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Mars N, Kerminen S, Tamlander M, Pirinen M, Jakkula E, Aaltonen K, Meretoja T, Heinävaara S, Widén E, Ripatti S. Comprehensive Inherited Risk Estimation for Risk-Based Breast Cancer Screening in Women. J Clin Oncol 2024; 42:1477-1487. [PMID: 38422475 DOI: 10.1200/jco.23.00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/24/2023] [Accepted: 12/20/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Family history (FH) and pathogenic variants (PVs) are used for guiding risk surveillance in selected high-risk women but little is known about their impact for breast cancer screening on population level. In addition, polygenic risk scores (PRSs) have been shown to efficiently stratify breast cancer risk through combining information about common genetic factors into one measure. METHODS In longitudinal real-life data, we evaluate PRS, FH, and PVs for stratified screening. Using FinnGen (N = 117,252), linked to the Mass Screening Registry for breast cancer (1992-2019; nationwide organized biennial screening for age 50-69 years), we assessed the screening performance of a breast cancer PRS and compared its performance with FH of breast cancer and PVs in moderate- (CHEK2)- to high-risk (PALB2) susceptibility genes. RESULTS Effect sizes for FH, PVs, and high PRS (>90th percentile) were comparable in screening-aged women, with similar implications for shifting age at screening onset. A high PRS identified women more likely to be diagnosed with breast cancer after a positive screening finding (positive predictive value [PPV], 39.5% [95% CI, 37.6 to 41.5]). Combinations of risk factors increased the PPVs up to 45% to 50%. A high PRS conferred an elevated risk of interval breast cancer (hazard ratio [HR], 2.78 [95% CI, 2.00 to 3.86] at age 50 years; HR, 2.48 [95% CI, 1.67 to 3.70] at age 60 years), and women with a low PRS (<10th percentile) had a low risk for both interval- and screen-detected breast cancers. CONCLUSION Using real-life screening data, this study demonstrates the effectiveness of a breast cancer PRS for risk stratification, alone and combined with FH and PVs. Further research is required to evaluate their impact in a prospective risk-stratified screening program, including cost-effectiveness.
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Affiliation(s)
- Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Sini Kerminen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Max Tamlander
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Matti Pirinen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eveliina Jakkula
- Department of Clinical Genetics, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Kirsimari Aaltonen
- Department of Clinical Genetics, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Tuomo Meretoja
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Sirpa Heinävaara
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Hagner KA, Nordgren HS, Aaltonen K, Sarjokari K, Rautala H, Sironen T, Sukura A, Rajala-Schultz PJ. Necropsy-based study on dairy cow mortality-Underlying causes of death. J Dairy Sci 2023; 106:2846-2856. [PMID: 36870842 DOI: 10.3168/jds.2022-22466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 03/06/2023]
Abstract
The worldwide problem of increasing dairy cow mortality is widespread in modern production systems, it causes economic losses, and indicates problems with herd health and welfare. Most studies on causes of dairy cow mortality are limited as they are based on secondary register data, or questionnaires for producers or veterinarians, and neither necropsies nor histopathologic analyses are usually performed. For this reason, no definite causes for dairy cow deaths have been determined making it difficult or impossible to implement effective preventive measures. The objectives of this study were to (1) determine the causes of on-farm mortality of Finnish dairy cows, (2) determine the usefulness of routine histopathologic analysis in bovine necropsies, and (3) assess how reliable producers' perception about the cause of death is. Underlying diagnoses of on-farm deaths were determined through necropsy of 319 dairy cows at an incineration plant. The necropsy data were combined with background information obtained from online questionnaires covering cow and herd records. Mastitis was the most common underlying diagnosis of death (26.6%), followed by digestive disorders (15.4%), other known disorders (13.8%), calving-associated disorders (12.2%), and locomotion disorders (11.9%). The underlying diagnoses of death varied during different stages of lactation and with parity. A large proportion of the study cows (46.7%) died during the first 30 d after calving, and of those, 63.6% died during the first 5 d. A routine histopathologic analysis was performed in every necropsy, and it changed the preliminary gross diagnosis in 18.2% of the cases. Producers' perception about the cause of death agreed with the necropsy-based underlying diagnosis of death in 42.8% of the cases. It was most consistent for mastitis, calving disorders, locomotion diseases, and accidents. In cases where producers had no insights about the cause of death, necropsy revealed the final underlying diagnosis in 88.2% of cases, demonstrating the usefulness of necropsy. Based on our findings, necropsies provide useful and reliable information to develop control programs for cow mortality. Including routine histopathologic analysis in necropsies, more accurate information may be obtained. Furthermore, targeting preventive measures on transitional cows may be most effective, as the number of deaths was highest at this time.
