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Jahani MA, Ghasemi B, Soltani SA, Naderi M, Nikbakht HA, Hashemi SN, Yazdani Charati J, Mahmoudi G. The relationship between demographic factors and known risk factors with breast cancer in women aged 30-69. Ann Med Surg (Lond) 2024; 86:3945-3953. [PMID: 38989175 PMCID: PMC11230782 DOI: 10.1097/ms9.0000000000002114] [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: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 07/12/2024] Open
Abstract
Background Breast cancer is one of the most important causes of cancer deaths in women. The present study was conducted to determine the relationship between demographic factors and known risk factors with breast cancer in women aged 30-69. Method This case-control study was conducted with two matched and unmatched control groups. Three hundred fifty women aged 30-69 with breast cancer, 350 age-matched women without cancer, and 350 not age-matched women were included in the study. Controls were selected from the records of women whose breast cancer screening results were normal. Study subjects were evaluated regarding the risk factors for breast cancer. The data collection tool was a checklist including the risk factors investigated in the integrated health system. The collected data were analyzed utilizing SPSS22 software at a significance level of less than 0.05. Results The average age in the case group was 46.63±11.77 years and 49.61±8.39 in the unmatched control group. The average age of marriage in the case group was 21.54±4.31, and the average age of women at first pregnancy in the case group was 24.06±3.39 years. In the case group, 163 people (46.57%) lived in the city, 221 people (63.14%) were over 40 years old, and 337 people (96.28%) were married. In multivariate analysis, the variable 'age of marriage' 0.821 (0.691-0.976) and 'age of first pregnancy' 1.213 (1.020-1.443) showed a significant relationship with breast cancer which were observed as predictors of breast cancer in comparison to the unmatched control group (P-value <0.05). Conclusion The age of the first pregnancy and the type of delivery were observed as predictors of breast cancer. Therefore, by performing breast cancer screening in women who are exposed to these risk factors, early diagnosis of the disease and increasing the speed of their treatment can be significantly helped.
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Affiliation(s)
- Mohammad-Ali Jahani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol
| | - Behnaz Ghasemi
- Hospital Administration Research Center, Sari Branch, Islamic Azad University
| | - Seyed Amir Soltani
- Golestan University of Medical Sciences, Gorgan, Islamic Republic of Iran
| | - Malihe Naderi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol
| | | | - Jamshid Yazdani Charati
- Department of Biostatistics and Epidemiology, School of Health, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari
| | - Ghahraman Mahmoudi
- Hospital Administration Research Center, Sari Branch, Islamic Azad University
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2
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Luo C, Cao J, Peng R, Guo Q, Ye H, Wang P, Wang K, Song C. Functional Variants in Linc-ROR are Associated with mRNA Expression of Linc-ROR and Breast Cancer Susceptibility. Sci Rep 2018; 8:4680. [PMID: 29549263 PMCID: PMC5856846 DOI: 10.1038/s41598-018-22881-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/01/2018] [Indexed: 12/22/2022] Open
Abstract
Functional polymorphisms in Linc-ROR may change its ability of regulation by regulating Linc-ROR expression. However, these functional polymorphisms in Linc-ROR and their associations with breast cancer (BC) susceptibility were scarcely reported. In this molecular epidemiological study, four SNPs (rs6420545, rs4801078, rs1942348 and rs9636089) were selected in Linc-ROR by bioinformatics method. Unconditional logistic regression model was performed to analyze the associations between four SNPs and BC susceptibility adjusted for reproductive factors. Quantitative real-time (qRT) PCR was used to evaluate relative expression of Linc-ROR in plasma. The interactions of gene reproductive factors were assessed by Multifactor Dimensionality Reduction (MDR) method. A novel finding showed TT (OR: 1.79; 95%CI: 1.20-2.68) genotype of rs4801078 in Linc-ROR had a significant association with the higher risk of BC and the expression of Linc-ROR mRNA was closely related with the alleles of rs4801078. In addition, we found the interaction of rs4801078, number of pregnancy and menopausal status might increase BC risk (OR: 2.78; 95%CI: 2.74-3.61). Our results suggest that interactions of SNPs in Linc-ROR and reproductive factors might contribute to BC risk, and alleles of rs4801078 might affect Linc-ROR expression level.
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Affiliation(s)
- Chenglin Luo
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
- Department of Biological Sciences, The University of Texas at El Paso, TX, 79968, USA
| | - Jingjing Cao
- Department of preventive medicine, Heze Medical College, Heze, 274000, Shandong, China
| | - Rui Peng
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
| | - Qiaoyun Guo
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
| | - Hua Ye
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
| | - Peng Wang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
| | - Kaijuan Wang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, PR China.
