 (1.01-1.23) and 1.18 (1.12-1.24), respectively) and of ER+/PR+ tumours. We found inverse associations between GGT levels and PR- breast cancers compared to PR+ (OR 0.87 (0.80-0.95)), between ER+/PR- tumours compared to ER+/PR+ tumours and between ER-/PR-/HER+ compared to ER+/HER2 or PR+/HER2 tumours (OR 0.55 (95% CI 0.34-0.90). CONCLUSION The observed associations between pre-diagnostic serum GGT and different breast cancer subtypes may indicate distinct underlying pathways and require further investigations to tease out their clinical implications.
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Affiliation(s)
- Lydia Shackshaft
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, Faculty of Life Sciences & Medicine, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, Faculty of Life Sciences & Medicine, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, Faculty of Life Sciences & Medicine, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.,Regional Cancer Centre, Uppsala, Sweden
| | - Håkan Malmström
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden.,Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Wahyu Wulaningsih
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, Faculty of Life Sciences & Medicine, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK. .,MRC Unit for Lifelong Health and Ageing at University College London, London, UK.
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Ellingjord-Dale M, Vos L, Tretli S, Hofvind S, Dos-Santos-Silva I, Ursin G. Parity, hormones and breast cancer subtypes - results from a large nested case-control study in a national screening program. Breast Cancer Res 2017; 19:10. [PMID: 28114999 PMCID: PMC5259848 DOI: 10.1186/s13058-016-0798-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 12/29/2022] Open
Abstract
Background Breast cancer comprises several molecular subtypes with different prognoses and possibly different etiology. Reproductive and hormonal factors are associated with breast cancer overall, and with luminal subtypes, but the associations with other subtypes are unclear. We used data from a national screening program to conduct a large nested case-control study. Methods We conducted a nested case-control study on participants in the Norwegian Breast Cancer Screening Program in 2006 − 2014. There was information on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) for 4748 cases of breast cancer. Breast cancer subtypes were defined as luminal A-like (ER+ PR+ HER2-), luminal B-like (ER+ PR- HER2- or ER+ PR+/PR-HER2+), HER2-positive (ER- PR- HER2+) and triple-negative (ER- PR- HER2-). Conditional logistic regression was used to estimate odds ratios (ORs) of breast cancer associated with age at first birth, number of pregnancies, oral contraceptive use, intrauterine devices and menopausal hormone therapy. Analyses were adjusted for age, body mass index, education, age at menarche, number of pregnancies and menopausal status. Results Number of pregnancies was inversely associated with relative risk of luminal-like breast cancers (p-trend ≤0.02), and although not statistically significant, with HER2-positive (OR = 0.60, 95% CI 0.31–1.19) and triple-negative cancer (OR = 0.70, 95% CI 0.41–1.21). Women who had ≥4 pregnancies were at >40% lower risk of luminal-like and HER2-positive cancers than women who had never been pregnant. However, there was a larger discrepancy between tumor subtypes with menopausal hormone use. Women who used estrogen and progesterone therapy (EPT) had almost threefold increased risk of luminal A-like cancer (OR = 2.92, 95% CI 2.36–3.62) compared to never-users, but were not at elevated risk of HER2-positive (OR = 0.88, 95% CI 0.33–2.30) or triple-negative (OR = 0.92, 95% CI 0.43 − 1.98) subtypes. Conclusions Reproductive factors were to some extent associated with all subtypes; the strongest trends were with luminal-like subtypes. Hormone therapy use was strongly associated with risk of luminal-like breast cancer, and less so with risk of HER2-positive or triple-negative cancer. There are clearly some, but possibly limited, etiologic differences between subtypes, with the greatest contrast between luminal A-like and triple-negative subtypes. Trial registration Not applicable.
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Affiliation(s)
| | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | | | | | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway. .,University of Oslo, Oslo, Norway. .,University of Southern California, Los Angeles, CA, USA.
