1
|
Kosem YOT, Uzun H, Velidedeoglu M, Kocael P, Dumur S, Simsek O. Clinical significance of serum synaptophysin-like 1 protein levels in breast cancer. J Med Biochem 2024; 43:273-280. [PMID: 38699696 PMCID: PMC11062335 DOI: 10.5937/jomb0-46198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 05/05/2024] Open
Abstract
Background Mammography, used for breast cancer (BC) screening, has limitations such as decreased sensitivity in dense breasts. Currently used tumor markers are insufficient in diagnosing breast cancer. In this study, we aimed to investigate the relationship between serum levels of synaptophysin-like protein 1 (SYPL1) and BC and compare SYPL1 with other blood tumor markers. Methods The study group consisted of 80 female patients with a histopathological diagnosis of invasive BC who received no radiotherapy/chemotherapy. The control group was 72 women with no previous history of breast disease and evaluated as Breast Imaging Reporting and Data Systems (BI-RADS 1-2) on imaging. Serum SYPL1, cancer antigen 15-3 (CA 15-3), and carcinoembryonic antigen (CEA) were measured in both groups.
Collapse
Affiliation(s)
- Yagmur Ozge Turac Kosem
- Istanbul University-Cerrahpas, Cerrahpa a Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Hafize Uzun
- Istanbul Atlas University, Faculty of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Istanbul University-Cerrahpas, Cerrahpa a Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Pınar Kocael
- Istanbul University-Cerrahpas, Cerrahpa a Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Seyma Dumur
- Istanbul Atlas University, Faculty of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Osman Simsek
- Istanbul University-Cerrahpas, Cerrahpa a Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| |
Collapse
|
2
|
Seo JY, Park SH, Choi SE, Lee M, Strauss SM. Development and Modification of a Culturally Tailored Education Program to Prevent Breast Cancer in Korean Immigrant Women in New York City. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:913-923. [PMID: 35921065 PMCID: PMC9362115 DOI: 10.1007/s13187-022-02207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 06/02/2023]
Abstract
Breast cancer (BC) is the most common cancer in Korean American (KA) women. In view of its high prevalence in these women, their low screening rates, and the cultural influence of BC risk factors in their lifestyles, we developed a community-based culturally tailored BC prevention program, the Korean Breast Cancer Risk Reduction Program (KBCRRP). Guided by the PRECEDE-PROCEDE and health belief models, the KBCRRP was developed to achieve four goals: (1) healthy weight, (2) physically active lifestyle, (3) healthy diet, and (4) BC screening and adherence. KBCRRP combines effective multicomponent strategies for BC screening and a group-based lifestyle intervention incorporating traditional Korean health beliefs and is tailored for BC risk reduction. In this paper, we provide an overview of the program, the process of program development, implementation, and evaluation, and modification during the COVID-19 pandemic. The initial program involved 8 weeks of in-person group education sessions led by interdisciplinary healthcare professionals and 16 weeks of follow-up involving smartphone applications, phone calls, and text messaging from trained lifestyle coaches. Participants received opportunities to obtain free mammography during the program. After feasibility testing, the program was modified by incorporating participants' feedback. During the COVID-19 pandemic, we provided the program using the Zoom video platform. Participants' recruitment and retention during the pandemic was successful, reflecting the fact that virtual delivery of group-based education was a feasible and acceptable alternative to in-person sessions. Collaboration with community organizations serving the target population is the key to developing and sustaining a successful community-based educational program.
Collapse
Affiliation(s)
- Jin Young Seo
- School of Nursing, Hunter College, the City University of New York, 425 E. 25th Street, New York, NY, 10010, USA.
| | - So-Hyun Park
- School of Nursing, Hunter College, the City University of New York, 425 E. 25th Street, New York, NY, 10010, USA
| | - Sung Eun Choi
- Department of Family, Nutrition, & Exercise Sciences, Queens College, the City University of New York, Flushing, NY, USA
| | - Minkyung Lee
- Medical Oncology Department, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Shiela M Strauss
- School of Nursing, Hunter College, the City University of New York, 425 E. 25th Street, New York, NY, 10010, USA
- Rory Meyers College of Nursing, NYU, New York, NY, USA
| |
Collapse
|
3
|
Estrada-Cruz NA, Manuel-Apolinar L, Segura-Uribe JJ, Almanza-Pérez JC, Fortis-Barrera Á, Orozco-Suárez S, Bautista-Poblet G, Coyoy-Salgado A, Guerra-Araiza C. Short-term administration of tibolone reduces inflammation and oxidative stress in the hippocampus of ovariectomized rats fed high-fat and high-fructose. Nutr Neurosci 2023; 26:275-289. [PMID: 35282801 DOI: 10.1080/1028415x.2022.2046964] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inflammation and oxidative stress are critical events involved in neurodegeneration. In animal models, it has been shown that chronic consumption of a hypercaloric diet, which leads to inflammatory processes, affects the hippocampus, a brain region fundamental for learning and memory processes. In addition, advanced age and menopause are risk factors for neurodegeneration. Hormone replacement therapy (HRT) ameliorates menopause symptoms. Tibolone (TB), a synthetic hormone, exerts estrogenic, progestogenic and androgenic effects on different tissues. We aimed to determine the effect of short-term TB administration on oxidative stress and inflammation markers in the hippocampus of ovariectomized rats fed a high-fat-and-fructose diet (HFFD). Adult female rats were ovariectomized (OVX) and fed standard diet or HFFD-consisting of 10% lard supplemented chow and 20% high-fructose syrup in the drinking water-and administered vehicle or TB (1 mg/kg for seven days). Finally, we administered hormone receptor antagonists (MPP, RU486 or FLU) to each of the OVX + HFFD + TB groups. Bodyweight, triglycerides and cholesterol, oxidative stress and inflammation markers, and the activity and expression of antioxidant enzymes were quantified in the hippocampus of each experimental group. We observed that short-term TB administration significantly reduced body weight, AGEs, MDA levels, increased SOD and GPx activity, improved GSH/GSSG ratio, and reduced IL-6 and TNF-α. Our findings suggest that short-term administration of TB decreases oxidative stress and reduces inflammation caused by HFFD and early estrogenic decline. These effects occurred via estrogen receptor alpha.
Collapse
Affiliation(s)
- Norma A Estrada-Cruz
- Unidad de Investigación Médica en Farmacología, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Leticia Manuel-Apolinar
- Unidad de Investigación Médica en Enfermedades Endocrinas, CMN Siglo XXI, IMSS, Mexico City, Mexico
| | - Julia J Segura-Uribe
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Julio C Almanza-Pérez
- Laboratorio de Farmacología, Departamento de Ciencias de la Salud, UAM-I, Mexico City, Mexico
| | - Ángeles Fortis-Barrera
- Laboratorio de Farmacología, Departamento de Ciencias de la Salud, UAM-I, Mexico City, Mexico
| | - Sandra Orozco-Suárez
- Unidad de Investigación Médica en Enfermedades Neurológicas, CMN Siglo XXI, IMSS, Mexico City, Mexico
| | - Guadalupe Bautista-Poblet
- Unidad de Investigación Médica en Farmacología, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Angélica Coyoy-Salgado
- Cátedras CONACyT-Unidad de Investigación Médica en Enfermedades Neurológicas, IMSS, Mexico City, Mexico
| | - Christian Guerra-Araiza
- Unidad de Investigación Médica en Farmacología, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| |
Collapse
|
4
|
Basavarajappa GM, Rehman A, Shiroorkar PN, Sreeharsha N, Anwer MK, Aloufi B. Therapeutic effects of Crataegus monogyna inhibitors against breast cancer. Front Pharmacol 2023; 14:1187079. [PMID: 37180727 PMCID: PMC10174464 DOI: 10.3389/fphar.2023.1187079] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Breast cancer is a silent killer disorder among women and a serious economic burden in healthcare management. Every 19 s, a woman is diagnosed with breast cancer, and every 74 s, a woman worldwide passes away from the disease. Despite the increase in progressive research, advanced treatment approaches, and preventive measures, breast cancer rates continue to increase. This study provides a combination of data mining, network pharmacology, and docking analysis that surely could revolutionize cancer treatment by exploiting prestigious phytochemicals. Crataegus monogyna is a small, rounded deciduous tree with glossy, deeply lobed leaves and flat sprays of cream flowers, followed by dark red berries in autumn. Various studies demonstrated that C. monogyna is therapeutically effective against breast cancer. However, the particular molecular mechanism is still unknown. This study is credited for locating bioactive substances, metabolic pathways, and target genes for breast cancer treatment. According to the current investigation, which examined compound-target genes-pathway networks, it was found that the bioactive compounds of C. monogyna may operate as a viable solution against breast cancer by altering the target genes implicated in the disease pathogenesis. The expression level of target genes was analyzed using GSE36295 microarray data. Docking analysis and molecular dynamic simulation studies further strengthened the current findings by validating the effective activity of the bioactive compounds against putative target genes. In summary, we propose that six key compounds, luteolin, apigenin, quercetin, kaempferol, ursolic acid, and oleanolic acid, contributed to the development of breast cancer by affecting the MMP9 and PPARG proteins. Integration of network pharmacology and bioinformatics revealed C. monogyna's multitarget pharmacological mechanisms against breast cancer. This study provides convincing evidence that C. monogyna might partially alleviate breast cancer and ultimately lays a foundation for further experimental research on the anti-breast cancer activity of C. monogyna.
Collapse
Affiliation(s)
| | - Abdur Rehman
- College of Life Sciences, Northwest A&F University, Yangling, China
- *Correspondence: Nagaraja Sreeharsha, ; Abdur Rehman,
| | | | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Hofuf, Saudi Arabia
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Bangalore, India
- *Correspondence: Nagaraja Sreeharsha, ; Abdur Rehman,
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Alkharj, Saudi Arabia
| | - Bandar Aloufi
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| |
Collapse
|
5
|
Baguley BJ, Dalla Via J, Fraser SF, Daly RM, Kiss N. Effectiveness of combined nutrition and exercise interventions on body weight, lean mass, and fat mass in adults diagnosed with cancer: a systematic review and meta-analysis. Nutr Rev 2022; 81:625-646. [PMID: 36206176 DOI: 10.1093/nutrit/nuac079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Changes in body weight and composition (fat and lean mass) are prominent side effects of cancer treatment. Nutrition and exercise interventions are both key strategies to protect against these adverse effects, yet their impact when combined has not been comprehensively reviewed in adults with cancer. OBJECTIVE This systematic review and meta-analysis aims to assess the effects of combined nutrition and exercise interventions on body weight and composition in adults with cancer. DATA SOURCES Four databases were searched until January 2021. Combined nutrition and exercise randomized controlled trials that detailed the nutrition and exercise prescription and reported body weight and composition outcomes were eligible. DATA EXTRACTION Risk of bias was assessed through the Cochrane Collaboration tool. The number of participants, mean values, and standard deviations of the outcome variables were extracted. Mean differences (MDs) were pooled using random-effects models. Predetermined subgroup analyses included cancer type, intervention intent, exercise modality, and use of behavior change strategies. DATA ANALYSIS Twenty-three RCTs were included. Nutrition plus exercise interventions significantly reduced body weight (MD - 2.13 kg; 95%CI, - 3.07 to - 1.19), fat mass (MD - 2.06 kg; 95%CI, - 3.02 to - 1.09), and lean mass (MD - 0.43; 95%CI, - 0.82 to - 0.04). Subgroup analyses in women with breast cancer showed that weight loss interventions and interventions incorporating behavior change strategies significantly reduced body weight and fat mass but also reduced lean mass. Interventions aiming to maintain body weight showed no changes in body weight, as intended. CONCLUSION Combined nutrition and exercise interventions successfully reduce body weight and fat mass in adults with cancer but also reduce lean mass. In contrast, weight loss-focused interventions are associated mostly with reduced lean mass. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020161805.
Collapse
Affiliation(s)
- Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Naaman SC, Shen S, Zeytinoglu M, Iyengar NM. Obesity and Breast Cancer Risk: The Oncogenic Implications of Metabolic Dysregulation. J Clin Endocrinol Metab 2022; 107:2154-2166. [PMID: 35453151 PMCID: PMC9282365 DOI: 10.1210/clinem/dgac241] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Indexed: 12/18/2022]
Abstract
CONTEXT Breast cancer is increasing in prevalence in parallel with rising rates of obesity worldwide. Obesity is recognized as a leading modifiable risk factor for the development of breast cancer; however, this association varies considerably by clinicopathologic features, and the underlying mechanisms are complex. EVIDENCE ACQUISITION Pubmed literature search using combinations of "obesity," "breast cancer risk," "diet," "exercise," "weight gain," "weight loss," "adipose tissue inflammation," "crown-like structure," "immune markers," "metformin," "gliflozins," "SGLT-2i," "GLP1-RA," and related terms. EVIDENCE SYNTHESIS Elevated body mass index and weight gain are associated with increased risk of postmenopausal, hormone receptor-positive breast cancer. Emerging evidence suggests that adverse measures of body composition in individuals of any weight can also confer increased breast cancer risk. Mechanistically, various factors including altered adipokine balance, dysfunctional adipose tissue, dysregulated insulin signaling, and chronic inflammation contribute to tumorigenesis. Weight loss and more specifically fat mass loss through lifestyle and pharmacologic interventions improve serum metabolic and inflammatory markers, sex hormone levels, and measures of breast density, suggesting a link to decreased breast cancer risk. CONCLUSION Incorporating markers of metabolic health and body composition measures with body mass index can capture breast cancer risk more comprehensively. Further studies of interventions targeting body fat levels are needed to curb the growing prevalence of obesity-related cancer.