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3
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Abstract
Aims and background The aim of the present study was to examine if certain aspects of a woman's experience of abortion might be associated with the risk of breast cancer. Methods and study design The case-control study was conducted in Kragujevac (Serbia) during the period 2004–2005. The case group (191 women) consisted of patients with newly diagnosed first primary breast cancer, which was histologically confirmed. The control group (191 women), individually matched by age (± 2 years), hospital admittance and place of residence (rural/urban) to the respective cases, was selected from female patients admitted for other diseases. The analysis was restricted to parous women (168 cases and 171 controls). Results Breast cancer risk was reduced among women who had a history of any abortion (adjusted OR, 0.46; 95% CI, 0.24–0.88). The protective effect was found for both induced abortion (adjusted OR, 0.47; 95% CI, 0.25–0.90) and spontaneous abortion (adjusted OR, 0.31; 95% CI, 0.10–0.98). It seems that these associations did not depend on the number of abortions, age at first abortion, or gestational age at first aborted pregnancy. Conclusions Our study suggests that even short pregnancies ending in abortion add to the protection against breast cancer.
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4
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Terry MB, Keegan THM, Houghton LC, Goldberg M, Andrulis IL, Daly MB, Buys SS, Wei Y, Whittemore AS, Protacio A, Bradbury AR, Chung WK, Knight JA, John EM. Pubertal development in girls by breast cancer family history: the LEGACY girls cohort. Breast Cancer Res 2017; 19:69. [PMID: 28595647 PMCID: PMC5465536 DOI: 10.1186/s13058-017-0849-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/03/2017] [Indexed: 01/29/2023] Open
Abstract
Background Pubertal milestones, such as onset of breast development and menstruation, play an important role in breast cancer etiology. It is unclear if these milestones are different in girls with a first- or second-degree breast cancer family history (BCFH). Methods In the LEGACY Girls Study (n = 1040), we examined whether three mother/guardian-reported pubertal milestones (having reached Tanner Stage 2 or higher (T2+) for breast and pubic hair development, and having started menstruation) differed by BCFH. We also examined whether associations between body size and race/ethnicity and pubertal milestones were modified by BCFH. We used mother/guardian reports as the primary measure of pubertal milestones, but also conducted sensitivity analyses using clinical Tanner measurements available for a subcohort (n = 204). We analyzed cross-sectional baseline data with logistic regression models for the entire cohort, and longitudinal data with Weibull survival models for the subcohort of girls that were aged 5–7 years at baseline (n = 258). Results BCFH was modestly, but not statistically significantly, associated with Breast T2+ (odds ratio (OR) = 1.36, 95% confidence interval (CI) = 0.88–2.10), with a stronger association seen in the subcohort of girls with clinical breast Tanner staging (OR = 2.20, 95% CI = 0.91–5.32). In a longitudinal analysis of girls who were aged 5–7 years at baseline, BCFH was associated with a 50% increased rate of having early breast development (hazard ratio (HR) = 1.49, 95% CI = 1.0–2.21). This association increased to twofold in girls who were not overweight at baseline (HR = 2.04, 95% CI = 1.29–3.21). BCFH was not associated with pubic hair development and post-menarche status. The median interval between onset of breast development and menarche was longer for BCFH+ than BCFH– girls (2.3 versus 1.7 years), suggesting a slower developmental tempo for BCFH+ girls. Associations between pubertal milestones and body size and race/ethnicity were similar in girls with or without a BCFH. For example, weight was positively associated with Breast T2+ in both girls with (OR = 1.06 per 1 kg, 95% CI = 1.03–1.10) and without (OR = 1.14 per 1 kg, 95% CI = 1.04–1.24) a BCFH. Conclusions These results suggest that BCFH may be related to earlier breast development and slower pubertal tempo independent of body size and race/ethnicity. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0849-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Theresa H M Keegan
- Division of Hematology and Oncology, University of California (UC) Davis School of Medicine, and UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Lauren C Houghton
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Mandy Goldberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Irene L Andrulis
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Saundra S Buys
- Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alice S Whittemore
- Departments of Biomedical Data Sciences and Health Research and Policy, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Angeline Protacio
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Angela R Bradbury