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Affiliation(s)
- K A Hagner
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland.
| | - H S Nordgren
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Virology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | | | - H Rautala
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Paroninkuja 20, 04920 Saarentaus, Finland
| | - T Sironen
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland; Department of Virology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014 Helsinki, Finland
| | - A Sukura
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Box 66, 00014 Helsinki, Finland
| | - P J Rajala-Schultz
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Paroninkuja 20, 04920 Saarentaus, Finland
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Virtanen J, Aaltonen K, Moisander-Jylhä AM, Nordgren H, Paulin L, Peura J, Vapalahti O, Kant R, Sironen T. Mechanisms behind the varying severity of Aleutian mink disease virus: Comparison of three farms with a different disease status. Vet Microbiol 2022; 270:109452. [DOI: 10.1016/j.vetmic.2022.109452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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Cordtz R, Askling J, Delcoigne B, Ekström Smedby K, Baecklund E, Ballegaard C, Isomäki P, Aaltonen K, Gudbjornsson B, Love T, Provan SA, Michelsen B, Sexton J, Dreyer L, Hellgren K. OP0257 RISK OF HAEMATOLOGICAL MALIGNANCY IN PATIENTS WITH PSORIATIC ARTHRITIS, OVERALL AND IN RELATION TO TNF INHIBITORS - A NORDIC COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSeveral autoimmune inflammatory diseases, including rheumatoid arthritis (RA), are associated with increased risk of malignant lymphomas. There is also a longstanding concern of lymphoma development with tumour necrosis factor inhibitor (TNFi) treatment, but most studies in RA to date do not indicate an additionally increased risk. Corresponding studies in psoriatic arthritis (PsA), both with respect to the underlying risks, and risks in relation to treatment with TNFi, are limited. Data on myeloid malignancies in PsA are scarce.ObjectivesTo estimate the risk of haematological malignancy overall and by lymphoid and myeloid types in TNFi treated versus (vs.) biologics-naïve patients with PsA across the five Nordic countries. Additionally, we investigated the underlying risk of haematological malignancies in PsA as compared to the general population.MethodsWe identified patients with PsA starting a first ever TNFi from the clinical rheumatology registers (CRR) in Sweden (SE), Denmark (DK), Norway (NO), Finland (FI), and Iceland (ICE) from 2006 through 2019 (n=10 621). We identified biologics-naïve patients with PsA from a) the CRR (n=18 705, all countries) and b) the national patient registers (NPR, n=27 286, SE and DK only). To estimate the underlying risk of haematological malignancy in PsA, we randomly sampled general population comparators in SE and DK matched on year of birth, sex, and calendar year at start of follow-up, to the patients with PsA.Through linkage to the mandatory national cancer registers in all five countries, we collected information on haematological malignancy overall, and categorised into lymphoid or myeloid types. By applying a modified Poisson regression, we estimated pooled incidence rate ratio (IRR) with 95% confidence intervals (CI) for TNFi treated vs. biologics-naïve PsA and for PsA vs. the general population, adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ResultsWe observed 40 events of haematological malignancies (during 59 827 person-years) among TNFi treated PsA, resulting in a crude incidence rate (IR) of 67 per 100 000 person-years. The corresponding IR was 91 (63 events) for biologics-naïve PsA from the CRR, and 118 (172 events) for biologics-naïve PsA from NPR. This resulted in a pooled IRR of 0.97 (0.69 to 1.37) for TNFi-treated