Collapse
Affiliation(s)
| | - Sherry Shen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Neil M Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical Center, New York, NY, USA
| |
Collapse
|
7
|
Cairat M, Rinaldi S, Navionis AS, Romieu I, Biessy C, Viallon V, Olsen A, Tjønneland A, Fournier A, Severi G, Kvaskoff M, Fortner RT, Kaaks R, Aleksandrova K, Schulze MB, Masala G, Tumino R, Sieri S, Grasso C, Mattiello A, Gram IT, Olsen KS, Agudo A, Etxezarreta PA, Sánchez MJ, Santiuste C, Barricarte A, Monninkhof E, Hiensch AE, Muller D, Merritt MA, Travis RC, Weiderpass E, Gunter MJ, Dossus L. Circulating inflammatory biomarkers, adipokines and breast cancer risk-a case-control study nested within the EPIC cohort. BMC Med 2022; 20:118. [PMID: 35430795 PMCID: PMC9014562 DOI: 10.1186/s12916-022-02319-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Inflammation has been hypothesized to play a role in the development and progression of breast cancer and might differently impact breast cancer risk among pre and postmenopausal women. We performed a nested case-control study to examine whether pre-diagnostic circulating concentrations of adiponectin, leptin, c-reactive protein (CRP), tumour necrosis factor-α, interferon-γ and 6 interleukins were associated with breast cancer risk, overall and by menopausal status. METHODS Pre-diagnostic levels of inflammatory biomarkers were measured in plasma from 1558 case-control pairs from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. We used conditional logistic regression to estimate the odds ratios (ORs) of breast cancer at blood collection, per one standard deviation increase in biomarker concentration. RESULTS Cases were diagnosed at a mean age of 61.4 years on average 8.6 years after blood collection. No statistically significant association was observed between inflammatory markers and breast cancer risk overall. In premenopausal women, borderline significant inverse associations were observed for leptin, leptin-to-adiponectin ratio and CRP [OR= 0.89 (0.77-1.03), OR= 0.88 (0.76-1.01) and OR= 0.87 (0.75-1.01), respectively] while positive associations were observed among postmenopausal women [OR= 1.16 (1.05-1.29), OR= 1.11 (1.01-1.23), OR= 1.10 (0.99-1.22), respectively]. Adjustment for BMI strengthened the estimates in premenopausal women [leptin: OR = 0.83 (0.68-1.00), leptin-to-adiponectin ratio: OR = 0.80 (0.66-0.97), CRP: OR = 0.85 (0.72-1.00)] but attenuated the estimates in postmenopausal women [leptin: OR = 1.09 (0.96-1.24), leptin-to-adiponectin ratio: OR = 1.02 (0.89-1.16), CRP: OR = 1.04 (0.92-1.16)]. CONCLUSIONS Associations between CRP, leptin and leptin-to-adiponectin ratio with breast cancer risk may represent the dual effect of obesity by menopausal status although this deserves further investigation.
Collapse
Affiliation(s)
- Manon Cairat
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Anne-Sophie Navionis
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Isabelle Romieu
- National Institute of Public Health, Centre for Population Health Research, Cuernavaca, Morelos, Mexico City, Mexico
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Vivian Viallon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Équipe "Exposome Et Hérédité", CESP UMR1018, 94805, Villejuif, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Équipe "Exposome Et Hérédité", CESP UMR1018, 94805, Villejuif, France
- Department of Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy
| | - Marina Kvaskoff
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Équipe "Exposome Et Hérédité", CESP UMR1018, 94805, Villejuif, France
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Krasimira Aleksandrova
- Department Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research AIRE -ONLUS, Ragusa, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Venezian, Milano, Italy
| | - Chiara Grasso
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Amalia Mattiello
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Karina Standahl Olsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Pilar Amiano Etxezarreta
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
- Centro De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria-Jose Sánchez
- Centro De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza De Salud Pública (EASP), Granada, Spain
- Instituto De Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Carmen Santiuste
- Centro De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Aurelio Barricarte
- Centro De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Evelyn Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David Muller
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Melissa A Merritt
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- University of Hawaii Cancer Center, Cancer Epidemiology Program, 701 Ilalo St., Honolulu, HI, 96813, USA
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 0NR, UK
| | - Elisabete Weiderpass
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372, Lyon, CEDEX 08, France.
| |
Collapse
|
8
|
Gathirua-Mwangi WG, Palmer JR, Champion V, Castro-Webb N, Stokes AC, Adams-Campbell L, Marley AR, Forman MR, Rosenberg L, Bertrand KA. Maximum and Time-Dependent Body Mass Index and Breast Cancer Incidence Among Postmenopausal Women in the Black Women's Health Study. Am J Epidemiol 2022; 191:646-654. [PMID: 35020804 PMCID: PMC9077111 DOI: 10.1093/aje/kwac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/13/2023] Open
Abstract
While excess weight is an established risk factor for postmenopausal breast cancer, consideration of maximum body mass index (maxBMI; BMI is calculated as weight (kg)/height (m)2) or BMI at a point in time relevant for breast carcinogenesis may offer new insights. We prospectively evaluated maxBMI and time-dependent BMI in relation to breast cancer incidence among 31,028 postmenopausal women in the Black Women's Health Study. During 1995-2015, a total of 1,384 diagnoses occurred, including 787 estrogen-receptor (ER)-positive (ER+) cases and 310 ER-negative (ER-) cases. BMI was assessed at baseline and 2, 4, 6, and 8 years before diagnosis. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with women with BMI <25, those with BMI ≥35 had increased risk of ER+ breast cancer but not ER- breast cancer. For BMI assessed 2 years before diagnosis, the HRs for ER+ breast cancer associated with maxBMI ≥35 and time-dependent BMI ≥35 were 1.42 (95% confidence interval (CI): 1.10, 1.84) and 1.63 (95% CI: 1.25, 2.13), respectively. The corresponding HR for time-dependent BMI assessed 6 years before diagnosis was 1.95 (95% CI: 1.45, 2.62). These findings suggest strong associations of BMI with risk of ER+ breast cancer in postmenopausal women, regardless of timing of BMI assessment.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kimberly A Bertrand
- Correspondence to Dr. Kimberly Bertrand, Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA 02118 (e-mail: )
| |
Collapse
|
9
|
Cho EJ, Choi Y, Jung SJ, Kwak HB. Role of exercise in estrogen deficiency-induced sarcopenia. J Exerc Rehabil 2022; 18:2-9. [PMID: 35356136 PMCID: PMC8934617 DOI: 10.12965/jer.2244004.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022] Open
Abstract
A decline in estrogen levels during menopause is associated with the loss of muscle mass and function, and it can accelerate sarcopenia. However, with the growing number of postmenopausal women due to the increase in life expectancy, the effects of estrogen on skeletal muscle are not completely understood. This article reviews the relationship between estrogen deficiency and skeletal muscle, its potential mechanisms, including those involving mitochondria, and the effects of exercise on estrogen deficiency-induced skeletal muscle impairment. In particular, mitochondrial dysfunction induced by estrogen deficiency accelerates sarcopenia via mitochondrial dynamics, mitophagy, and mitochondrial-mediated apoptosis. It is well known that exercise training is essential for health, including for the improvement of sarcopenia. This review highlights the importance of exercise training (aerobic and resistance exercise) as a therapeutic intervention against estrogen deficiency-induced sarcopenia.
Collapse
Affiliation(s)
- Eun-Jeong Cho
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University, Incheon,
Korea
| | - Youngju Choi
- Institute of Sports & Arts Convergence, Inha University, Incheon,
Korea
| | - Su-Jeen Jung
- Department of Leisure Sports, Seoil University, Seoul,
Korea
| | - Hyo-Bum Kwak
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University, Incheon,
Korea
- Institute of Sports & Arts Convergence, Inha University, Incheon,
Korea
- Corresponding author: Hyo-Bum Kwak, Department of Biomedical Science, Program in Biomedical Science and Engineering Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Korea,
| |
Collapse
|
10
|
Swerdlow AJ, Bruce C, Cooke R, Coulson P, Schoemaker MJ, Jones ME. Risk of breast cancer in men in relation to weight change: a national case‐control study in England and Wales. Int J Cancer 2022; 150:1804-1811. [PMID: 35049043 PMCID: PMC9303449 DOI: 10.1002/ijc.33938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
Breast cancer is uncommon in men and knowledge about its causation limited. Obesity is a risk factor but there has been no investigation of whether weight change is an independent risk factor, as it is in women. In a national case‐control study, 1998 men with breast cancer incident in England and Wales during 2005 to 2017 and 1597 male controls were interviewed about risk factors for breast cancer including anthropometric factors at several ages. Relative risks of breast cancer in relation to changes in body mass index (BMI) and waist/height ratios at these ages were obtained by logistic regression modelling. There were significant trends of increasing breast cancer risk with increase in BMI from age 20 to 40 (odds ratio [OR] 1.11 [95% confidence interval (CI) 1.05‐1.17] per 2 kg/m2 increase in BMI; P < .001), and from age 40 to 60 (OR 1.12 [1.04‐1.20]; P = .003), and with increase in self‐reported adiposity compared to peers at age 11 to BMI compared with peers at age 20 (OR 1.19 [1.09‐1.30]; P < .001). Increase in waist/height ratio from age 20 to 5 years before diagnosis was also highly significantly associated with risk (OR 1.13 [1.08‐1.19]; P < .001). The associations with increases in BMI and waist/height ratio were significant independently of each other and of BMI or waist/height ratio at the start of the period of change analysed, and effects were similar for invasive and in situ tumours separately. Increases in BMI and abdominal obesity are each risk factors for breast cancer in men, independently of obesity per se. These associations might relate to increasing oestrogen levels with weight gain, but this needs investigation.
What's new?
Although obesity is an established risk factor for breast cancer in men, there have been no investigations of whether weight change is an independent risk factor, as it is in women. In an interview case‐control study including 1998 cases and 1597 controls, authors found that increase in body mass index and in abdominal obesity are each significant risk factors for breast cancer in men, independent of obesity per se.
Collapse
Affiliation(s)
- Anthony J Swerdlow
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Division of Breast Cancer Research The Institute of Cancer Research London UK
| | - Cydney Bruce
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham Nottingham UK
| | - Rosie Cooke
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Penny Coulson
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Michael E Jones
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| |
Collapse
|
11
|
Hao Y, Jiang M, Miao Y, Li X, Hou C, Zhang X, Chen H, Zhong X, Li J. Effect of long-term weight gain on the risk of breast cancer across women's whole adulthood as well as hormone-changed menopause stages: A systematic review and dose-response meta-analysis. Obes Res Clin Pract 2021; 15:439-448. [PMID: 34456166 DOI: 10.1016/j.orcp.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023]
Abstract
Adult weight gain is a good indicator of excess body fatness for breast cancer risk. However, little is known about the effect of weight gain during other special periods in women's lifetime. A publication search in PubMed and Embase through April 2020 was conducted. A primary meta-analysis comparing the highest and lowest category and a secondary meta-analysis based on dose-response meta-analysis were performed to calculate risk estimates with 95% confidence intervals using a random-effects model. For postmenopausal breast cancer, the relative risk for highest vs. lowest category of adult weight gain and weight gain since menopause were 1.55 and 1.59 (RR = 1.55, 95% CI: 1.40, 1.71; RR = 1.59, 95% CI: 1.23, 2.05). For per 5 kg increase in adult weight gain, the summary RR of postmenopausal breast cancer was 1.08 (RR = 1.08, 95% CI: 1.07, 1.09), which is much stronger in Asian women (RR = 1.34, 95% CI: 1.22, 1.47). There was no significant finding among premenopausal women (RR = 1.00, 95% CI: 0.83, 1.21). Same as adult weight gain, weight gain since menopause might be an equivalent predictor for postmenopausal breast cancer risk. More studies are warranted to confirm the magnitude of this association further.