- Departments of Medicine, Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, CA, USA.,Department of Health Research and Policy (Epidemiology), and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
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Dite GS, MacInnis RJ, Bickerstaffe A, Dowty JG, Milne RL, Antoniou AC, Weideman P, Apicella C, Giles GG, Southey MC, Jenkins MA, Phillips KA, Win AK, Terry MB, Hopper JL. Testing for Gene-Environment Interactions Using a Prospective Family Cohort Design: Body Mass Index in Early and Later Adulthood and Risk of Breast Cancer. Am J Epidemiol 2017; 185:487-500. [PMID: 28399571 PMCID: PMC6158796 DOI: 10.1093/aje/kww241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/01/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022] Open
Abstract
The ability to classify people according to their underlying genetic susceptibility to a disease is increasing with new knowledge, better family data, and more sophisticated risk prediction models, allowing for more effective prevention and screening. To do so, however, we need to know whether risk associations are the same for people with different genetic susceptibilities. To illustrate one way to estimate such gene-environment interactions, we used prospective data from 3 Australian family cancer cohort studies, 2 enriched for familial risk of breast cancer. There were 288 incident breast cancers in 9,126 participants from 3,222 families. We used Cox proportional hazards models to investigate whether associations of breast cancer with body mass index (BMI; weight (kg)/height (m)2) at age 18-21 years, BMI at baseline, and change in BMI differed according to genetic risk based on lifetime breast cancer risk from birth, as estimated by BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) software, adjusted for age at baseline data collection. Although no interactions were statistically significant, we have demonstrated the power with which gene-environment interactions can be investigated using a cohort enriched for persons with increased genetic risk and a continuous measure of genetic risk based on family history.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - John L. Hopper
- Correspondence to Prof. John L. Hopper, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC 3010, Australia (e-mail: )
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6
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Cao J, Luo C, Yan R, Peng R, Wang K, Wang P, Ye H, Song C. rs15869 at miRNA binding site in BRCA2 is associated with breast cancer susceptibility. Med Oncol 2016; 33:135. [PMID: 27807724 DOI: 10.1007/s12032-016-0849-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022]
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Abstract
The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.
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Affiliation(s)
- A MacDonald
- Dietetic Department, Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, England
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8
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Sufian SN, Masroor I, Mirza W, Butt S, Afzal S, Sajjad Z. Evaluation of Common Risk Factors for Breast Carcinoma in Females: a Hospital Based Study in Karachi, Pakistan. Asian Pac J Cancer Prev 2016; 16:6347-52. [PMID: 26434841 DOI: 10.7314/apjcp.2015.16.15.6347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast malignancies are one of the leading causes of deaths in females worldwide. There are a number of risk factors associated with breast cancer but in Karachi Pakistan there are insufficient data available. MATERIALS AND METHODS A case control study was conducted on females in age group between 30-80 years. This study was accomplished by retrospective data collection in Aga Khan University Hospital Karachi, Pakistan. A total of 108 females with primary malignancy of breast were included along with 108 matched controls. Relationship of various factors with disease was studied using logistic regression to calculate odds ratios with 95 % confidence intervals. RESULTS A total of 14 variables were analyzed and based on and 7 were found to be risk factors: old age, family history of breast cancer, family history of other carcinomas, personal history of breast carcinoma, early age of menarche, older age of mother at first delivery and lower number of children. Five factors, parity, breast feeding, history of oral contraceptive pills intake, past history of oophorectomy and hysterectomy showed protective associations. One variable, use of hormonal replacement therapy, showed a controversial link and one other, marital status, was not significant in this study. CONCLUSIONS It is concluded that most of the well-known risk factors for breast cancer are also associated with the disease in the female population of Karachi, Pakistan. High risk patients should be the focus with the help of this study so that screening can be more effective for early diagnosis before clinically evident breast malignancy.