vs. biologics-naïve PsA patients from the CRR, and 0.84 (0.64 to 1.10) vs. biologics-naïve PsA patients from the NPR. The pooled IRR of haematological malignancies in PsA overall vs. the general population was 1.35 (1.17 to 1.55). Throughout, the estimates were largely similar for lymphoid and myeloid malignancies (Figure 1). The crude IR of haematological malignancies were substantially akin across different TNFi agents.Figure 1.Pooled incidence rate ratios (IRRs) (95% CI) of haematological malignancy overall and by lymphoid and myeloid types, in first ever TNFi treated versus biologics-naïve patients with PsA, and versus general population comparators. Legend: Lymphoid malignancies include international classification of diseases (ICD) 10 codes C81-86, C88, C90-91. Myeloid malignancies include ICD10 codes C92-95, D45-D46, D47.1, D47.3-5. Incidence rate ratios adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ConclusionIn this large five-country cohort study, we did not observe any increased risk of haematological malignancies overall, nor for lymphoid and myeloid types, in patients with PsA treated with TNFi. By contrast, there were signals of a moderately increased underlying risk of haematological malignancies, both of lymphoid and myeloid types, in patients with PsA overall as compared to the general population. The findings are of importance from a patient information perspective.AcknowledgementsWe would like to acknowledge the NordForsk and FOREUM, and especially the patient representatives of the NordForsk collaboration for their valuable contribution to this study.Disclosure of InterestsRené Cordtz: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Bénédicte Delcoigne: None declared, Karin Ekström Smedby: None declared, Eva Baecklund: None declared, Christine Ballegaard: None declared, Pia Isomäki Speakers bureau: AbbVie, Eli Lilly and Pfizer, Consultant of: AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma, Grant/research support from: Pfizer, Kalle Aaltonen: None declared, Björn Gudbjornsson Speakers bureau: Novartis, not related to this work, Consultant of: Novartis, not related to this work, Thorvardur Love Speakers bureau: Celgene, Sella Aa. Provan: None declared, Brigitte Michelsen Grant/research support from: Novartis, not related to this work, Joe Sexton: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS not related to this work, Karin Hellgren: None declared
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DI Giuseppe D, Lindström U, Aaltonen K, Relas H, Aarrestad Provan S, Gudbjornsson B, Hetland ML, Askling J, Schjødt Jørgensen T, Dreyer L, Nordström D, Michelsen B, Geirsson AJ, Jacobsson LTH, Glintborg B. OP0140 BIOLOGIC REFRACTORY DISEASE IN AXIAL SPONDYLOARTHRITIS - DEFINITION, PREVALENCE AND PATIENT CHARACTERISTICS. A COLLABORATION BETWEEN FIVE NORDIC BIOLOGIC REGISTRIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In clinical practice, some patients with axial spondyloarthritis (axSpA) fail several consecutive biological treatments (bDMARDs). How this group of ”refractory” patients should best be defined, how common they are, and what their characteristics are, is poorly understood.Objectives:To explore the point prevalence of bDMARD refractory disease in axSpA over time, according to different definitions, and to describe the characteristics of refractory vs. not-refractory patients upon start of their first bDMARD.Methods:Observational prospective cohort study. Patients with axSpA (ankylosing spondylitis/non-radiographic axial SpA) starting a first bDMARD 2009-2018 were identified in biologic registries in Denmark, Sweden, Finland, Norway and Iceland. Clinical characteristics and treatments were retrieved, and data were pooled for analysis.Refractory disease was defined based on the number of different bDMARD treatments started in individual patients: mild (≥3 bDMARDs), moderate (≥4), and strict (5 