Collapse
Affiliation(s)
- Yu Hao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Menglu Jiang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Yunqi Miao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Xu Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Can Hou
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Xiaofan Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Hui Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China
| | - Xiaorong Zhong
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiayuan Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan Univetsity, Chengdu, Sichuan, China.
| |
Collapse
|
12
|
Albalawi IA, Mir R, Abu-Duhier FM. Molecular Evaluation of PROGINS Mutation in Progesterone Receptor Gene and Determination of its Frequency, Distribution Pattern and Association with Breast Cancer Susceptibility in Saudi Arabia. Endocr Metab Immune Disord Drug Targets 2021; 20:760-770. [PMID: 31763970 DOI: 10.2174/1871530319666191125153050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/15/2022]
Abstract
AIMS Experimental and clinical evidence demonstrate that progesterone hormone and its nuclear receptor, the Progesterone Receptor (PR), play critical role in controlling mammary gland tumorigenesis and breast cancer development. Hormonal therapy (Tomaxifen) is the frontline treatment for hormone-dependent breast cancers. Progesterone hormone induces its action on the target cells by binding with its Progesterone receptor (PgR) therefore any genetic variations, which might induce alienation in the progesterone receptor, can result in an increased susceptibility of gynecological cancers. Alu insertion (PROGINS) mutation in PgR gene is reported to be associated with an increased risk of ovarian cancer and a decreased risk of breast cancer. However, its association with breast cancer risk remains inconclusive. Therefore, we investigated the association of PROGINS allele and its link with breast cancer risk. METHODS This case control study was performed on 200 subjects in which 100 were breast cancer cases and 100 gender matched healthy controls.The mutation was detected by using mutation specific PCR and results were confirmed by direct Sanger sequencing. RESULTS A clinically significant difference was reported in genotype distribution of PROGINs allele among the cases and gender-matched healthy controls (P<0. 032). Genotype frequencies of A1/A1, A1/A2, A2/A2 reported in cases was 81%, 19% (18% & 1%) and in matched healthy controls were 93%, 7% (6% & 1%). The higher frequency of PROGINs allele (19%) was observed in cases than the healthy controls (7%). The findings indicated that PgR variants (CC vs CT) increased the risk of Breast cancer in codominant inheritance model with OR= 3.44, 95% CI =1. 30-9.09, P<0.021) whereas nonsignificant association was found for CC vs TT genotypes with OR=1.14, 95% CI=0.07-18.658, P=0. 92. However, subgroup analysis revealed that CT + TT vs CC genotype increased the risk of breast cancer in dominant inheritance model tested OR = 3. 11, 95% CI = (1.24-7.79), P = 0.015). A nonsignificant association for PgR (CC+CT) vs TT) genotypes were reported in breast cancer OR = 1. 0, 95% CI= (0. 061-16.21), P=1) in recessive inheritance model tested. However, analysis with clinicalpathological variables revealed that the PROGINs allele is significantly associated with the distant metastasis and advanced stage of the disease. CONCLUSION The mutation specific PCR was successfully developed as an alternative to Sanger sequencing for the cost-effective detection for PROGINS allele of progesterone receptor gene. A clinically significant correlation of PROGINs allele was reported with the distant metastasis and advanced stage of the disease. Taken together, these results demonstrated that PROGINS variant is associated with an increased susceptibility to Breast cancer, providing novel insights into the genetic etiology and underlying biology of Breast carcinogenesis. Further studies with large sample sizes are required to validate our findings.
Collapse
Affiliation(s)
- Ibrahim A Albalawi
- Department of Surgical Oncology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Rashid Mir
- Department of Medical Laboratory Technology, Prince Fahd Bin Sultan Research Chair, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Fasel M Abu-Duhier
- Department of Medical Laboratory Technology, Prince Fahd Bin Sultan Research Chair, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| |
Collapse
|
13
|
Steinberg J, Yap S, Goldsbury D, Nair-Shalliker V, Banks E, Canfell K, O'Connell DL. Large-scale systematic analysis of exposure to multiple cancer risk factors and the associations between exposure patterns and cancer incidence. Sci Rep 2021; 11:2343. [PMID: 33504831 PMCID: PMC7841154 DOI: 10.1038/s41598-021-81463-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 12/28/2020] [Indexed: 12/29/2022] Open
Abstract
Exposures to cancer risk factors such as smoking and alcohol are not mutually independent. We aimed to identify risk factor exposure patterns and their associations with sociodemographic characteristics and cancer incidence. We considered 120,771 female and, separately, 100,891 male participants of the Australian prospective cohort 45 and Up Study. Factor analysis grouped 36 self-reported variables into 8 combined factors each for females (largely representing 'smoking', 'alcohol', 'vigorous exercise', 'age at childbirth', 'Menopausal Hormone Therapy', 'parity and breastfeeding', 'standing/sitting', 'fruit and vegetables') and males (largely representing 'smoking', 'alcohol', 'vigorous exercise', 'urology and health', 'moderate exercise', 'standing/sitting', 'fruit and vegetables', 'meat and BMI'). Associations with cancer incidence were investigated using multivariable logistic regression (4-8 years follow-up: 6193 females, 8749 males diagnosed with cancer). After multiple-testing correction, we identified 10 associations between combined factors and cancer incidence for females and 6 for males, of which 14 represent well-known relationships (e.g. bowel cancer: females 'smoking' factor Odds Ratio (OR) 1.16 (95% Confidence Interval (CI) 1.08-1.25), males 'smoking' factor OR 1.15 (95% CI 1.07-1.23)), providing evidence for the validity of this approach. The catalogue of associations between exposure patterns, sociodemographic characteristics, and cancer incidence can help inform design of future studies and targeted prevention programmes.
Collapse
Affiliation(s)
- Julia Steinberg
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Visalini Nair-Shalliker
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
14
|
Olabumuyi A, Abdus-Salam A, Ogunnorin B, Kuti M. Lipid profile in breast cancer patients: A case-control study done at a public tertiary hospital in Ibadan Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ 2020; 371:m3873. [PMID: 33115755 PMCID: PMC7592147 DOI: 10.1136/bmj.m3873] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the risks of breast cancer associated with different types and durations of hormone replacement therapy (HRT). DESIGN Two nested case-control studies. SETTING UK general practices contributing to QResearch or Clinical Practice Research Datalink (CPRD), linked to hospital, mortality, social deprivation, and cancer registry (QResearch only) data. PARTICIPANTS 98 611 women aged 50-79 with a primary diagnosis of breast cancer between 1998 and 2018, matched by age, general practice, and index date to 457 498 female controls. MAIN OUTCOME MEASURES Breast cancer diagnosis from general practice, mortality, hospital, or cancer registry records. Odds ratios for HRT types, adjusted for personal characteristics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs. Separate results from QResearch or CPRD were combined. RESULTS Overall, 33 703 (34%) women with a diagnosis of breast cancer and 134 391 (31%) controls had used HRT prior to one year before the index date. Compared with never use, in recent users (<5 years) with long term use (≥5 years), oestrogen only therapy and combined oestrogen and progestogen therapy were both associated with increased risks of breast cancer (adjusted odds ratio 1.15 (95% confidence interval 1.09 to 1.21) and 1.79 (1.73 to 1.85), respectively). For combined progestogens, the increased risk was highest for norethisterone (1.88, 1.79 to 1.99) and lowest for dydrogesterone (1.24, 1.03 to 1.48). Past long term use of oestrogen only therapy and past short term (<5 years) use of oestrogen-progestogen were not associated with increased risk. The risk associated with past long term oestrogen-progestogen use, however, remained increased (1.16, 1.11 to 1.21). In recent oestrogen only users, between three (in younger women) and eight (in older women) extra cases per 10 000 women years would be expected, and in oestrogen-progestogen users between nine and 36 extra cases per 10 000 women years. For past oestrogen-progestogen users, the results would suggest between two and eight extra cases per 10 000 women years. CONCLUSION This study has produced new generalisable estimates of the increased risks of breast cancer associated with use of different hormone replacement preparations in the UK. The levels of risks varied between types of HRT, with higher risks for combined treatments and for longer duration of use.
Collapse
Affiliation(s)
- Yana Vinogradova
- Division of Primary Care, University Park, University of Nottingham, Nottingham NG2 7RD, UK
| | - Carol Coupland
- Division of Primary Care, University Park, University of Nottingham, Nottingham NG2 7RD, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
16
|
Renehan AG, Pegington M, Harvie MN, Sperrin M, Astley SM, Brentnall AR, Howell A, Cuzick J, Gareth Evans D. Young adulthood body mass index, adult weight gain and breast cancer risk: the PROCAS Study (United Kingdom). Br J Cancer 2020; 122:1552-1561. [PMID: 32203222 PMCID: PMC7217761 DOI: 10.1038/s41416-020-0807-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We tested the hypothesis that body mass index (BMI) aged 20 years modifies the association of adult weight gain and breast cancer risk. METHODS We recruited women (aged 47-73 years) into the PROCAS (Predicting Risk Of Cancer At Screening; Manchester, UK: 2009-2013) Study. In 47,042 women, we determined BMI at baseline and (by recall) at age 20 years, and derived weight changes. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for new breast cancer using Cox models and explored relationships between BMI aged 20 years, subsequent weight changes and breast cancer risk. RESULTS With median follow-up of 5.6 years, 1142 breast cancers (post-menopausal at entry: 829) occurred. Among post-menopausal women at entry, BMI aged 20 years was inversely associated [HR per SD: 0.87 (95% CI: 0.79-0.95)], while absolute weight gain was associated with breast cancer [HR per SD:1.23 (95% CI: 1.14-1.32)]. For post-menopausal women who had a recall BMI aged 20 years <23.4 kg/m2 (75th percentile), absolute weight gain was associated with breast cancer [HR per SD: 1.31 (95% CIs: 1.21-1.42)], but there were no associations for women with a recall BMI aged 20 years of >23.4 kg/m2 (Pinteraction values <0.05). CONCLUSIONS Adult weight gain increased post-menopausal breast cancer risk only among women who were <23.4 kg/m2 aged 20 years.
Collapse
Affiliation(s)
- Andrew G Renehan
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Mary Pegington
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Michelle N Harvie
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Matthew Sperrin
- MRC Health eResearch Centre (HeRC), Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Susan M Astley
- Centre for Imaging Science, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
- The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Manchester, UK
| | - Adam R Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anthony Howell
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - D Gareth Evans
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Prevent Breast Cancer, Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
- Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| |
Collapse
|
17
|
The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review. Breast 2020; 50:95-103. [PMID: 32120064 PMCID: PMC7073883 DOI: 10.1016/j.breast.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The majority of ‘low-risk’ (grade I/II) Ductal Carcinoma In Situ (DCIS) may not progress to invasive breast cancer during a women’s lifetime. Therefore, the safety of active surveillance versus standard surgical treatment for DCIS is prospectively being evaluated in clinical trials. If proven safe and selectively implemented in clinical practice, a significant group of women with low-risk DCIS may forego surgery and radiotherapy in the future. Identification of modifiable and non-modifiable risk factors associated with prognosis after a primary DCIS would also enhance our care of women with low-risk DCIS. Methods To identify modifiable and non-modifiable risk factors for subsequent breast events after DCIS, we performed a systematic literature search in PUBMED, EMBASE and Scopus. Results Six out of the 3870 articles retrieved were included for final data extraction. These six studies included a total of 4950 patients with primary DCIS and 640 recorded subsequent breast events. There was moderate evidence for an association of a family history of breast cancer, premenopausal status, high BMI, and high breast density with a subsequent breast cancer or further DCIS. Conclusion There is a limited number of recent studies published on the impact of modifiable and non-modifiable risk factors on subsequent events after DCIS. The available evidence is insufficient to identify potential targets for risk reduction strategies, reflecting the relatively small numbers and the lack of long-term follow-up in DCIS, a low-event condition. Need for risk management strategies for untreated DCIS patients. Limited evidence for association between lifestyle factors and prognosis after DCIS. Positive family history, premenopausal status, high breast density associated with prognosis.
Collapse
|
18
|
Kour A, Sharma S, Sambyal V, Guleria K, Singh NR, Uppal MS, Manjari M, Sudan M, Kukreja S. Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab, India. Asian Pac J Cancer Prev 2019; 20:3299-3304. [PMID: 31759352 PMCID: PMC7062992 DOI: 10.31557/apjcp.2019.20.11.3299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city. METHODS In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females. RESULTS Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women. CONCLUSION Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer. .