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Affiliation(s)
- Saira Naz Sufian
- Department of Diagnostic Radiology, Aga Khan University Hospital Karachi, Pakistan E-mail :
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Terry MB, Phillips KA, Daly MB, John EM, Andrulis IL, Buys SS, Goldgar DE, Knight JA, Whittemore AS, Chung WK, Apicella C, Hopper JL. Cohort Profile: The Breast Cancer Prospective Family Study Cohort (ProF-SC). Int J Epidemiol 2016; 45:683-92. [PMID: 26174520 PMCID: PMC5005937 DOI: 10.1093/ije/dyv118] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA,
| | - Kelly-Anne Phillips
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, School of Population and Global Health, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, CA, USA, Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - David E Goldgar
- Department of Dermatology, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada and
| | - Alice S Whittemore
- Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
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10
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John EM, Terry MB, Keegan TH, Bradbury AR, Knight JA, Chung WK, Frost CJ, Lilge L, Patrick-Miller L, Schwartz LA, Whittemore AS, Buys SS, Daly MB, Andrulis IL. The LEGACY Girls Study: Growth and Development in the Context of Breast Cancer Family History. Epidemiology 2016; 27:438-48. [PMID: 26829160 PMCID: PMC5341739 DOI: 10.1097/ede.0000000000000456] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although the timing of pubertal milestones has been associated with breast cancer risk, few studies of girls' development include girls at increased breast cancer risk due to their family history. METHODS The Lessons in Epidemiology and Genetics of Adult Cancer from Youth (LEGACY) Girls Study was initiated in 2011 in the USA and Canada to assess the relation between early life exposures and intermediate markers of breast cancer risk (e.g., pubertal development, breast tissue characteristics) and to investigate psychosocial well being and health behaviors in the context of family history. We describe the methods used to establish and follow a cohort of 1,040 girls ages 6-13 years at baseline, half with a breast cancer family history, and the collection of questionnaire data (family history, early life exposures, growth and development, psychosocial and behavioral), anthropometry, biospecimens, and breast tissue characteristics using optical spectroscopy. RESULTS During this initial 5-year phase of the study, follow-up visits are conducted every 6 months for repeated data and biospecimen collection. Participation in baseline components was high (98% for urine, 97.5% for blood or saliva, and 98% for anthropometry). At enrollment, 77% of girls were premenarcheal and 49% were at breast Tanner stage T1. CONCLUSIONS This study design allows thorough examination of events affecting girls' growth and development and how they differ across the spectrum of breast cancer risk. A better understanding of early life breast cancer risk factors will be essential to enhance prevention across the lifespan for those with and without a family history of the disease.
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Affiliation(s)
- Esther M. John
- Cancer Prevention Institute of California, Fremont, CA, USA
- Department of Health Research & Policy (Epidemiology), and
Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of
Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University
Medical Center, New York, NY, USA
| | - Theresa H.M. Keegan
- Cancer Prevention Institute of California, Fremont, CA, USA
- Department of Health Research & Policy (Epidemiology), and
Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA
| | - Angela R. Bradbury
- Departments of Medicine and Medical Ethics & Health Policy,
Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA,
USA
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health,
University of Toronto, Toronto, Ontario, Canada
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University, New
York, NY USA
| | - Caren J. Frost
- College of Social Work, University of Utah, Salt Lake City, UT,
USA
| | - Lothar Lilge
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Linda Patrick-Miller
- Center for Clinical Cancer Genetics and Department of Medicine,
University of Chicago, Chicago, IL, USA
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia and Department of
Pediatrics, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, USA
| | - Alice S. Whittemore
- Department of Health Research & Policy (Epidemiology), and
Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA
| | - Saundra S. Buys
- Department of Medicine, Huntsman Cancer Institute, University of
Utah School of Medicine, Salt Lake City, UT, USA
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center,
Philadelphia, PA, USA
| | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto,
Ontario, Canada
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11
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Hajiebrahimi M, Cnattingius S, Lambe M, Bahmanyar S. Pregnancy history and risk of premenopausal breast cancer-a nested case-control study. Int J Epidemiol 2015; 45:816-24. [PMID: 26559546 DOI: 10.1093/ije/dyv293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reproductive factors are well-known risk factors for premenopausal breast cancer (PBC). It is unknown whether these associations are modified by familial factors, including genetic and early environment factors. METHODS Using Swedish health registries, we performed a nested case-control study with two control groups: sister controls and population controls. The study population included women with live singleton births between 1973 and 2010, who also had a full sister who gave birth during this period. All women subsequently diagnosed with PBC were selected as cases (n = 8327). Sisters with the least age difference and without PBC at the time of her sister's diagnosis were selected as sister controls. For each incident case, one population control without previous PBC was selected.The population controls were individually matched with the sister controls on year of birth. Conditional logistic regression was used to estimate associations between reproductive factors and PBC. RESULTS Increasing parity was inversely associated with PBC using population controls, and multiparity was a risk factor using sister controls. Very preterm delivery (≤ 31 weeks) was associated with a slightly higher PBC risk using sister controls. Preeclampsia was associated with a slightly protective effect using population controls. With respect to other factors, there were no substantial differences in risks of PBC by choice of control group. CONCLUSIONS The divergent results with regard to parity and PBC risk when using sister and population controls suggest that the influence of childbearing may be modified by genotype. Selection bias when using different control groups must also be considered.