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Rezende LM, Marson FAL, Lima CSP, Bertuzzo CS. Variants of estrogen receptor alpha and beta genes modify the severity of sporadic breast cancer. Gene 2017; 608:73-78. [PMID: 28109853 DOI: 10.1016/j.gene.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/14/2016] [Accepted: 01/17/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Reproductive factors pose a risk for sporadic breast cancer (BC) development owing to the lifetime exposure to estrogen, a hormone responsible for cell proliferation in the breast. Because variants of the estrogen receptor (ER) alpha and beta genes have been associated with BC risk in numerous populations, the objective of the study was to determine whether the risk and severity of sporadic BC was associated with the rs2228480 (ESR1) and rs4986938 (ESR2) variants in a Brazilian population. METHODS A total of 253 DNA samples from sporadic BC patients and 257 DNA samples from healthy controls were studied. The samples were genotyped by PCR-RFLP. Epidemiological, clinical, and reproductive factors were analyzed. Statistical tests conducted included the χ2 test, Fisher's exact test, and Mann-Whitney and Kruskal-Wallis tests or their parametric equivalents. RESULTS There was a high frequency of the rs2228480*GG genotype among the ER-positive tumors (OR=2.13; 95% CI=1.189-3.816) and it showed minor association with clinical stage 0 (OR=0.324; 95% CI=0.116-0.904). The rs2228480*GA genotype was associated with minor ER expression, whereas rs2228480*GG was associated with high expression of the progesterone receptor (PR). The frequency of rs4986938*GA was high among women who breastfed (OR=2.11; 95% CI=1.203-3.702), and it showed high association with clinical stage 0 (OR=4.383; 95% CI=1.606-11.96) whereas it had minor association with systemic arterial hypertension (OR=0.53; 95% CI=0.319-0.880). The rs2228480*GG/rs4986938*GG haplotype occurred at a low frequency among women who breastfed (OR=0.525; 95% CI=0.298-0.924) but it was associated with a high expression of PR. CONCLUSION The rs2228480 and rs4986938 variants did not alter sporadic BC risk, but they did modulate the BC severity.
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Affiliation(s)
- Luciana Montes Rezende
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas - Unicamp, Brazil.
| | - Fernando Augusto Lima Marson
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas - Unicamp, Brazil; Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas - Unicamp, Brazil.
| | - Carmen Sílvia Passos Lima
- Department of Medical Clinics, Faculty of Medical Sciences, State University of Campinas - Unicamp, Brazil.
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas - Unicamp, Brazil.
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Ma H, Ursin G, Xu X, Lee E, Togawa K, Duan L, Lu Y, Malone KE, Marchbanks PA, McDonald JA, Simon MS, Folger SG, Sullivan-Halley J, Deapen DM, Press MF, Bernstein L. Reproductive factors and the risk of triple-negative breast cancer in white women and African-American women: a pooled analysis. Breast Cancer Res 2017; 19:6. [PMID: 28086982 PMCID: PMC5237290 DOI: 10.1186/s13058-016-0799-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early age at menarche, nulliparity, late age at first completed pregnancy, and never having breastfed, are established breast cancer risk factors. However, among breast cancer subtypes, it remains unclear whether all of these are risk factors for triple-negative breast cancer (TNBC). METHODS We evaluated the associations of these reproductive factors with TNBC, in 2658 patients with breast cancer (including 554 with TNBC) and 2448 controls aged 20-64 years, who participated in one of the three population-based case-control studies: the Women's Contraceptive and Reproductive Experiences Study, the Women's Breast Carcinoma in situ Study, or the Women's Learning the Influence of Family and Environment Study. We used multivariable polychotomous unconditional logistic regression methods to conduct case-control comparisons among breast cancer subtypes defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 expression status. RESULTS TNBC risk decreased with increasing duration of breastfeeding (P trend = 0.006), but age at menarche, age at first completed pregnancy, and nulliparity were not associated with risk of TNBC. Parous women who breastfed for at least one year had a 31% lower risk of TNBC than parous women who had never breastfed (odds ratio, OR = 0.69; 95% confidence interval, CI = 0.50-0.96). The association between breastfeeding and risk of TNBC was modified by age and race. Parous African-American women aged 20-44 years who breastfed for 6 months or longer had an 82% lower risk of TNBC than their counterparts who had never breastfed (OR = 0.18, 95% CI = 0.07-0.46). CONCLUSIONS Our data indicate that breastfeeding decreases the risk of TNBC, especially for younger African-American women.