Collapse
Affiliation(s)
- Akeen Kour
- Human Cytogenetics Laboratory, Department of Human Genetics, Guru Nanak Dev University,
| | - Sarika Sharma
- Human Cytogenetics Laboratory, Department of Human Genetics, Guru Nanak Dev University,
| | - Vasudha Sambyal
- Human Cytogenetics Laboratory, Department of Human Genetics, Guru Nanak Dev University,
| | - Kamlesh Guleria
- Human Cytogenetics Laboratory, Department of Human Genetics, Guru Nanak Dev University,
| | | | | | | | | | - Sahiba Kukreja
- Department of Biochemistry, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India.
| |
Collapse
|
19
|
His M, Viallon V, Dossus L, Gicquiau A, Achaintre D, Scalbert A, Ferrari P, Romieu I, Onland-Moret NC, Weiderpass E, Dahm CC, Overvad K, Olsen A, Tjønneland A, Fournier A, Rothwell JA, Severi G, Kühn T, Fortner RT, Boeing H, Trichopoulou A, Karakatsani A, Martimianaki G, Masala G, Sieri S, Tumino R, Vineis P, Panico S, van Gils CH, Nøst TH, Sandanger TM, Skeie G, Quirós JR, Agudo A, Sánchez MJ, Amiano P, Huerta JM, Ardanaz E, Schmidt JA, Travis RC, Riboli E, Tsilidis KK, Christakoudi S, Gunter MJ, Rinaldi S. Prospective analysis of circulating metabolites and breast cancer in EPIC. BMC Med 2019; 17:178. [PMID: 31547832 PMCID: PMC6757362 DOI: 10.1186/s12916-019-1408-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/13/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Metabolomics is a promising molecular tool to identify novel etiologic pathways leading to cancer. Using a targeted approach, we prospectively investigated the associations between metabolite concentrations in plasma and breast cancer risk. METHODS A nested case-control study was established within the European Prospective Investigation into Cancer cohort, which included 1624 first primary incident invasive breast cancer cases (with known estrogen and progesterone receptor and HER2 status) and 1624 matched controls. Metabolites (n = 127, acylcarnitines, amino acids, biogenic amines, glycerophospholipids, hexose, sphingolipids) were measured by mass spectrometry in pre-diagnostic plasma samples and tested for associations with breast cancer incidence using multivariable conditional logistic regression. RESULTS Among women not using hormones at baseline (n = 2248), and after control for multiple tests, concentrations of arginine (odds ratio [OR] per SD = 0.79, 95% confidence interval [CI] = 0.70-0.90), asparagine (OR = 0.83 (0.74-0.92)), and phosphatidylcholines (PCs) ae C36:3 (OR = 0.83 (0.76-0.90)), aa C36:3 (OR = 0.84 (0.77-0.93)), ae C34:2 (OR = 0.85 (0.78-0.94)), ae C36:2 (OR = 0.85 (0.78-0.88)), and ae C38:2 (OR = 0.84 (0.76-0.93)) were inversely associated with breast cancer risk, while the acylcarnitine C2 (OR = 1.23 (1.11-1.35)) was positively associated with disease risk. In the overall population, C2 (OR = 1.15 (1.06-1.24)) and PC ae C36:3 (OR = 0.88 (0.82-0.95)) were associated with risk of breast cancer, and these relationships did not differ by breast cancer subtype, age at diagnosis, fasting status, menopausal status, or adiposity. CONCLUSIONS These findings point to potentially novel pathways and biomarkers of breast cancer development. Results warrant replication in other epidemiological studies.
Collapse
Affiliation(s)
- Mathilde His
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Vivian Viallon
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Laure Dossus
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Audrey Gicquiau
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - David Achaintre
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Augustin Scalbert
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Pietro Ferrari
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Isabelle Romieu
- Centre for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | | | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Agnès Fournier
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Joseph A Rothwell
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Gianluca Severi
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "M.P.Arezzo"Hospital, ASP Ragusa, Ragusa, Italy
| | - Paolo Vineis
- Italian Institute for Genomic Medicine (IIGM), 10126, Turin, Italy
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Salvatore Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Therese H Nøst
- Department of Community Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Guri Skeie
- Department of Community Medicine, UiT the Arctic University of Norway, Tromso, Norway
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Pilar Amiano
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - José María Huerta
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London, SE1 9RT, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| |
Collapse
|
20
|
World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes Control 2019; 30:1183-1200. [PMID: 31471762 DOI: 10.1007/s10552-019-01223-w] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/16/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the present study was to systematically review the complex associations between energy balance-related factors and breast cancer risk, for which previous evidence has suggested different associations in the life course of women and by hormone receptor (HR) status of the tumor. METHODS Relevant publications on adulthood physical activity, sedentary behavior, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, and weight change and pre- and postmenopausal breast cancer risk were identified in PubMed up to 30 April 2017. Random-effects meta-analyses were conducted to summarize the relative risks across studies. RESULTS One hundred and twenty-six observational cohort studies comprising over 22,900 premenopausal and 103,000 postmenopausal breast cancer cases were meta-analyzed. Higher physical activity was inversely associated with both pre- and postmenopausal breast cancers, whereas increased sitting time was positively associated with postmenopausal breast cancer. Although higher early adult BMI (ages 18-30 years) was inversely associated with pre- and postmenopausal breast cancers, adult weight gain and greater body adiposity increased breast cancer risk in postmenopausal women, and the increased risk was evident for HR+ but not HR- breast cancers, and among never but not current users of postmenopausal hormones. The evidence was less consistent in premenopausal women. There were no associations with adult weight gain, inverse associations with adult BMI (study baseline) and hip circumference, and non-significant associations with waist circumference and waist-to-hip ratio that were reverted to positive associations on average in studies accounting for BMI. No significant associations were observed for HR-defined premenopausal breast cancers. CONCLUSION Better understanding on the impact of these factors on pre- and postmenopausal breast cancers and their subtypes along the life course is needed.
Collapse
|
21
|
Karkeni E, Morin SO, Bou Tayeh B, Goubard A, Josselin E, Castellano R, Fauriat C, Guittard G, Olive D, Nunès JA. Vitamin D Controls Tumor Growth and CD8+ T Cell Infiltration in Breast Cancer. Front Immunol 2019; 10:1307. [PMID: 31244851 PMCID: PMC6563618 DOI: 10.3389/fimmu.2019.01307] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
Women with low levels of vitamin D have a higher risk of developing breast cancer. Numerous studies associated the presence of a CD8+ T cell infiltration with a good prognosis. As vitamin D may play a key role in the modulation of the immune system, the objective of this work was to evaluate the impact of vitamin D on the breast cancer progression and mammary tumor microenvironment. We show that vitamin D decreases breast cancer tumor growth. Immunomonitoring of the different immune subsets in dissociated tumors revealed an increase in tumor infiltrating CD8+ T cells in the vitamin D-treated group. Interestingly, these CD8+ T cells exhibited a more active T cell (TEM/CM) phenotype. However, in high-fat diet conditions, we observed an opposite effect of vitamin D on breast cancer tumor growth, associated with a reduction of CD8+ T cell infiltration. Our data show that vitamin D is able to modulate breast cancer tumor growth and inflammation in the tumor microenvironment in vivo. Unexpectedly, this effect is reversed in high-fat diet conditions, revealing the importance of diet on tumor growth. We believe that supplementation with vitamin D can in certain conditions represent a new adjuvant in the treatment of breast cancers.
Collapse
Affiliation(s)
- Esma Karkeni
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Stéphanie O Morin
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Berna Bou Tayeh
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Armelle Goubard
- Centre de Recherche en Cancérologie de Marseille, Plateforme d'essai préclinique TrGET, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Emmanuelle Josselin
- Centre de Recherche en Cancérologie de Marseille, Plateforme d'essai préclinique TrGET, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Rémy Castellano
- Centre de Recherche en Cancérologie de Marseille, Plateforme d'essai préclinique TrGET, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Cyril Fauriat
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Geoffrey Guittard
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Daniel Olive
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| | - Jacques A Nunès
- Immunity and Cancer Team, Centre de Recherche en Cancérologie de Marseille, Equipe Labellisée Fondation pour la Recherche Médicale, Institut Paoli-Calmettes, Inserm, CNRS, Aix Marseille Université, Marseille, France
| |
Collapse
|
22
|
Adult weight gain accelerates the onset of breast cancer. Breast Cancer Res Treat 2019; 176:649-656. [PMID: 31073792 PMCID: PMC7214103 DOI: 10.1007/s10549-019-05268-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Weight gain in adulthood is a risk factor for breast cancer; however, the impact on age of onset is unknown. The objective of this study was to investigate whether weight gain from early- to mid-adulthood influenced the timing of breast cancer onset. METHODS Increase in body mass index (BMI) from lowest adult BMI to BMI at diagnosis and age at which these events occurred were calculated from breast cancer survivors enrolled in a weight loss trial (n = 660). Quartiles (Q) of the average increase in BMI were determined and associations between weight gain and age at disease onset were analyzed using analysis of covariance and spline regression models. RESULTS A significant linear trend was observed across the quartiles of BMI change for earlier age at diagnosis [Q1 52.3 (± 0.73), Q2 51.9 (± 0.70), Q3 49.6 (± 0.66), Q4 47.3 (± 0.67), p < 0.0001] after adjusting for potential confounders. In analyses that stratified by tumor subtype and menopausal status, significant linear trends continued to be observed for earlier age at diagnosis across quartiles of BMI for ER ± , PR ± , HER2 + , as well as pre- and postmenopausal status (p-values < 0.001). CONCLUSIONS Women who gain excess weight during adulthood are not only at risk for breast cancer, but also may experience earlier onset of disease and reduced cancer-free years.
Collapse
|
23
|
Purnell JQ, Urbanski HF, Kievit P, Roberts CT, Bethea CL. Estradiol Replacement Timing and Obesogenic Diet Effects on Body Composition and Metabolism in Postmenopausal Macaques. Endocrinology 2019; 160:899-914. [PMID: 30753523 PMCID: PMC6435013 DOI: 10.1210/en.2018-00884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/02/2019] [Indexed: 12/14/2022]
Abstract
Whether hormone replacement therapy has beneficial metabolic effects in postmenopausal women remains controversial because of between-study differences in menopausal duration, estrogen formulations, and diet. Additionally, animal studies have not reflected the typical human obesogenic, Western-style diet (WSD). In this study, we determined the effects of immediate 17β-estradiol (ImE) or delayed 17β-estradiol treatment on weight and metabolism parameters in old ovo-hysterectomized rhesus macaques consuming a WSD over a 30-month period. The placebo and ImE groups exhibited progressive gains in weight and fat mass, which ImE initially attenuated but did not prevent. Progression of insulin resistance (IR) was lessened by ImE compared with placebo under both fasting and IV glucose-stimulated conditions, plateauing in all groups between 24 and 30 months. Consequently, relative euglycemia was maintained through lower stimulated insulin levels with ImE than with placebo. Bone mineral density decreased in the placebo group but was maintained in the ImE group, whereas bone mineral content was unaffected by placebo and increased with ImE. Daily activity was reduced while macaques consumed a WSD and was not affected by ImE. Over time, total cholesterol, triglyceride, very-low-density cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and IL-8 levels increased or trended upward in all animals, with only the change in HDL-C affected by ImE. Delayed estrogen treatment (months 24 to 30) had no significant impact on body composition or glucometabolic parameters. In summary, detrimental WSD-induced changes in body composition and metabolism were only temporarily ameliorated by ImE, with the important exception of glucose homeostasis, which benefited from E replacement even as body composition worsened.
Collapse
Affiliation(s)
- Jonathan Q Purnell
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- Division of Endocrinology, Diabetes, Clinical Nutrition, Oregon Health & Science University, Portland, Oregon
- Correspondence: Jonathan Q. Purnell, MD, Oregon Health & Science University, Mailstop MDYMI, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239. E-mail:
| | - Henryk F Urbanski
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | - Paul Kievit
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, Oregon
| | - Charles T Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, Oregon
| | - Cynthia L Bethea
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
24
|
Kim K, Choi S, Lee G, Jeong SM, Kim SM, Son JS, Yun JM, Kim YY, Park SY, Park SM. Cancer risk among young men with weight gain after smoking cessation: A population-based cohort study. Cancer Epidemiol 2019; 60:86-92. [PMID: 30933889 DOI: 10.1016/j.canep.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Smoking cessation may help the current smokers to reduce cancer risk. However, weight gain following smoking cessation may attenuate the protective association of cessation with cancer. PATIENTS AND METHODS Our study included 1,278,794 men who were aged 20-39 years and underwent two consecutive health examinations by the National Health Insurance Service, without previous diagnosis of cancer. Participants were categorized into continual smokers, quitters with different degree of body weight change, and never smokers based on the biennial national health screening program (2002-2003 and 2004-2005) and were followed from January 1, 2006 to December 31, 2015. Cox proportional hazard models and restricted cubic spline model was used to evaluate the association of post-cessation weight change and cancer risk after adjustment for potential confounders. RESULTS During the 10 years of follow-up, the analyses included 1,278,794 men with 21,494 cancer incidences. Compared to continual smokers, quitters without weight gain of 2.0 kg had significantly lower risk of obesity-related cancer (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97), smoking-related cancer (HR, 0.90; 95% CI, 0.83 to 0.98), and gastrointestinal cancer (HR, 89; 95% CI, 0.80 to 0.98). Weight gain among quitters attenuated the risk reduction of cancer compared to continual smoking. Among quitters, weight gain up to 5.0 kg with smoking cessation showed protective association with cancer risk among quitters without weight gain. CONCLUSION Excessive weight gain with smoking cessation among quitters was not associated with reduced risk of several cancer types. This association should be taken into account when recommending smoking cessation to prevent cancer.