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Affiliation(s)
- Mohammadhossein Hajiebrahimi
- Clinical Epidemiology Unit, Department of Public Health, Public Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden, Regional Cancer Center, Uppsala, Sweden and
| | - Shahram Bahmanyar
- Clinical Epidemiology Unit, Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Sweden, Department of Public Health, Public Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
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12
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Zhang F, Khalili A, Lin S. Optimum study design for detecting imprinting and maternal effects based on partial likelihood. Biometrics 2015; 72:95-105. [PMID: 26288102 DOI: 10.1111/biom.12380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 06/01/2015] [Accepted: 07/01/2015] [Indexed: 11/28/2022]
Abstract
Despite spectacular advances in molecular genomic technologies in the past two decades, resources available for genomic studies are still finite and limited, especially for family-based studies. Hence, it is important to consider an optimum study design to maximally utilize limited resources to increase statistical power in family-based studies. A particular question of interest is whether it is more profitable to genotype siblings of probands or to recruit more independent families. Numerous studies have attempted to address this study design issue for simultaneous detection of imprinting and maternal effects, two important epigenetic factors for studying complex diseases. The question is far from settled, however, mainly due to the fact that results and recommendations in the literature are based on anecdotal evidence from limited simulation studies rather than based on rigorous statistical analysis. In this article, we propose a systematic approach to study various designs based on a partial likelihood formulation. We derive the asymptotic properties and obtain formulas for computing the information contents of study designs being considered. Our results show that, for a common disease, recruiting additional siblings is beneficial because both affected and unaffected individuals will be included. However, if a disease is rare, then any additional siblings recruited are most likely to be unaffected, thus contributing little additional information; in such cases, additional families will be a better choice with a fixed amount of resources. Our work thus offers a practical strategy for investigators to select the optimum study design within a case-control family scheme before data collection.
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Affiliation(s)
- Fangyuan Zhang
- Department of Statistics, The Ohio State University, 1958 Neil Avenue, Columbus, Ohio 43210, U.S.A
| | - Abbas Khalili
- Department of Mathematics and Statistics, McGill University, 805 Sherbrooke Street West, Montreal, Quebec H3A 0B9, Canada
| | - Shili Lin
- Department of Statistics, The Ohio State University, 1958 Neil Avenue, Columbus, Ohio 43210, U.S.A
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Ilic M, Vlajinac H, Marinkovic J. Breastfeeding and Risk of Breast Cancer: Case-Control Study. Women Health 2015; 55:778-94. [DOI: 10.1080/03630242.2015.1050547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Hristina Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pan L, Han LL, Tao LX, Zhou T, Li X, Gao Q, Wu LJ, Luo YX, Ding H, Guo XH. Clinical risk factor analysis for breast cancer: 568,000 subjects undergoing breast cancer screening in Beijing, 2009. Asian Pac J Cancer Prev 2014; 14:5325-9. [PMID: 24175820 DOI: 10.7314/apjcp.2013.14.9.5325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Although there are many reports about the risk of breast cancer, few have reported clinical factors including history of breast-related or other diseases that affect the prevalence of breast cancer. This study explores these risk factors for breast cancer cases reported in Beijing in 2009. MATERIALS AND METHODS Data were derived from a Beijing breast cancer screening performed in 2009, of 568,000 women, from 16 districts of Beijing, all aged between 40 and 60 years. In this study, multilevel statistical modeling was used to identify clinical factors that affect the prevalence of breast cancer and to provide more reliable evidence for clinical diagnostics by using screening data. RESULTS AND CONCLUSION Those women who had organ transplants, compared with those with none, were associated with breast cancer with an odds ratio (OR) = 65.352 [95% confidence interval (CI): 8.488-503.165] and those with solid breast mass compared with none had OR = 1.384 (95% CI: 1.022- 1.873). Malignant tendency was strongly associated with increased risk of breast cancer, OR = 207.999(95% CI: 151.950-284.721). The risk of breast cancer increased with age, OR1 = 2.759 (95% CI: 1.837-4.144, 56-60 vs. 40-45), OR2 = 2.047 (95% CI: 1.394-3.077, 51-55 vs. 40-45), OR3 = 1.668 (95% CI: 1.145-2.431). Normal results of B ultrasonic examination show a lower risk among participants, OR= 0.136 (95% CI: 0.085-0.218). Those women with ductal papilloma compared with none were associated with breast cancer, OR=6.524 (95% CI: 1.871-22.746). Therefore, this study suggests that clinical doctors should pay attention to these high-risk factors.