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Affiliation(s)
- Huiyan Ma
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Xinxin Xu
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Kayo Togawa
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Lei Duan
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
- School of Social Work, University of Southern California, Los Angeles, CA 90033 USA
| | - Yani Lu
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Kathleen E. Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Polly A. Marchbanks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Jill A. McDonald
- College of Health and Social Services, New Mexico State University, Las Cruces, NM 88003 USA
| | - Michael S. Simon
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI 48201 USA
| | - Suzanne G. Folger
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Jane Sullivan-Halley
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Dennis M. Deapen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Michael F. Press
- Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
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Peiris HH, Mudduwa LKB, Thalagala NI, Jayatilaka KAPW. Do Breast Cancer Risk Factors Affect the Survival of Breast Cancer Patients in Southern Sri Lanka? Asian Pac J Cancer Prev 2017; 18:69-79. [PMID: 28240012 PMCID: PMC5563122 DOI: 10.22034/apjcp.2017.18.1.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer continues to be a major cause of morbidity among women in Sri Lanka. Possible effects of etiological risk factors on breast cancer specific survival (BCSS) of the disease is not clear. This study was designed to explore the impact of breast cancer risk factors on the BCSS of patients in Southern Sri Lanka. Method: This retro-prospective study included all breast cancer patients who had sought immunohistochemistry services at our unit from May 2006 to December 2012. A pre-tested, interviewer-administered questionnaire was used to gather information on risk factors. BCSS was estimated using the Kaplan-Meier model. Univariate Cox-regression analysis was performed with 95% confidence intervals using the SPSS statistical package. Results: A total of 944 breast cancer patients were included. Five year BCSS was 78.8%. There was a statistically significant difference between the patients who had a family history of breast cancer and no family history of any cancer in terms of the presence/absence of lymph node metastasis (p=0.011) and pathological stage (p=0.042). The majority of the premenopausal patients had associated DCIS (p<0.001) and large tumours (p=0.015) with positive lymph nodes (p=0.016). There was no statistically significant association between hormone receptor subtypes and hormone related risk factors. Univariate analysis revealed that breast cancer risk factors had no significant effect on the BCSS. Conclusion: Even though family history of breast cancer and premenopausal status are associated with poor prognostic features, they, in line with the other breast cancer risk factors, appear to have no significant effect on the BCSS of patients in Southern Sri Lanka.
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Bertrand KA, Bethea TN, Adams-Campbell LL, Rosenberg L, Palmer JR. Differential Patterns of Risk Factors for Early-Onset Breast Cancer by ER Status in African American Women. Cancer Epidemiol Biomarkers Prev 2016; 26:270-277. [PMID: 27756774 DOI: 10.1158/1055-9965.epi-16-0692] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Given the disproportionately high incidence of early-onset breast cancer and aggressive subtypes, such as estrogen receptor (ER)-negative tumors, in African American (AA) women, elucidation of risk factors for early onset of specific subtypes of breast cancer is needed. METHODS We evaluated associations of reproductive, anthropometric, and other factors with incidence of invasive breast cancer by age at onset (<45, ≥45) in 57,708 AA women in the prospective Black Women's Health Study. From 1995 to 2013, we identified 529 invasive breast cancers among women <45 years of age (151 ER-, 219 ER+) and 1,534 among women ≥45 years (385 ER-, 804 ER+). We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) for associations by age and ER status. RESULTS Higher parity, older age at first birth, never having breastfed, and abdominal adiposity were associated with increased risk of early-onset ER- breast cancer: HRs were 1.71 for ≥3 births versus one birth; 2.29 for first birth after age 25 versus <20 years; 0.61 for ever having breastfed versus never; and 1.64 for highest versus lowest tertile of waist-to-hip ratio. These factors were not associated with ER- cancer in older women or with ER+ cancer regardless of age. CONCLUSIONS Differences in risk factors by ER subtype were observed for breast cancer diagnosed before the age of 45 years. IMPACT Etiological heterogeneity by tumor subtype in early-onset breast cancer, in combination with a higher prevalence of the risk factors in AA women, may explain, in part, racial disparities in breast cancer incidence. Cancer Epidemiol Biomarkers Prev; 26(2); 270-7. ©2016 AACR.