Collapse
Affiliation(s)
- Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeon-Yong Kim
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Seong Yong Park
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
25
|
Coughlin SS. Epidemiology of Breast Cancer in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:9-29. [PMID: 31456177 DOI: 10.1007/978-3-030-20301-6_2] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epidemiologic studies have contributed importantly to current knowledge of environmental and genetic risk factors for breast cancer. Worldwide, breast cancer is an important cause of human suffering and premature mortality among women. In the United States, breast cancer accounts for more cancer deaths in women than any site other than lung cancer. A variety of risk factors for breast cancer have been well-established by epidemiologic studies including race, ethnicity, family history of cancer, and genetic traits, as well as modifiable exposures such as increased alcohol consumption, physical inactivity, exogenous hormones, and certain female reproductive factors. Younger age at menarche, parity, and older age at first full-term pregnancy may influence breast cancer risk through long-term effects on sex hormone levels or by other biological mechanisms. Recent studies have suggested that triple negative breast cancers may have a distinct etiology. Genetic variants and mutations in genes that code for proteins having a role in DNA repair pathways and the homologous recombination of DNA double stranded breaks (APEX1, BRCA1, BRCA2, XRCC2, XRCC3, ATM, CHEK2, PALB2, RAD51, XPD), have been implicated in some cases of breast cancer.
Collapse
Affiliation(s)
- Steven S Coughlin
- Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| |
Collapse
|
26
|
Cao S, Zhou J, Zhu Z, Wei F, Li W, Lu S, Su J, Yu H, Du W, Cui L, Wei P, Wu M. Adult weight change and the risk of pre- and postmenopausal breast cancer in the Chinese Wuxi Exposure and Breast Cancer Study. Breast Cancer Res Treat 2018; 173:647-655. [PMID: 30368743 DOI: 10.1007/s10549-018-5016-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The accumulating evidence indicates that weight gain in adulthood is more predictive of breast cancer risk than absolute body weight. However, the relative impact of timing of weight gain in adulthood on breast cancer as well as other characteristics of the association between weight and breast cancer has not been well documented. METHODS This population-based case-control study of breast cancer included 818 patients with newly diagnosed primary breast cancer and 935 residence and age-matched healthy controls. The body weight values at 18 years old, 1 year before diagnosis, and at menopause were obtained during in-person interviews. Unconditional logistic regression was used to estimate the effects of the weight change over adulthood on breast cancer risk. Linear mixed-effects regression was also applied as a secondary analysis. RESULTS We found that the increased risk of breast cancer was associated with the weight gain in adulthood among postmenopausal women (OR 1.23; 95% CI 1.10-1.37 per 5 kg increase) but not in the premenopausal women. The risk associated with weight gain since menopause (OR 1.65; 95% CI 1.28-2.14 a 5-kg increase) was higher than that from age 18 to menopause (OR 1.14; 95% CI 1.02, 1.28 a 5-kg increase). The association tended to be stronger in those with higher waist circumference and who had never used hormone replacement therapy (HRT). Women who had never used HRT, the increased risk of breast cancer associated with weight gain was more consistent in leaner women at age 18 (BMI < 18.5) or at menopause (BMI < 24). CONCLUSIONS Our findings indicated that weight gain has significant impact on postmenopausal breast cancer risk. The time periods of weight gain, central body fat, and HRT may affect the observed association, which should be further studied.
Collapse
Affiliation(s)
- Shang Cao
- Department of Epidemiology and Health Statistics, Southeast University, Dingjiaqiao Road 87th, Nanjing, 210009, Jiangsu, China
| | - Jinyi Zhou
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zheng Zhu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Feiran Wei
- Department of Oncology, Southeast University, Nanjing, China
| | - Wei Li
- Department of Epidemiology and Health Statistics, Southeast University, Dingjiaqiao Road 87th, Nanjing, 210009, Jiangsu, China
| | - Shurong Lu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hao Yu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Wencong Du
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lan Cui
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, Southeast University, Dingjiaqiao Road 87th, Nanjing, 210009, Jiangsu, China
| | - Ming Wu
- Department of Epidemiology and Health Statistics, Southeast University, Dingjiaqiao Road 87th, Nanjing, 210009, Jiangsu, China. .,Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| |
Collapse
|
27
|
Impact of hormonal therapy and other adjuvant therapies on contralateral breast volume change after implant-based breast reconstruction. Arch Plast Surg 2018; 45:432-440. [PMID: 30282414 PMCID: PMC6177640 DOI: 10.5999/aps.2018.00563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adjuvant therapy after breast surgery, including tamoxifen or aromatase inhibitors, improves the postoperative outcomes and long-term survival of breast cancer patients. The aim of this study was to determine whether volume changes occurred in the contralateral breast during hormonal or other adjuvant therapies. METHODS This study reviewed 90 patients who underwent unilateral breast reconstruction between September 2012 and April 2018 using tissue expanders and a permanent implant after the surgical removal of breast cancer. The volume of the contralateral breast was measured using a cast before the first (tissue expander insertion) and second (permanent implant change) stages of surgery. Changes in breast volume were evaluated to determine whether adjuvant therapy such as hormonal therapy, chemotherapy, and radiation therapy influenced the volume of the contralateral breast. RESULTS The group receiving tamoxifen therapy demonstrated a significant decrease in volume compared with the group without tamoxifen (-7.8% vs. 1.0%; P=0.028). The aromatase inhibitor-treated group showed a significant increase in volume compared with those who did not receive therapy (-6.2% vs. 4.5%; P=0.023). There were no significant differences between groups treated with other hormonal therapy, chemotherapy, or radiation therapy. CONCLUSIONS Patients who received tamoxifen therapy showed a significant decrease in volume in the contralateral breast, while no significant change in weight or body mass index was found. Our findings suggest that we should choose smaller implants for premenopausal patients, who have a high likelihood of receiving tamoxifen therapy.
Collapse
|
28
|
Midlife weight gain is a risk factor for obesity-related cancer. Br J Cancer 2018; 118:1665-1671. [PMID: 29895939 PMCID: PMC6008441 DOI: 10.1038/s41416-018-0106-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 12/22/2022] Open
Abstract
Background Overweight and diabetes are known cancer risk factors. This study examines independent and combined effects of weight gain and metabolic dysfunction during middle-adult years on obesity-related cancer risk. Methods Subjects (n = 3850) aged 45–69 years at exams 3–5 in the Framingham Offspring Study were classified according to current and prior (~14 years earlier) weight status, interim weight change and prevalent metabolic dysfunction. Cancer risk among subjects who were overweight at baseline and remained overweight, as well as those who became overweight during follow-up, was compared with risk among normal-weight individuals. Results Gaining ≥0.45 kg (≥1.0 pound)/year (vs. maintaining stable weight) over ~14 years increased cancer risk by 38% (95% confidence interval (CI), 1.09, 1.76); combined with metabolic dysfunction, weight gain increased cancer risk by 77% (95% CI, 1.21, 2.59). Compared with non-overweight adults, men and women who became overweight during midlife had 2.18-fold and 1.60-fold increased cancer risks; those who were overweight from baseline had non-statistically significant 28 and 33% increased cancer risks, respectively, despite having a midlife body mass index that was 3.4 kg/m2 higher than those who gained weight later. Conclusion Midlife weight gain was a strong cancer risk factor. This excess risk was somewhat stronger among those with concurrent metabolic dysfunction.
Collapse
|
29
|
Hidayat K, Yang CM, Shi BM. Body fatness at a young age, body fatness gain and risk of breast cancer: systematic review and meta-analysis of cohort studies. Obes Rev 2018; 19:254-268. [PMID: 29130623 DOI: 10.1111/obr.12627] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 01/22/2023]
Abstract
Higher body fatness in adulthood has been consistently associated with an increased risk of postmenopausal breast cancer, as well as a tendency towards a lower risk of premenopausal breast cancer. However, the association between body fatness at a young age (≤30 years), body fatness gain and the risk of breast cancer is less defined. PubMed and Web of Science databases were searched to identify relevant publications. Risk estimates with 95% confidence intervals from each study were transformed into a continuous variable for each 5 kg m-2 increase in body mass index (BMI) and were pooled under a random-effects model. Each 5 kg m-2 increase in BMI was significantly associated with a 14%, 12% and 17% lower risk of breast cancer later in life among all women, premenopausal women and postmenopausal women, respectively. Significant heterogeneity and publication bias were observed. The results remained unchanged after the trim and fill method was applied to correct the bias. Each 5 kg m-2 increase in BMI from a young age until cohort entry was significantly associated with a 13% and 14% higher risk of breast cancer in all women and postmenopausal women, respectively. In summary, higher body fatness at a young age may have a protective role in the later development of breast cancer in both premenopausal and postmenopausal women. However, this potential benefit should not be overemphasized, as our findings suggest that increased body fatness gain from a young age is positively associated with postmenopausal breast cancer risk. These findings further justify the need to maintain a steady weight throughout life.
Collapse
Affiliation(s)
- K Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - C-M Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - B-M Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
30
|
Liu K, Zhang W, Dai Z, Wang M, Tian T, Liu X, Kang H, Guan H, Zhang S, Dai Z. Association between body mass index and breast cancer risk: evidence based on a dose-response meta-analysis. Cancer Manag Res 2018; 10:143-151. [PMID: 29403312 PMCID: PMC5783020 DOI: 10.2147/cmar.s144619] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction Breast cancer is the most common cancer in women worldwide. The association between body mass index (BMI) and breast cancer risk has been paid more attention in the past few years, but the findings are still controversial. To obtain a more reliable conclusion, we performed a dose–response meta-analysis on 12 prospective cohort studies comprising 22,728,674 participants. Methods Linear and nonlinear trend analyses were conducted to explore the dose–response relationship between BMI and breast cancer risk. The summary relative risk (SRR) and 95% confidence intervals (CIs) were used to evaluate the cancer risk. Results The overall results showed a weak positive association between a 5-unit increase in BMI and breast cancer risk, indicating that a 5 kg/m2 increase in BMI corresponded to a 2% increase in breast cancer risk (SRR: 1.02, 95% CI: 1.01–1.04, p<0.001). Notably, further subgroup meta-analysis found that higher BMI could be a protective factor of breast cancer risk for premenopausal women (SRR: 0.98, 95% CI: 0.96–0.99, p<0.001). In addition, the dose–response result demonstrated that there was a linear association between BMI and breast cancer risk (Pnonlinearity=0.754). Conclusion In summary, this dose–response meta-analysis of prospective cohort studies showed that every 5 kg/m2 increase in BMI corresponded to a 2% increase in breast cancer risk in women. However, higher BMI could be a protective factor in breast cancer risk for premenopausal women. Further studies are necessary to verify these findings and elucidate the pathogenic mechanisms.
Collapse
Affiliation(s)
- Kang Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Weining Zhang
- Department of Surgical Chest and Oncology, Xian XD Group Hospital
| | - Zhiming Dai
- Department of Hematology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Meng Wang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Tian Tian
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Xinghan Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Huafeng Kang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Haitao Guan
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Shuqun Zhang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| | - Zhijun Dai
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University
| |
Collapse
|
31
|
Ghali RM, Al-Mutawa MA, Ebrahim BH, Jrah HH, Zaied S, Bhiri H, Hmila F, Mahjoub T, Almawi WY. Progesterone Receptor (PGR) Gene Variants Associated with Breast Cancer and Associated Features: a Case-Control Study. Pathol Oncol Res 2018; 26:141-147. [PMID: 29302853 DOI: 10.1007/s12253-017-0379-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/20/2017] [Indexed: 12/17/2022]
Abstract
Insofar as altered estrogen receptor-progesterone receptor (PR) expression contribute to breast cancer pathogenesis, previous studies examined the association of genetic variation in PR gene (PGR) with breast cancer, but with mixed outcome. We evaluated the association between PGR variants, and breast cancer and associated features. A retrospective case-control study involving 183 female breast cancer patients, and 222 control women. PGR genotyping was done by real-time PCR. Minor allele frequencies of rs1042838, rs590688, and rs10895068 PGR gene polymorphisms were significantly higher in breast cancer patients compared to controls. Patients carrying rs1042838 G/T, rs590688 C/C, and rs10895068 G/A genotypes had higher risk of breast cancer, while carriage of rs3740753 G/G genotype was associated with marginal reduction in breast cancer risk. In addition, carriage of rs1042839, rs3740753, and rs10895068 minor allele was associated with Her2 status, while rs3740753 and rs10895068 were associated with effective hormone replacement therapy. Furthermore, carriage of rs10895068 minor allele in breast cancer women were also associated with age at first pregnancy, hormone receptor (RH) status, and previous use of oral contraceptives. PGR haploview analysis documented moderate-strong linkage disequilibrium (non-random association of alleles at different loci) between 7 of the 8 tested PGR SNPs, thus allowing construction of 7-locus PGR haplotypes. Two haplotypes, ATGCCGA and GTGCCGA, both containing rs590688, were positively associated with breast cancer, thus assigning a breast cancer-susceptible nature to these haplotypes. PGR rs1042838, rs590688, and rs10895068, and ATGCCGA and GTGCCGA haplotypes are related with increased breast cancer susceptibility in Tunisian women.