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Affiliation(s)
- Lei Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China E-mail : ,
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15
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Dennis J, Hawken S, Krewski D, Birkett N, Gheorghe M, Frei J, McKeown-Eyssen G, Little J. Bias in the case-only design applied to studies of gene-environment and gene-gene interaction: a systematic review and meta-analysis. Int J Epidemiol 2011; 40:1329-41. [PMID: 21729879 DOI: 10.1093/ije/dyr088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The case-only study, proposed as a design specifically for assessing departure from multiplicative gene-environment and gene-gene interactions, is of considerable potential value but there are concerns about its validity. The objective of this study was to evaluate the extent and sources of bias in the case-only design by means of a systematic review and meta-regression analysis. METHODS The MEDLINE, CINAHL, EMBASE and PUBMED databases were searched through to 7 October 2009. Studies that assessed bias in the case-only design applied to the study of gene-environment and gene-gene interaction were identified. Qualitative comments on the sources and extent of bias were extracted. A meta-regression analysis of the ratio (IOR(CC)/IOR(CO)) of the case-control (IOR(CC)) and case-only (IOR(CO)) interaction odds ratios was conducted based on studies in which both methods were applied to the same data set. RESULTS The search yielded 365 unique articles of which 38 met the inclusion criteria. Potential sources of bias in the case-only design included non-independence of genotype and exposure in the source population. Meta-regression analysis, based on 24 evaluations, produced a mean IOR(CC)/IOR(CO) of 1.06 [95% confidence interval (95% CI) 0.93-1.22], suggesting that bias in case-only designs is not common in practice. The I(2) statistic indicated that 23.9% (95% uncertainty interval 0-53.9%) of the observed variation was due to heterogeneity between studies, which was not explained by any methodological characteristics of the included studies. CONCLUSION As understanding of the relationships between genes and environmental exposures in the population improves, the case-only design may prove to be of considerable value.
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Affiliation(s)
- Jessica Dennis
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
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16
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Graber-Naidich A, Gorfine M, Malone KE, Hsu L. Missing genetic information in case-control family data with general semi-parametric shared frailty model. LIFETIME DATA ANALYSIS 2011; 17:175-194. [PMID: 21153764 PMCID: PMC3174530 DOI: 10.1007/s10985-010-9178-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 06/15/2010] [Indexed: 05/30/2023]
Abstract
Case-control family data are now widely used to examine the role of gene-environment interactions in the etiology of complex diseases. In these types of studies, exposure levels are obtained retrospectively and, frequently, information on most risk factors of interest is available on the probands but not on their relatives. In this work we consider correlated failure time data arising from population-based case-control family studies with missing genotypes of relatives. We present a new method for estimating the age-dependent marginalized hazard function. The proposed technique has two major advantages: (1) it is based on the pseudo full likelihood function rather than a pseudo composite likelihood function, which usually suffers from substantial efficiency loss; (2) the cumulative baseline hazard function is estimated using a two-stage estimator instead of an iterative process. We assess the performance of the proposed methodology with simulation studies, and illustrate its utility on a real data example.
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Affiliation(s)
- Anna Graber-Naidich
- Faculty of Industrial Engineering and Management, Technion City, Haifa 32000, Israel
| | - Malka Gorfine
- Faculty of Industrial Engineering and Management, Technion City, Haifa 32000, Israel
| | - Kathleen E. Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Li Hsu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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17
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Stuebe AM, Willett WC, Xue F, Michels KB. Lactation and incidence of premenopausal breast cancer: a longitudinal study. ACTA ACUST UNITED AC 2009; 169:1364-71. [PMID: 19667298 DOI: 10.1001/archinternmed.2009.231] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Findings from observational studies suggest an inverse association between lactation and premenopausal breast cancer risk, but results are inconsistent, and data from large prospective cohort studies are lacking. METHODS We used information from 60,075 parous women participating in the prospective cohort study of the Nurses' Health Study II from 1997 to 2005. Our primary outcome was incident premenopausal breast cancer. RESULTS We ascertained 608 incident cases of premenopausal breast cancer during 357,556 person-years of follow-up. Women who had ever breastfed had a covariate-adjusted hazard ratio (HR) of 0.75 (95% confidence interval [CI], 0.56-1.00) for premenopausal breast cancer compared with women who had never breastfed. No linear trend was found with duration of total lactation (P = .95), exclusive lactation (P = .74), or lactation amenorrhea (P = .88). The association between lactation and premenopausal breast cancer was modified by family history of breast cancer (P value for interaction = .03). Among women with a first-degree relative with breast cancer, those who had ever breastfed had a covariate-adjusted HR of 0.41 (95% CI, 0.22-0.75) for premenopausal breast cancer compared with women who had never breastfed, whereas no association was observed among women without a family history of breast cancer. CONCLUSION In this large, prospective cohort study of parous premenopausal women, having ever breastfed was inversely associated with incidence of breast cancer among women with a family history of breast cancer.