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Affiliation(s)
| | - Traci N Bethea
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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Rauscher GH, Campbell RT, Wiley EL, Hoskins K, Stolley MR, Warnecke RB. Mediation of Racial and Ethnic Disparities in Estrogen/Progesterone Receptor-Negative Breast Cancer by Socioeconomic Position and Reproductive Factors. Am J Epidemiol 2016; 183:884-93. [PMID: 27076668 DOI: 10.1093/aje/kwv226] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/19/2015] [Indexed: 11/12/2022] Open
Abstract
Hispanic and non-Hispanic black breast cancer patients are more likely than non-Hispanic white patients to be diagnosed with breast cancer that is negative for estrogen and progesterone receptors (ER/PR-negative). This disparity might be transmitted through socioeconomic and reproductive factors. Data on 746 recently diagnosed breast cancer patients (300 non-Hispanic white, 303 non-Hispanic black, 143 Hispanic) were obtained from the population-based Breast Cancer Care in Chicago Study (Chicago, Illinois, 2005-2008). Income, educational level, and census tract measures of concentrated disadvantage and affluence were combined into a single measure of socioeconomic position (SEP). Parity and age at first birth were combined into a single measure of reproductive factors (RPF). We constructed path models to estimate direct and indirect associations of SEP and RPF, and we estimated average marginal controlled direct associations. Compared with non-Hispanic white patients, non-Hispanic black patients and Hispanic patients were more likely to have ER/PR-negative disease (28% and 20% for non-Hispanic black patients and Hispanic patients, respectively, vs. 12% for non-Hispanic white patients; P ≤ 0.001). The ethnic disparity in ER/PR-negative breast cancer (prevalence difference = 0.13, 95% confidence interval: 0.07, 0.18) was reduced by approximately 60% (prevalence difference = 0.05, 95% confidence interval: -0.04, 0.13) after control for SEP and RPF. At least part of the ethnic disparity in the aggressiveness of breast tumors might be transmitted through social influences on tumor biology.
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Loof-Johanson M, Brudin L, Sundquist M, Rudebeck CE. Hormone Use is Associated with Lymphovascular Invasion in Breast Cancer. Asian Pac J Cancer Prev 2016; 17:1507-12. [PMID: 27039798 DOI: 10.7314/apjcp.2016.17.3.1507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk of developing breast cancer increases with short breastfeeding and the use of hormones. The prognosis of breast cancer is better if the tumours are hormone receptor positive. Since breast feeding affects estrogen and progesterone receptors, we wanted to investigate how such reproductive factors as breastfeeding and the use of hormones interact with known prognostic markers and specific tumour characteristics in women with breast cancer. MATERIALS AND METHODS A total of 250 women treated for breast cancer from a larger cohort completed a questionnaire on breastfeeding, number and age at births and use of hormones. A logistic regression analysis was made to search for connections between known prognostic markers on the one hand (type of cancer, grade, tumor size, estrogen receptor and progesterone receptor, lymphovascular invasion and DNA-ploidy) and reproductive data, breastfeeding, and hormone use on the other. RESULTS AND CONCLUSIONS Hormone use, but not breastfeeding, was significantly associated, also on multivariate analysis, with the prognostic variable lymphovascular invasion, connected to a worse prognosis. No other hormone use or breast feeding correlations with prognostic variables were found.