Collapse
Affiliation(s)
- Rabeb M Ghali
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Maryam A Al-Mutawa
- Faculty of Sciences, Universite' de Tunis El Manar, Campus Universitaire, 2092 Manar II, Tunis, Tunisia
| | - Bashayer H Ebrahim
- Faculty of Sciences, Universite' de Tunis El Manar, Campus Universitaire, 2092 Manar II, Tunis, Tunisia
| | - Hanen H Jrah
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Sonia Zaied
- Department of Clinical Oncology, CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Hanen Bhiri
- Department of Clinical Oncology, CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Fahmi Hmila
- Department of Surgery, CHU Farhat Hached, Sousse, Tunisia
| | - Touhami Mahjoub
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Wassim Y Almawi
- Faculty of Sciences, Universite' de Tunis El Manar, Campus Universitaire, 2092 Manar II, Tunis, Tunisia.
| |
Collapse
|
32
|
Change in risk of breast cancer after receiving hormone replacement therapy by considering effect-modifiers: a systematic review and dose-response meta-analysis of prospective studies. Oncotarget 2017; 8:81109-81124. [PMID: 29113371 PMCID: PMC5655266 DOI: 10.18632/oncotarget.20154] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/30/2017] [Indexed: 01/26/2023] Open
Abstract
We synthesize the current literatures and use the power of meta-analysis to examine trends on association between hormone replacement therapy (HRT) and the risk of breast cancer (BC). We performed a comprehensive literature search using PubMed, EMBASE, and Web of Science from their inception until Jan 2017. Prospective studies that provided adjusted risk estimates of HRT and BC risk were eligible. Categorical and dose-response meta-analyses followed the PRISMA were conducted using random effects model and restricted cubic spline model, respectively. Forty-seven publications from thirty-five unique studies were included, involving 3,898,376 of participants and 87,845 of BC cases. Compared with non-users, RR for current estrogen-only therapy (ET) users was 1.14 (95% confidence interval (CI) = 1.05–1.22), and for per year increases was 1.02 (95% CI = 1.02–1.02). Moreover, RR for current estrogen plus progestin therapy (EPT) users was 1.76, (95% CI = 1.56–1.96), and for per year increases was 1.08 (95% CI = 1.08–1.08). Dose-response analyses revealed 8–10 years’ onset peaks, and indicated residual increased BC risk remained after stopping use of ET regimen rather than for EPT. Effect-modifiers like BMI, duration of use, race/ethnicity, routes of administration were recognized. In Conclusions, current use of EP or EPT and ever use of tibolone are associated with an elevated risk of BC. Compared with slim HRT users and non-users, lower BC risks were found among overweight/obese HRT users and former EPT users, respectively. Both ET and EPT users are associated with higher risk of lobular BC than ductal BC, and more ER-positive than negative BC cases were detected among EPT users.
Collapse
|
33
|
BMI and serum lipid parameters predict increasing risk and aggressive prostate cancer in Chinese people. Oncotarget 2017; 8:66051-66060. [PMID: 29029491 PMCID: PMC5630391 DOI: 10.18632/oncotarget.19790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/29/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To determine if obesity and serum lipid parameters are associated with increased risk and more aggressive prostate cancer in Chinese population. MATERIALS AND METHODS We conducted a retrospective cohort analysis including 3102 patients. Kruskal-Wallis test for continuous variables and the chi-squared tests for categorical variables were used for univariate comparison of the differences in patient characteristics across BMI categories between different groups. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between prostate cancer and the various patient characteristics. Multivariable Cox proportional hazards regression was performed to assess the risk of prostate cancer recurrence. RESULTS 974 consecutive men were diagnosed as prostate cancer and 700 patients subsequently received radical prostatectomy immediately, and 1031 patients were pathologically diagnosed as biopsy negative. The level of low-density-lipoprotein cholesterol (LDL-c) and total cholesterol was significantly higher and the high-density-lipoprotein cholesterol (HDL-c) level is much lower in prostate cancer patients. Patients with low level of HDL-c, who subsequently received radical prostatectomy, had increased risk of high risk disease. In addition, patients with normal weight were less likely to develop a biochemical recurrence. Combined analysis revealed that obese patients had significantly higher rates of PSA recurrence over time than nonobese patients. CONCLUSIONS In our study, lipid parameters are supposed to be associated with prostate cancer risk and aggressiveness. Obese men are at increased risk of PSA recurrence after radical prostatectomy.
Collapse
|
34
|
Cordina-Duverger E, Truong T, Anger A, Sanchez M, Arveux P, Kerbrat P, Guénel P. Weight and weight changes throughout life and postmenopausal breast cancer risk: a case-control study in France. BMC Cancer 2016; 16:761. [PMID: 27681230 PMCID: PMC5041340 DOI: 10.1186/s12885-016-2793-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 09/19/2016] [Indexed: 11/28/2022] Open
Abstract
Background Overweight and weight gain throughout adult life have been associated with increased risk of breast cancer after the menopause. However the role of body weight at a young age and of the timing of weight gain over the lifetime in postmenopausal breast cancer is not well documented. Methods We conducted a population-based case-control study on breast cancer in France that included 739 cases and 815 population controls in postmenopausal women. Height, weight at age 20, 40 and 50 as well as weight one year before diagnosis were obtained during in-person interviews. Results No association between body mass index at the age of 20 years and breast cancer after the menopause was detected. However, we found that postmenopausal breast cancer was associated with weight gain between ages 40 and 50 years (OR per 5 kg/m2 increase in BMI: 1.45 [95%ci 1.06−1.98]). The increased risk of breast cancer associated with weight gain was more consistent in leaner women at age 20, in older postmenopausal women (>65 years), and in women who did not use menopausal hormone therapy. Conclusions These findings point to the importance of controlling for weight gain in middle aged-women. The role of low body weight in young adulthood in breast cancer risk after the menopause should be further scrutinized. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2793-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emilie Cordina-Duverger
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Thérèse Truong
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Antoinette Anger
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Marie Sanchez
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Patrick Arveux
- Centre Georges-François Leclerc, Côte d'Or Breast Cancer Registry, Dijon, France
| | | | - Pascal Guénel
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France.
| |
Collapse
|
35
|
Sebastiani F, Cortesi L, Sant M, Lucarini V, Cirilli C, De Matteis E, Marchi I, Negri R, Gallo E, Federico M. Increased Incidence of Breast Cancer in Postmenopausal Women with High Body Mass Index at the Modena Screening Program. J Breast Cancer 2016; 19:283-291. [PMID: 27721878 PMCID: PMC5053313 DOI: 10.4048/jbc.2016.19.3.283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. Methods The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2–104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. Results After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p=0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. Conclusion We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women.
Collapse
Affiliation(s)
- Federica Sebastiani
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Milena Sant
- Department of Preventive and Predictive Medicine, National Tumor Institute, Milan, Italy
| | - Valeria Lucarini
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Cirilli
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta De Matteis
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Negri
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Gallo
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
36
|
Usset JL, Raghavan R, Tyrer JP, McGuire V, Sieh W, Webb P, Chang-Claude J, Rudolph A, Anton-Culver H, Berchuck A, Brinton L, Cunningham JM, DeFazio A, Doherty JA, Edwards RP, Gayther SA, Gentry-Maharaj A, Goodman MT, Høgdall E, Jensen A, Johnatty SE, Kiemeney LA, Kjaer SK, Larson MC, Lurie G, Massuger L, Menon U, Modugno F, Moysich KB, Ness RB, Pike MC, Ramus SJ, Rossing MA, Rothstein J, Song H, Thompson PJ, van den Berg DJ, Vierkant RA, Wang-Gohrke S, Wentzensen N, Whittemore AS, Wilkens LR, Wu AH, Yang H, Pearce CL, Schildkraut JM, Pharoah P, Goode EL, Fridley BL. Assessment of Multifactor Gene-Environment Interactions and Ovarian Cancer Risk: Candidate Genes, Obesity, and Hormone-Related Risk Factors. Cancer Epidemiol Biomarkers Prev 2016; 25:780-90. [PMID: 26976855 PMCID: PMC4873330 DOI: 10.1158/1055-9965.epi-15-1039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many epithelial ovarian cancer (EOC) risk factors relate to hormone exposure and elevated estrogen levels are associated with obesity in postmenopausal women. Therefore, we hypothesized that gene-environment interactions related to hormone-related risk factors could differ between obese and non-obese women. METHODS We considered interactions between 11,441 SNPs within 80 candidate genes related to hormone biosynthesis and metabolism and insulin-like growth factors with six hormone-related factors (oral contraceptive use, parity, endometriosis, tubal ligation, hormone replacement therapy, and estrogen use) and assessed whether these interactions differed between obese and non-obese women. Interactions were assessed using logistic regression models and data from 14 case-control studies (6,247 cases; 10,379 controls). Histotype-specific analyses were also completed. RESULTS SNPs in the following candidate genes showed notable interaction: IGF1R (rs41497346, estrogen plus progesterone hormone therapy, histology = all, P = 4.9 × 10(-6)) and ESR1 (rs12661437, endometriosis, histology = all, P = 1.5 × 10(-5)). The most notable obesity-gene-hormone risk factor interaction was within INSR (rs113759408, parity, histology = endometrioid, P = 8.8 × 10(-6)). CONCLUSIONS We have demonstrated the feasibility of assessing multifactor interactions in large genetic epidemiology studies. Follow-up studies are necessary to assess the robustness of our findings for ESR1, CYP11A1, IGF1R, CYP11B1, INSR, and IGFBP2 Future work is needed to develop powerful statistical methods able to detect these complex interactions. IMPACT Assessment of multifactor interaction is feasible, and, here, suggests that the relationship between genetic variants within candidate genes and hormone-related risk factors may vary EOC susceptibility. Cancer Epidemiol Biomarkers Prev; 25(5); 780-90. ©2016 AACR.
Collapse
Affiliation(s)
- Joseph L Usset
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - Rama Raghavan
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - Jonathan P Tyrer
- Department of Oncology, University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Valerie McGuire
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Weiva Sieh
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Penelope Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Irvine, California
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Julie M Cunningham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Anna DeFazio
- Discipline of Obstetrics, Gynecology, and Neonatology, University of Sydney, Westmead Institute for Cancer Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Jennifer A Doherty
- Department of Epidemiology, Geisel School of Medicine, Hanover, New Hampshire
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simon A Gayther
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Marc T Goodman
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Estrid Høgdall
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sharon E Johnatty
- Division of Genetics and Public Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lambertus A Kiemeney
- Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Susanne K Kjaer
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Melissa C Larson
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Galina Lurie
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Leon Massuger
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Usha Menon
- Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Roberta B Ness
- School of Public Health, The University of Texas, Houston, Texas
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Susan J Ramus
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Mary Anne Rossing
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joseph Rothstein
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Honglin Song
- Department of Oncology, University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Pamela J Thompson
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - David J van den Berg
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Robert A Vierkant
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Shan Wang-Gohrke
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Alice S Whittemore
- Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Anna H Wu
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Hannah Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Celeste Leigh Pearce
- Department of Preventive Medicine, University of Southern California, Los Angeles, California. Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Paul Pharoah
- Department of Oncology, University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom. Department of Public Health and Primary Care, University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Ellen L Goode
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Brooke L Fridley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas.
| |
Collapse
|
37
|
Risk of breast cancer in relation to combined effects of hormone therapy, body mass index, and alcohol use, by hormone-receptor status. Epidemiology 2016; 26:353-61. [PMID: 25695354 DOI: 10.1097/ede.0000000000000261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Alcohol consumption, increased body mass index (BMI), and hormone therapy are risk factors for postmenopausal breast cancer, but their combined effects are not well understood. Because hormone therapy is effective for the relief of menopausal symptoms, the identification of "high-risk" users is important for therapeutic reasons. We investigated interactions between hormone therapy use and alcohol-use/high BMI status in relation to invasive breast cancer risk, both overall and according to estrogen receptor (ER) status. METHODS Two Danish prospective cohorts were pooled, including 30,789 women ages 50+ years (study period 1981 to 2009). Information on risk factors was obtained in baseline questionnaires. We performed analyses using the Aalen additive hazards model. Serum estradiol and testosterone measurements were obtained in a subsample of approximately 1000 women. RESULTS During 392,938 person-years of follow-up, 1579 women developed invasive breast cancer. Among nonusers of hormone therapy, the risk of breast cancer was slightly increased with overweight/obesity and increasing alcohol consumption. Compared with normal-weight nonusers, the risk of breast cancer was higher in hormone therapy users across all BMI strata (P for interaction = 0.003). A markedly higher risk of breast cancer was also observed for alcohol combined with hormone therapy use compared with abstinent nonusers (P for interaction = 0.02). These effects were primarily restricted to ER-positive cases. Combined effects of hormone therapy/high BMI and hormone therapy/alcohol on serum estradiol and testosterone supported the hypothesis of a hormonal pathway linking these exposures to breast cancer. CONCLUSION These analyses suggest an increased risk of breast cancer associated with hormone therapy use-a risk that may be particularly strong among women consuming alcohol.