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Affiliation(s)
- Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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18
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Yang L, Jacobsen KH. A Systematic Review of the Association between Breastfeeding and Breast Cancer. J Womens Health (Larchmt) 2008; 17:1635-45. [DOI: 10.1089/jwh.2008.0917] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Li Yang
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Kathryn H. Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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Abstract
Much can be learned about a process by observing changes over time or by comparing two different processes under different conditions. This chapter introduces the major types of observational study designs: the longitudinal or cohort study, the comparative or case-control study, and some of their variants. It also includes examples of the key measures of relationship between factor and outcome in observational studies, the relative risk and the odds ratio. The similarity of the two measures for low incidence outcomes is illustrated, as is the use of attributable risk to assess how much of a binary outcome is due to a single factor.
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Affiliation(s)
- Raymond G Hoffmann
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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20
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Albrektsen G, Heuch I, Thoresen S, Kvåle G. Family history of breast cancer and short-term effects of childbirths on breast cancer risk. Int J Cancer 2006; 119:1468-74. [PMID: 16642468 DOI: 10.1002/ijc.22003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The long-term protective effect of a pregnancy on breast cancer risk is preceded by a short-term adverse effect, possibly reflecting a promoting effect of pregnancy hormones. In the present study, we explore whether a family history of breast cancer modifies time-related effects of pregnancies, with special emphasis on the transient increase in risk of breast cancer shortly after birth. Our study cohort comprises 1,067,289 Norwegian women aged 20-74 years. The mean follow-up time was 18 years. Incidence rate ratios were estimated by Poisson regression analyses of person-years at risk. Of the 7,377 women diagnosed with breast cancer during follow-up, a total of 828 (11%) had a mother or a sister with breast cancer diagnosis. Women with a family history of breast cancer had a 2-3-fold higher risk of breast cancer than did women without any affected family member, highest for those with a relative diagnosed before they were 50 years. Similar to women without a familial excess risk, increasing parity was associated with an overall protective effect among women with a familial predisposition, regardless of age at diagnosis of the relative. Whereas women with no familial excess risk experienced a transient increase in risk mainly after late age births, women with a family history of breast cancer experienced an adverse effect of pregnancies also at younger ages. The present results give further support to the hypothesis that the adverse effect of a term birth can be explained by a promoting effect of pregnancy hormones.
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Abstract
Designs that involve families (the traditional strength of genetic epidemiology) and population-based sampling (the traditional strength of environmental epidemiology) allow investigation of both genes and environment, separately or together, and allow valid inference to the population. These case-control-family designs (including those involving twin pairs), can be regarded as retrospective cohort studies of relatives, and can be used for: determining familial risks and genetic models; estimating risk (penetrance) for measured genotypes; genetic association studies; stratifying risks by family history and known mutation status; and studying modifiers of risk in genetically susceptible individuals. Follow-up of families allows genetic and environmental risks to be studied prospectively. We discuss statistical methods, theoretical and practical strengths, limitations, and other issues. Given their versatility, population-based family studies could become a principal framework in epidemiology, and move genetics from its traditional focus on high-risk families to give it a wider clinical and population health relevance.
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Affiliation(s)
- John L Hopper
- University of Melbourne, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, 723 Swanston Street, Carlton, Victoria 3053, Australia.
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22
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Andrieu N, Goldstein AM. The case-combined-control design was efficient in detecting gene-environment interactions. J Clin Epidemiol 2004; 57:662-71. [PMID: 15358394 DOI: 10.1016/j.jclinepi.2003.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2003] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The interest in studying gene-environment (GxE) interaction is increasing for complex diseases. A design combining both related and unrelated controls (e.g., population-based and siblings) is proposed to increase the power to detect GxE interaction. STUDY DESIGN AND SETTING We used simulations to assess the efficiency of the case-combined-control design relative to a classical case-control study under a variety of assumptions. RESULTS The case-combined-control design appears more efficient and feasible than a classical case-control study for detecting interaction involving rare exposures and/or genetic factors. The number of available sibling controls per case and the frequencies of the risk factors are the most important parameters for determining relative efficiency. Relative efficiencies decrease as the frequency of the gene (G) increases. A positive correlation in exposure (E) between siblings decreases relative efficiency. CONCLUSIONS Although the case-combined-control design may not be efficient for common genes with moderate effects, it appears to be a useful alternative in certain situations where classical approaches remain unrealistic.
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Affiliation(s)
- N Andrieu
- Inserm EMI00-06, Tour Evry 2, 523 Place des Terrasses de l'Agora, 91034 Evry Cedex, France.