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Cytologic atypia in the contralateral unaffected breast is related to parity and estrogen-related genes. Surg Oncol 2016; 25:449-456. [PMID: 26856771 DOI: 10.1016/j.suronc.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/07/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE The contralateral unaffected breast (CUB) of women with unilateral breast cancer provides a model for the study of breast tissue-based risk factors. Using random fine needle aspiration (rFNA), we have investigated hormonal and gene expression patterns related to atypia in the CUBs of newly diagnosed breast cancer patients. METHODS 83 women underwent rFNA of the CUB. Cytologic analysis was performed using the Masood Score (MS), atypia was defined as MS > 14. RNA was extracted using 80% of the sample. The expression of 20 hormone related genes was quantified using Taqman Low Density Arrays. Statistical analysis was performed using 2-tailed t tests and linear regression. RESULTS Cytological atypia was more frequent in multiparous women (P = 0.0392), and was not associated with any tumor-related features in the affected breast. Masood Score was higher with shorter interval since last pregnancy (R = 0.204, P = 0.0417), higher number of births (R = 0.369, P = 0.0006), and estrogen receptor (ER) negativity of the index cancer (R = -0.203, P = 0.065). Individual cytologic features were associated with aspects of parity. Specifically, anisonucleosis was correlated with shorter interval since last pregnancy (R = 0.318, P = 0.0201), higher number of births (R = 0.382, P = 0.0004), and ER status (R = -0.314, P = 0.0038). Eight estrogen-regulated genes were increased in atypical samples (P < 0.005), including TFF1, AGT, PDZK1, PGR, GREB1, PRLR, CAMK2B, and CCND1. CONCLUSIONS Cytologic atypia, and particularly anisonucleosis, is associated with recent and multiple births and ER negative status of the index tumor. Atypical samples showed increased expression of estrogen-related genes, consistent with the role of estrogen exposure in breast cancer development.
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Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104:96-113. [PMID: 26172878 PMCID: PMC4670483 DOI: 10.1111/apa.13102] [Citation(s) in RCA: 541] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the effect of breastfeeding on long-term (breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea, postpartum depression, postpartum weight change) maternal health outcomes. METHODS A systematic literature search was conducted in PubMed, Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored. RESULTS Breastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37%, respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking. CONCLUSION This review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident.
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Affiliation(s)
- Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied StudiesNew Delhi, India
| | - Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied StudiesNew Delhi, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, ICMR Centre for Advanced Research in Newborn Health, Department of Paediatrics, All India Institute of Medical SciencesNew Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied StudiesNew Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied StudiesNew Delhi, India
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, World Health OrganizationGeneva, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health OrganizationGeneva, Switzerland
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of BergenBergen, Norway
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Islami F, Liu Y, Jemal A, Zhou J, Weiderpass E, Colditz G, Boffetta P, Weiss M. Breastfeeding and breast cancer risk by receptor status--a systematic review and meta-analysis. Ann Oncol 2015; 26:2398-407. [PMID: 26504151 DOI: 10.1093/annonc/mdv379] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/06/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breastfeeding is inversely associated with overall risk of breast cancer. This association may differ in breast cancer subtypes defined by receptor status, as they may reflect different mechanisms of carcinogenesis. We conducted a systematic review and meta-analysis of case-control and prospective cohort studies to investigate the association between breastfeeding and breast cancer by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. DESIGN We searched the PubMed and Scopus databases and bibliographies of pertinent articles to identify relevant articles and used random-effects models to calculate summary odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS This meta-analysis represents 27 distinct studies (8 cohort and 19 case-control), with a total of 36 881 breast cancer cases. Among parous women, the risk estimates for the association between ever (versus never) breastfeeding and the breast cancers negative for both ER and PR were similar in three cohort and three case-control studies when results were adjusted for several factors, including the number of full-term pregnancies (combined OR 0.90; 95% CI 0.82-0.99), with little heterogeneity and no indication of publication bias. In a subset of three adjusted studies that included ER, PR, and HER2 status, ever breastfeeding showed a stronger inverse association with triple-negative breast cancer (OR 0.78; 95% CI 0.66-0.91) among parous women. Overall, cohort studies showed no significant association between breastfeeding and ER+/PR+ or ER+ and/or PR+ breast cancers, although one and two studies (out of four and seven studies, respectively) showed an inverse association. CONCLUSIONS This meta-analysis showed a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer. The association between breastfeeding and receptor-positive breast cancers needs more investigation.