Collapse
|
38
|
Schairer C, Fuhrman BJ, Boyd-Morin J, Genkinger JM, Gail MH, Hoover RN, Ziegler RG. Quantifying the Role of Circulating Unconjugated Estradiol in Mediating the Body Mass Index-Breast Cancer Association. Cancer Epidemiol Biomarkers Prev 2016; 25:105-13. [PMID: 26637268 PMCID: PMC5555590 DOI: 10.1158/1055-9965.epi-15-0687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/23/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Higher body mass index (BMI) and circulating estrogen levels each increase postmenopausal breast cancer risk, particularly estrogen receptor-positive (ER(+)) tumors. Higher BMI also increases estrogen production. METHODS We estimated the proportion of the BMI-ER(+) breast cancer association mediated through estrogen in a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Participants included 143 women with invasive ER(+) breast cancer and 268 matched controls, all postmenopausal and never having used hormone therapy at baseline. We used liquid chromatography-tandem mass spectrometry to measure 15 estrogens and estrogen metabolites in baseline serum. We calculated BMI from self-reported height and weight at baseline. We estimated the mediating effect of unconjugated estradiol on the BMI-ER(+) breast cancer association using Aalen additive hazards and Cox regression models. RESULTS All estrogens and estrogen metabolites were statistically significantly correlated with BMI, with unconjugated estradiol most strongly correlated [Pearson correlation (r) = 0.45]. Approximately 7% to 10% of the effect of overweight, 12% to 15% of the effect of obesity, and 19% to 20% of the effect of a 5 kg/m(2) BMI increase on ER(+) breast cancer risk was mediated through unconjugated estradiol. The BMI-breast cancer association, once adjusted for unconjugated estradiol, was not modified by further adjustment for two metabolic ratios statistically significantly associated with both breast cancer and BMI. CONCLUSION Circulating unconjugated estradiol levels partially mediate the BMI-breast cancer association, but other potentially important estrogen mediators (e.g., bioavailable estradiol) were not evaluated. IMPACT Further research is required to identify mechanisms underlying the BMI-breast cancer association.
Collapse
Affiliation(s)
- Catherine Schairer
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Barbara J Fuhrman
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Mitchell H Gail
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert N Hoover
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Regina G Ziegler
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| |
Collapse
|
39
|
Abstract
The relationship between adiposity and breast cancer risk and prognosis is complex, with associations that differ depending on when body size is assessed (e.g., pre- vs. postmenopausal obesity) and when breast cancer is diagnosed (i.e., pre- vs. postmenopausal disease). Further, the impact of obesity on risk differs by tumor hormone receptor status (e.g., estrogen (ER) and progesterone (PR) receptor) and, among postmenopausal women, use of exogenous hormones (i.e., hormone replacement therapy (HRT)). In the context of these complexities, this review focuses on associations between childhood and adolescent adiposity, general adiposity, weight changes (i.e., loss and gain), abdominal adiposity, and breast cancer risk and survival. Finally, we discuss potential mechanisms linking adiposity to breast cancer.
Collapse
Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
40
|
Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, Ochs-Balcom HM, Thomson CA, Caan BJ, Tinker LF, Urrutia RP, Knudtson J, Anderson GL. Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trials. JAMA Oncol 2015; 1:611-21. [PMID: 26182172 PMCID: PMC5070941 DOI: 10.1001/jamaoncol.2015.1546] [Citation(s) in RCA: 382] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE More than two-thirds of US women are overweight or obese, placing them at increased risk for postmenopausal breast cancer. OBJECTIVE To investigate in this secondary analysis the associations of overweight and obesity with risk of postmenopausal invasive breast cancer after extended follow-up in the Women's Health Initiative (WHI) clinical trials. DESIGN, SETTING, AND PARTICIPANTS The WHI clinical trial protocol incorporated measured height and weight, baseline and annual or biennial mammography, and adjudicated breast cancer end points in 67 142 postmenopausal women ages 50 to 79 years at 40 US clinical centers. The women were enrolled from 1993 to 1998 with a median of 13 years of follow-up through 2010; 3388 invasive breast cancers were observed. MAIN OUTCOMES AND MEASURES Height and weight were measured at baseline, and weight was measured annually thereafter. Data were collected on demographic characteristics, personal and family medical history, and personal habits (smoking, physical activity). Women underwent annual or biennial mammograms. Breast cancers were verified by medical records reviewed by physician adjudicators. RESULTS Women who were overweight and obese had an increased invasive breast cancer risk vs women of normal weight. Risk was greatest for obesity grade 2 plus 3 (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, >35.0) (hazard ratio [HR] for invasive breast cancer, 1.58; 95% CI, 1.40-1.79). A BMI of 35.0 or higher was strongly associated with risk for estrogen receptor-positive and progesterone receptor-positive breast cancers (HR, 1.86; 95% CI, 1.60-2.17) but was not associated with estrogen receptor-negative cancers. Obesity grade 2 plus 3 was also associated with advanced disease, including larger tumor size (HR, 2.12; 95% CI, 1.67-2.69; P = .02), positive lymph nodes (HR, 1.89; 95% CI, 1.46-2.45; P = .06), regional and/or distant stage (HR, 1.94; 95% CI, 1.52-2.47; P = .05), and deaths after breast cancer (HR, 2.11; 95% CI, 1.57-2.84; P < .001). Women with a baseline BMI of less than 25.0 who gained more than 5% of body weight over the follow-up period had an increased breast cancer risk (HR, 1.36; 95% CI, 1.1-1.65), but among women already overweight or obese we found no association of weight change (gain or loss) with breast cancer during follow-up. There was no effect modification of the BMI-breast cancer relationship by postmenopausal hormone therapy, and the direction of association across BMI categories was similar for never, past, and current hormone therapy use. CONCLUSIONS AND RELEVANCE Obesity is associated with increased invasive breast cancer risk in postmenopausal women. These clinically meaningful findings should motivate programs for obesity prevention. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000611.
Collapse
Affiliation(s)
- Marian. L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Aaron K. Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ross L. Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rowan Chlebowski
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Cara L. Carty
- George Washington University School of Medicine, Washington, DC, USA
| | | | | | - Bette J. Caan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Garnet L. Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
41
|
Risk Factors for Premenopausal Breast Cancer in Bangladesh. Int J Breast Cancer 2015; 2015:612042. [PMID: 26229688 PMCID: PMC4502307 DOI: 10.1155/2015/612042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background. The incidence of premenopausal breast cancer is rising throughout South Asia. Our objective was to determine the role of risk factors associated with Westernization for premenopausal breast cancer in Bangladesh. Methods. We conducted a matched case-control study between January 1, 2007, and December 31, 2010, at four hospitals in Bangladesh. Cases were premenopausal women diagnosed with invasive breast cancer. Controls were premenopausal women with no personal history of breast cancer. Logistic regression was used to calculate the odds ratios (OR) for breast cancer. Results. We identified 129 age-matched pairs. The mean age of breast cancer diagnosis was 37.5 years. Each year decrease in the age of menarche significantly increased the risk of breast cancer (OR = 1.67, 95% CI 1.09–2.56, P = 0.02). The risk was also increased with a current body mass index of ≥25 kg/m2 (OR = 5.24, 95% CI 1.10–24.9, P = 0.04). Age at first childbirth, parity, and breastfeeding were not significantly associated with premenopausal breast cancer risk (P > 0.05). Conclusions. Age at menarche and adult weight gain were associated with premenopausal breast cancer risk. Other factors associated with Westernization may not be relevant to premenopausal breast cancer risk in Bangladesh.
Collapse
|
42
|
Rosner B, Eliassen AH, Toriola AT, Hankinson SE, Willett WC, Natarajan L, Colditz GA. Short-term weight gain and breast cancer risk by hormone receptor classification among pre- and postmenopausal women. Breast Cancer Res Treat 2015; 150:643-53. [PMID: 25796612 PMCID: PMC4383816 DOI: 10.1007/s10549-015-3344-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/11/2015] [Indexed: 01/02/2023]
Abstract
Obesity is well established as a cause of postmenopausal breast cancer incidence and mortality. In contrast, adiposity in early life reduces breast cancer incidence. However, whether short-term weight change influences breast cancer risk is not well known. We followed a cohort of 77,232 women from 1980 to 2006 (1,445,578 person-years), with routinely updated risk factor information, documenting 4196 incident cases of invasive breast cancer. ER and PR status were obtained from pathology reports and medical records yielding a total of 2033 ER+/PR+ tumors, 595 ER-/PR- tumors, 512 ER+/PR- tumors. The log incidence breast cancer model was used to assess the association of short-term weight gain (over past 4 years) while controlling for average BMI before and after menopause. Short-term weight change was significantly associated with breast cancer risk (RR 1.20; 95 % CI 1.09-1.33) for a 4-year weight gain of ≥15 lbs versus no change (≤5 lbs) (P_trend < 0.001). The association was stronger for premenopausal women (RR 1.38; 95 % CI 1.13-1.69) (P_trend = 0.004) than for postmenopausal women (RR 1.10; 95 % CI 0.97-1.25) (P_trend = 0.063). Short-term weight gain during premenopause had a stronger association for ER+/PR- (RR per 25 lb weight gain = 2.19; 95 % CI 1.33-3.61, P = 0.002) and ER-/PR- breast cancer (RR per 25 lb weight gain = 1.61; 95 % CI 1.09-2.38, P = 0.016) than for ER+/PR+ breast cancer (RR per 25 lb weight gain = 1.13; 95 % CI 0.89-1.43, P = 0.32). There are deleterious effects of short-term weight gain, particularly during pre-menopause, even after controlling for average BMI before and after menopause. The association was stronger for ER+/PR- and ER-/PR- than for ER+/PR+ breast cancer.
Collapse
Affiliation(s)
- Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA,
| | | | | | | | | | | | | |
Collapse
|
43
|
Keum N, Greenwood DC, Lee DH, Kim R, Aune D, Ju W, Hu FB, Giovannucci EL. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 2015; 107:djv088. [PMID: 25757865 DOI: 10.1093/jnci/djv088] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adiposity, measured by body mass index, is implicated in carcinogenesis. While adult weight gain has diverse advantages over body mass index in measuring adiposity, systematic reviews on adult weight gain in relation to adiposity-related cancers are lacking. METHODS PubMed and Embase were searched through September 2014 for prospective observational studies investigating the relationship between adult weight gain and the risk of 10 adiposity-related cancers. Dose-response meta-analyses were performed using a random-effects model to estimate summary relative risk (RR) and 95% confidence interval (CI) for each cancer type. All statistical tests were two-sided. RESULTS A total of 50 studies were included. For each 5 kg increase in adult weight gain, the summary relative risk was 1.11 (95% CI = 1.08 to 1.13) for postmenopausal breast cancer among no- or low-hormone replacement therapy (HRT) users, 1.39 (95% CI = 1.29 to 1.49) and 1.09 (95% CI = 1.02 to 1.16) for postmenopausal endometrial cancer among HRT nonusers and users, respectively, 1.13 (95% CI = 1.03 to 1.23) for postmenopausal ovarian cancer among no or low HRT users, 1.09 (95% CI = 1.04 to 1.13) for colon cancer in men. The relative risk of kidney cancer comparing highest and lowest level of adult weight gain was 1.42 (95% CI = 1.11 to 1.81). Adult weight gain was unrelated to cancers of the breast (premenopausal women, postmenopausal HRT users), prostate, colon (women), pancreas, and thyroid. An increase in risk associated with adult weight gain for breast cancer was statistically significantly greater among postmenopausal women (P(heterogeneity) = .001) and HRT nonusers (P(heterogeneity) = .001); that for endometrial cancer was alike among HRT nonusers (P(heterogeneity) = .04). CONCLUSIONS Avoiding adult weight gain itself may confer protection against certain types of cancers, particularly among HRT nonusers.