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23
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Romero R, Chaiworapongsa T, Kuivaniemi H, Tromp G. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of preterm birth. Am J Obstet Gynecol 2004; 190:1509-19. [PMID: 15284723 DOI: 10.1016/j.ajog.2004.01.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
MESH Headings
- Female
- Fetal Membranes, Premature Rupture/epidemiology
- Fetal Membranes, Premature Rupture/genetics
- Genetic Predisposition to Disease
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Male
- Obstetric Labor, Premature/genetics
- Obstetric Labor, Premature/prevention & control
- Polymorphism, Genetic
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Outcome
- Prognosis
- Risk Assessment
- Tumor Necrosis Factor-alpha/genetics
- Vaginosis, Bacterial/epidemiology
- Vaginosis, Bacterial/genetics
- Vaginosis, Bacterial/prevention & control
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, National Institute of Child Health & Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA
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Beral V, Bull D, Doll R, Peto R, Reeves G. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet 2004; 363:1007-16. [PMID: 15051280 DOI: 10.1016/s0140-6736(04)15835-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Collaborative Group on Hormonal Factors in Breast Cancer has brought together the worldwide epidemiological evidence on the possible relation between breast cancer and previous spontaneous and induced abortions. METHODS Data on individual women from 53 studies undertaken in 16 countries with liberal abortion laws were checked and analysed centrally. Relative risks of breast cancer--comparing the effects of having had a pregnancy that ended as an abortion with those of never having had that pregnancy--were calculated, stratified by study, age at diagnosis, parity, and age at first birth. Because the extent of under-reporting of past induced abortions might be influenced by whether or not women had been diagnosed with breast cancer, results of the studies--including a total of 44000 women with breast cancer--that used prospective information on abortion (ie, information that had been recorded before the diagnosis of breast cancer) were considered separately from results of the studies--including 39000 women with the disease--that used retrospective information (recorded after the diagnosis of breast cancer). FINDINGS The overall relative risk of breast cancer, comparing women with a prospective record of having had one or more pregnancies that ended as a spontaneous abortion versus women with no such record, was 0.98 (95% CI 0.92-1.04, p=0.5). The corresponding relative risk for induced abortion was 0.93 (0.89-0.96, p=0.0002). Among women with a prospective record of having had a spontaneous or an induced abortion, the risk of breast cancer did not differ significantly according to the number or timing of either type of abortion. Published results on induced abortion from the few studies with prospectively recorded information that were not available for inclusion here are consistent with these findings. Overall results for induced abortion differed substantially between studies with prospective and those with retrospective information on abortion (test for heterogeneity between relative risks: chi2(1) =33.1, p<0.0001). INTERPRETATION Pregnancies that end as a spontaneous or induced abortion do not increase a woman's risk of developing breast cancer. Collectively, the studies of breast cancer with retrospective recording of induced abortion yielded misleading results, possibly because women who had developed breast cancer were, on average, more likely than other women to disclose previous induced abortions.
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25
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Lash TL, Fink AK. Null association between pregnancy termination and breast cancer in a registry-based study of parous women. Int J Cancer 2004; 110:443-8. [PMID: 15095312 DOI: 10.1002/ijc.20136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies suggesting a positive association between pregnancy termination and breast cancer risk have often been of retrospective case-control design, so subject to selection and recall biases. We undertook a registry-based analysis with minimal selection bias and prospective record-based ascertainment of terminations. The source population comprised Massachusetts women with a record of giving birth between 1987 and 1999 in the Massachusetts Vital Statistics Registry. Primary breast cancer cases were 25-55 years old at diagnosis between 1988 and 2000 and had a record of the diagnosis in the Massachusetts Cancer Registry. We matched 3 controls to each case on maternal age, year of giving birth and birth facility. Information on terminations (induced and spontaneous) before the birth of record, the matched factors and potential confounders were collected from the birth certificate. After adjustment for the matched factors, age, parity and maternal and paternal education, the odds ratio associating any termination history with breast cancer risk equaled 0.91 (95% CI = 0.79-1.05). The marginally protective adjusted odds ratio largely derived from a protective effect among women with parity equaled to 1 (OR for any termination = 0.68; 95% CI = 0.45-1.03), suggesting a protective effect of terminated pregnancy among women with one live birth.
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Affiliation(s)
- Timothy L Lash
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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26
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Hopper JL. Commentary: Case-control-family designs: a paradigm for future epidemiology research? Int J Epidemiol 2003; 32:48-50. [PMID: 12690007 DOI: 10.1093/ije/dyg114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John L Hopper
- The University of Melbourne, Centre for Genetic Epidemiology, 723 Swanston Street, Carlton, Victoria 3053, Australia
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