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Affiliation(s)
- F Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Y Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA
| | - A Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta
| | - J Zhou
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - E Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø Cancer Registry of Norway, Oslo, Norway Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - G Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA Siteman Cancer Center, Washington University School of Medicine, St Louis
| | - P Boffetta
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - M Weiss
- Breastcancer.org/breasthealth.org, Lankenau Medical Center, Wynnewood, USA
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Kwan ML, Bernard PS, Kroenke CH, Factor RE, Habel LA, Weltzien EK, Castillo A, Gunderson EP, Maxfield KS, Stijleman IJ, Langholz BM, Quesenberry CP, Kushi LH, Sweeney C, Caan BJ. Breastfeeding, PAM50 tumor subtype, and breast cancer prognosis and survival. J Natl Cancer Inst 2015; 107:djv087. [PMID: 25921910 DOI: 10.1093/jnci/djv087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breastfeeding is associated with decreased breast cancer risk, yet associations with prognosis and survival by tumor subtype are largely unknown. METHODS We conducted a cohort study of 1636 women from two prospective breast cancer cohorts. Intrinsic tumor subtype (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2]-enriched, basal-like) was determined by the PAM50 gene expression assay. Breastfeeding history was obtained from participant questionnaires. Questionnaires and medical record reviews documented 383 recurrences and 290 breast cancer deaths during a median follow-up of nine years. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between breastfeeding and tumor subtype. Cox regression was used to estimate hazard ratios (HRs) for breast cancer recurrence or death. Statistical significance tests were two-sided. RESULTS Breast cancer patients with basal-like tumors were less likely to have previously breastfed than those with luminal A tumors (OR = 0.56, 95% CI = 0.39 to 0.80). Among all patients, ever breastfeeding was associated with decreased risk of recurrence (HR = 0.70, 95% CI = 0.53 to 0.93), especially breastfeeding for six months or more (HR = 0.63, 95% CI = 0.46 to 0.87, P trend = .01). Similar associations were observed for breast cancer death. Among women with luminal A subtype, ever breastfeeding was associated with decreased risks of recurrence (HR = 0.52, 95% CI = 0.31 to 0.89) and breast cancer death (HR = 0.52, 95% CI = 0.29 to 0.93), yet no statistically significant associations were observed among the other subtypes. Effects appeared to be limited to tumors with lower expression of proliferation genes. CONCLUSIONS History of breastfeeding might affect prognosis and survival by establishing a luminal tumor environment with lower proliferative activity.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML).
| | - Philip S Bernard
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Rachel E Factor
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Erin K Weltzien
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Adrienne Castillo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Kaylynn S Maxfield
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Inge J Stijleman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Bryan M Langholz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Carol Sweeney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (MLK, CHK, LAH, EKW, AC, EPG, CPQJr, LHK, BJC); Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (PSB, REF, IJS, CS); Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, UT (PSB, REF); Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT (KSM, CS); Department of Preventive Medicine, University of Southern California, Los Angeles, CA (BML)
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Figueroa JD, Pfeiffer RM, Patel DA, Linville L, Brinton LA, Gierach GL, Yang XR, Papathomas D, Visscher D, Mies C, Degnim AC, Anderson WF, Hewitt S, Khodr ZG, Clare SE, Storniolo AM, Sherman ME. Terminal duct lobular unit involution of the normal breast: implications for breast cancer etiology. J Natl Cancer Inst 2014; 106:dju286. [PMID: 25274491 DOI: 10.1093/jnci/dju286] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Greater degrees of terminal duct lobular unit (TDLU) involution have been linked to lower breast cancer risk; however, factors that influence this process are poorly characterized. METHODS To study this question, we developed three reproducible measures that are inversely associated with TDLU involution: TDLU counts, median TDLU span, and median acini counts/TDLU. We determined factors associated with TDLU involution using normal breast tissues from 1938 participants (1369 premenopausal and 569 postmenopausal) ages 18 to 75 years in the Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center. Multivariable zero-inflated Poisson models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) for factors associated with TDLU counts, and multivariable ordinal logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for factors associated with categories of median TDLU span and acini counts/TDLU. RESULTS All TDLU measures started declining in the third age decade (all measures, two-sided P trend ≤ .001); and all metrics were statistically significantly lower among postmenopausal women. Nulliparous women demonstrated lower TDLU counts compared with uniparous women (among premenopausal women, RR = 0.79, 95% CI = 0.73 to 0.85; among postmenopausal, RR = 0.67, 95% CI = 0.56 to 0.79); however, rates of age-related TDLU decline were faster among parous women. Other factors were related to specific measures of TDLU involution. CONCLUSION Morphometric analysis of TDLU involution warrants further evaluation to understand the pathogenesis of breast cancer and assessing its role as a progression marker for women with benign biopsies or as an intermediate endpoint in prevention studies.