Collapse
Affiliation(s)
- NaNa Keum
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG).
| | - Darren C Greenwood
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Dong Hoon Lee
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Rockli Kim
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Dagfinn Aune
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Woong Ju
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Frank B Hu
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| | - Edward L Giovannucci
- Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG)
| |
Collapse
|
44
|
Adult Weight Gain and Adiposity-Related Cancers: A Dose-Response Meta-Analysis of Prospective Observational Studies. ACTA ACUST UNITED AC 2015; 107:dju428. [DOI: 10.1093/jnci/dju428] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
45
|
Merdad A, Karim S, Schulten HJ, Jayapal M, Dallol A, Buhmeida A, Al-Thubaity F, GariI MA, Chaudhary AGA, Abuzenadah AM, Al-Qahtani MH. Transcriptomics profiling study of breast cancer from Kingdom of Saudi Arabia revealed altered expression of Adiponectin and Fatty Acid Binding Protein4: Is lipid metabolism associated with breast cancer? BMC Genomics 2015; 16 Suppl 1:S11. [PMID: 25923423 PMCID: PMC4315151 DOI: 10.1186/1471-2164-16-s1-s11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Breast cancer incidence rates are increasing at an alarming rate among Saudi Arabian females. Most molecular genetic discoveries on breast cancer and other cancers have arisen from studies examining European and American patients. However, possibility of specific changes in molecular signature among cancer patients of diverse ethnic groups remains largely unexplored. We performed transcriptomic profiling of surgically-resected breast tumors from 45 patients based in the Western region of Saudi Arabia using Affymetrix Gene 1.0 ST chip. Pathway and biological function-based clustering was apparent across the tissue samples. RESULTS Pathway analysis revealed canonical pathways that had not been previously implicated in breast cancer. Biological network analysis of differentially regulated genes revealed that Fatty acid binding protein 4, adipocyte (FABP4), adiponectin (ADIPOQ), and retinol binding protein 4 (RBP4) were most down regulated genes, sharing strong connection with the other molecules of lipid metabolism pathway. The marked biological difference in the signatures uncovered between the USA and Saudi samples underpins the importance of this study. Connectivity Map identified compounds that could reverse an observed gene expression signature CONCLUSIONS This study describes, to our knowledge, the first genome-wide profiling of breast cancer from Saudi ethnic females. We demonstrate the involvement of the lipid metabolism pathway in the pathogenesis of breast cancer from this region. This finding also highlights the need for strategies to curb the increasing rates of incidence of this disease by educating the public about life-style risk factors such as unhealthy diet and obesity.
Collapse
|
46
|
John EM, Sangaramoorthy M, Hines LM, Stern MC, Baumgartner KB, Giuliano AR, Wolff RK, Slattery ML. Body size throughout adult life influences postmenopausal breast cancer risk among hispanic women: the breast cancer health disparities study. Cancer Epidemiol Biomarkers Prev 2015; 24:128-37. [PMID: 25352523 PMCID: PMC4295775 DOI: 10.1158/1055-9965.epi-14-0560] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Few studies have assessed the association of body size with postmenopausal breast cancer risk in Hispanic women. Findings are inconsistent and appear to contradict those reported for non-Hispanic white (NHW) women. METHODS We pooled interview and anthropometric data for 2,023 Hispanic and 2,384 NHW women from two U.S. population-based case-control studies. Using logistic regression analysis, we examined associations of overall and abdominal adiposity with risk of postmenopausal breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR) status. RESULTS Weight gain was associated with increased risk of ER(+)PR(+) breast cancer in Hispanics not currently using menopausal hormone therapy (HT), but only among those with a low young-adult body mass index (BMI). In the subset of Hispanics with data on genetic ancestry, the association with weight gain was limited to women with lower Indigenous American ancestry. Young-adult BMI was inversely associated with both ER(+)PR(+) and ER(-)PR(-) breast cancers for both ethnicities combined, with similar, although nonsignificant, inverse trends in Hispanics and NHWs. Among all Hispanics, regardless of HT use, height was associated with risk of ER(-)PR(-) breast cancer and hip circumference with risk of breast cancer overall. CONCLUSIONS Body size throughout adult life is associated with breast cancer risk among postmenopausal Hispanic women, as has been reported for NHW women. Associations were specific for breast cancer subtypes defined by hormone receptor status. IMPACT Avoiding weight gain and maintaining a healthy weight are important strategies to reduce the risk of postmenopausal ER(+)PR(+) breast cancer, the most common breast cancer subtype.
Collapse
Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, Fremont, California. Division of Epidemiology, Department of Health Research and Policy and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
| | | | - Lisa M Hines
- Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, Colorado
| | - Mariana C Stern
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Anna R Giuliano
- Moffitt Cancer Center, Cancer Prevention and Control, Tampa, Florida
| | - Roger K Wolff
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | |
Collapse
|
47
|
Emaus MJ, van Gils CH, Bakker MF, Bisschop CNS, Monninkhof EM, Bueno-de-Mesquita HB, Travier N, Berentzen TL, Overvad K, Tjønneland A, Romieu I, Rinaldi S, Chajes V, Gunter MJ, Clavel-Chapelon F, Fagherazzi G, Mesrine S, Chang-Claude J, Kaaks R, Boeing H, Aleksandrova K, Trichopoulou A, Naska A, Orfanos P, Palli D, Agnoli C, Tumino R, Vineis P, Mattiello A, Braaten T, Borch KB, Lund E, Menéndez V, Sánchez MJ, Navarro C, Barricarte A, Amiano P, Sund M, Andersson A, Borgquist S, Olsson A, Khaw KT, Wareham N, Travis RC, Riboli E, Peeters PHM, May AM. Weight change in middle adulthood and breast cancer risk in the EPIC-PANACEA study. Int J Cancer 2014; 135:2887-99. [PMID: 24771551 DOI: 10.1002/ijc.28926] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/20/2014] [Indexed: 01/21/2023]
Abstract
Long-term weight gain (i.e., weight gain since age 20) has been related to higher risk of postmenopausal breast cancer, but a lower risk of premenopausal breast cancer. The effect of weight change in middle adulthood is unclear. We investigated the association between weight change in middle adulthood (i.e., women aged 40-50 years) and the risk of breast cancer before and after the age of 50. We included female participants of the European Prospective Investigation into Cancer and Nutrition cohort, with information on anthropometric measures at recruitment and after a median follow-up of 4.3 years. Annual weight change was categorized using quintiles taking quintile 2 and 3 as the reference category (-0.44 to 0.36 kg/year). Multivariable Cox proportional hazards regression analysis was used to examine the association. 205,723 women were included and 4,663 incident breast cancer cases were diagnosed during a median follow-up of 7.5 years (from second weight assessment onward). High weight gain (Q5: 0.83-4.98 kg/year) was related to a slightly, but significantly higher breast cancer risk (HRQ5_versus_Q2/3 : 1.09, 95% CI: 1.01-1.18). The association was more pronounced for breast cancer diagnosed before or at age 50 (HRQ5_versus_Q2/3 : 1.37, 95% CI: 1.02-1.85). Weight loss was not associated with breast cancer risk. There was no evidence for heterogeneity by hormone receptor status. In conclusion, high weight gain in middle adulthood increases the risk of breast cancer. The association seems to be more pronounced for breast cancer diagnosed before or at age 50. Our results illustrate the importance of avoiding weight gain in middle adulthood.
Collapse
Affiliation(s)
- Marleen J Emaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Howell A, Anderson AS, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, Gescher AJ, Key TJ, Saxton JM, Harvie MN. Risk determination and prevention of breast cancer. Breast Cancer Res 2014; 16:446. [PMID: 25467785 PMCID: PMC4303126 DOI: 10.1186/s13058-014-0446-2] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is an increasing public health problem. Substantial advances have been made in the treatment of breast cancer, but the introduction of methods to predict women at elevated risk and prevent the disease has been less successful. Here, we summarize recent data on newer approaches to risk prediction, available approaches to prevention, how new approaches may be made, and the difficult problem of using what we already know to prevent breast cancer in populations. During 2012, the Breast Cancer Campaign facilitated a series of workshops, each covering a specialty area of breast cancer to identify gaps in our knowledge. The risk-and-prevention panel involved in this exercise was asked to expand and update its report and review recent relevant peer-reviewed literature. The enlarged position paper presented here highlights the key gaps in risk-and-prevention research that were identified, together with recommendations for action. The panel estimated from the relevant literature that potentially 50% of breast cancer could be prevented in the subgroup of women at high and moderate risk of breast cancer by using current chemoprevention (tamoxifen, raloxifene, exemestane, and anastrozole) and that, in all women, lifestyle measures, including weight control, exercise, and moderating alcohol intake, could reduce breast cancer risk by about 30%. Risk may be estimated by standard models potentially with the addition of, for example, mammographic density and appropriate single-nucleotide polymorphisms. This review expands on four areas: (a) the prediction of breast cancer risk, (b) the evidence for the effectiveness of preventive therapy and lifestyle approaches to prevention, (c) how understanding the biology of the breast may lead to new targets for prevention, and (d) a summary of published guidelines for preventive approaches and measures required for their implementation. We hope that efforts to fill these and other gaps will lead to considerable advances in our efforts to predict risk and prevent breast cancer over the next 10 years.
Collapse
Affiliation(s)
- Anthony Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
- Breakthrough Breast Cancer Research Unit, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, M20 2QJ UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Level 7, University of Dundee, Ninewells Hospital & Medical School, Mailbox 7, George Pirie Way, Dundee, DD1 9SY UK
| | - Robert B Clarke
- Breakthrough Breast Cancer Research Unit, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, M20 2QJ UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - D Gareth Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
- Manchester Centre for Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St. Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Montserat Garcia-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG London, UK
| | - Andy J Gescher
- Department of Cancer Studies and Molecular Medicine, University of Leicester, University Road, Leicester, LE2 7LX UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF UK
| | - John M Saxton
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, University Drive, Norwich, NR4 7TJ UK
| | - Michelle N Harvie
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
| |
Collapse
|
49
|
Associations between anthropometric characteristics, physical activity, and breast cancer risk in a Canadian cohort. Breast Cancer Res Treat 2014; 145:545-52. [DOI: 10.1007/s10549-014-2973-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/22/2023]
|
50
|
Catsburg C, Gunter MJ, Chen C, Cote ML, Kabat GC, Nassir R, Tinker L, Wactawski-Wende J, Page DL, Rohan TE. Insulin, estrogen, inflammatory markers, and risk of benign proliferative breast disease. Cancer Res 2014; 74:3248-58. [PMID: 24755474 DOI: 10.1158/0008-5472.can-13-3514] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women with benign proliferative breast disease (BPBD) are at increased risk for developing breast cancer. Evidence suggests that accumulation of adipose tissue can influence breast cancer development via hyperinsulinemia, increased estrogen, and/or inflammation. However, there are limited data investigating these pathways with respect to risk of BPBD. We evaluated serologic markers from these pathways in a case-control study of postmenopausal women nested within the Women's Health Initiative Clinical Trial. Cases were the 667 women who developed BPBD during follow-up, and they were matched to 1,321 controls. Levels of insulin, estradiol, C-reactive protein (CRP), and adiponectin were measured in fasting serum collected at baseline. Conditional logistic regression models were used to estimate ORs for the association of each factor with BPBD risk. Among nonusers of hormone therapy, fasting serum insulin was associated with a statistically significant increase in risk of BPBD (OR for highest vs. lowest quartile = 1.80; 95% confidence interval, CI, 1.16-2.79; Ptrend = 0.003) as were levels of estradiol (OR for highest vs. lowest tertile = 1.89; 95% CI, 1.26-2.83; Ptrend = 0.02) and CRP (OR for highest vs. lowest quartile = 2.46; 95% CI, 1.59-3.80; Ptrend < 0.001). Baseline adiponectin level was inversely associated with BPBD risk (OR for highest vs. lowest quartile = 0.47; 95% CI, 0.31-0.71; Ptrend < 0.001). These associations persisted after mutual adjustment, but were not observed among users of either estrogen alone or of estrogen plus progestin hormone therapy. Our results indicate that serum levels of estrogen, insulin, CRP, and adiponectin are independent risk factors for BPBD and suggest that the estrogen, insulin, and inflammation pathways are associated with the early stages of breast cancer development.
Collapse
Affiliation(s)
- Chelsea Catsburg
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Marc J Gunter
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Chu Chen
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Michele L Cote
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Geoffrey C Kabat
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Rami Nassir
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Lesley Tinker
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Jean Wactawski-Wende
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - David L Page
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Thomas E Rohan
- Authors' Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx; Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, New York; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Public Health Sciences, University of California - Davis, Davis, California; Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| |
Collapse
|