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Affiliation(s)
- Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS).
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Laura Linville
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Daniel Visscher
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Carolyn Mies
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Amy C Degnim
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Stephen Hewitt
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Zeina G Khodr
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Susan E Clare
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Anna Maria Storniolo
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
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Palmer JR, Viscidi E, Troester MA, Hong CC, Schedin P, Bethea TN, Bandera EV, Borges V, McKinnon C, Haiman CA, Lunetta K, Kolonel LN, Rosenberg L, Olshan AF, Ambrosone CB. Parity, lactation, and breast cancer subtypes in African American women: results from the AMBER Consortium. J Natl Cancer Inst 2014; 106:dju237. [PMID: 25224496 DOI: 10.1093/jnci/dju237] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND African American (AA) women have a disproportionately high incidence of estrogen receptor-negative (ER-) breast cancer, a subtype with a largely unexplained etiology. Because childbearing patterns also differ by race/ethnicity, with higher parity and a lower prevalence of lactation in AA women, we investigated the relation of parity and lactation to risk of specific breast cancer subtypes. METHODS Questionnaire data from two cohort and two case-control studies of breast cancer in AA women were combined and harmonized. Case patients were classified as ER+ (n = 2446), ER- (n = 1252), or triple negative (ER-, PR-, HER2-; n = 567) based on pathology data; there were 14180 control patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated in polytomous logistic regression analysis with adjustment for study, age, reproductive and other risk factors. RESULTS ORs for parity relative to nulliparity was 0.92 (95% CI = 0.81 to 1.03) for ER+, 1.33 (95% CI = 1.11 to 1.59) for ER-, and 1.37 (95% CI = 1.06 to 1.70) for triple-negative breast cancer. Lactation was associated with a reduced risk of ER- (OR = 0.81, 95% CI = 0.69 to 0.95) but not ER+ cancer. ER- cancer risk increased with each additional birth in women who had not breastfed, with an OR of 1.68 (95% CI = 1.15 to 2.44) for 4 or more births relative to one birth with lactation. CONCLUSIONS The findings suggest that parous women who have not breastfed are at increased risk of ER- and triple-negative breast cancer. Promotion of lactation may be an effective tool for reducing occurrence of the subtypes that contribute disproportionately to breast cancer mortality.
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Affiliation(s)
- Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK).
| | - Emma Viscidi
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Melissa A Troester
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Chi-Chen Hong
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Pepper Schedin
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Traci N Bethea
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Elisa V Bandera
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Virginia Borges
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Craig McKinnon
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Christopher A Haiman
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Kathryn Lunetta
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Laurence N Kolonel
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Andrew F Olshan
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
| | - Christine B Ambrosone
- Slone Epidemiology Center at Boston University, Boston, MA (JRP, EV, TNB, LR); University of North Carolina Lineberger Cancer Center, Chapel Hill, NC (MAT, AFO); Roswell Park Cancer Institute, Buffalo, NY (CCH, CBA); University of Colorado Denver School of Medicine, Denver, CO (PS, VB); Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (EVB); Boston University School of Public Health, Boston, MA (CM, KL); Department of Preventive Medicine and Norris Comprehensive Cancer Cencer, University of Southern California Keck School of Medicine, Los Angeles, CA (CAH); Department of Public Health Sciences, University of Hawaii School of Medicine, Honolulu, HI (LNK)
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