or more). Restart of same bDMARD with another bDMARD in between counted as separate courses whereas switch from originator to corresponding biosimilar was ignored.Proportions of patients fulfilling each definition of refractory disease at 2 and 5 years after the start of 1st bDMARD were calculated.Point-prevalence per calendar-year was calculated as the number of patients with refractory disease at the end of each year, divided by the total number of patients ever having starting a first bDMARD before that time-point, and who were still alive and resident in the country.Results:The point prevalence of refractory axSpA increased with calendar-time (Figure). Among 12,037 included axSpA patients (64% male), the point-prevalence of bDMARD refractory disease in 2018 was 16%/7%/3% according to mild/moderate/strict definitions (Table).Table 1.Biologic refractory axSpA according to three definitionsA.Baseline characteristics upon start 1st bDMARDRefractory definitionOverall cohortMILDMODERATESTRICTN120371969832351Age, years42 (13)41 (12)41 (12)41 (12)Male, %64%57%54%56%Disease duration, years7 (10)6 (9)6 (8)5 (8)BASDAI, 0-10053 (28)60 (29)63 (27)66 (35)ASDAS3.3 (1.1)3.5 (1.2)3.6 (1.0)3.7 (1.1)CRP, mg/L16 (23)18 (26)21 (28)23 (32)Patient global, VAS, 0-10059 (25)65 (22)66 (22)67 (23)Patient Pain, VAS, 0-10057 (24)62 (22)63 (22)63 (22)Fatigue, VAS, 0-10059 (27)66 (26)66 (26)68 (25)B.Proportions of patients having refractory disease 2 and 5 years after start of their first bDMARD2 years, %5%1%0%5 years, %13%4%1%Numbers are means (SD) unless otherwise statedUpon start of their 1st bDMARD, patients later fulfilling the definitions for refractory axSpA were more frequently women, had shorter disease duration, higher C-reactive protein and higher patient reported outcomes.Overall, 5%/1%/0% had mild/moderate/strict refractory disease 2 years after start of first bDMARD, after 5 years it was 13%/4%/1% (Table).Conclusion:In this large Nordic observational cohort of axSpA patients treated in routine care, we could demonstrate that a substantial proportion of all patients had used multiple bDMARDs. In 2018, one in six patients had received ≥3 bDMARDs, indicating a bDMARD refractory disease. Multiple switching was more frequent during later years, probably due to more bDMARDs becoming available. The characteristics of refractory axSpA, including sex and disease activity, will have to be further explored, as will the impact of refractory disease on long-term outcomes.Acknowledgements:the DANBIO, SRQ, ICEBIO, ROB-FIN and NOR-DMARD registries.Partly sponsored by Nordforsk and Foreum.Disclosure of Interests:Daniela Di Giuseppe: None declared, Ulf Lindström: None declared, Kalle Aaltonen: None declared, Heikki Relas Speakers bureau: Abbvie, Celgene, MSD, Roche, Sella Aarrestad Provan: None declared, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Merete L. Hetland Grant/research support from: AbbVie, Biogen, BMS, Celtrion, Eli Lilly Denmark A/S, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopis, Sandoz. MLH chairs the steering committee of the Danish Rheumatology Quality Registry (DANBIO), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs the EuroSpA research collaboration, which generates real-world evidence of treatment of psoriatic arthritis and axial spondyloarthritis based on secondary use of quality data and is partly funded by Novartis., Johan Askling: None declared, Tanja Schjødt Jørgensen: None declared, Lene Dreyer Speakers bureau: Eli-Lilly and Galderma, Grant/research support from: BMS, Dan Nordström: None declared, Brigitte Michelsen: None declared, Arni Jon Geirsson: None declared, Lennart T.H. Jacobsson: None declared, Bente Glintborg Grant/research support from: Abbvie, BMS, Pfizer, Lundbeck foundation
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Aarrestad Provan S, Michelsen B, Ljung L, Jonmundsson T, Gudbjornsson B, DI Giuseppe D, Hetland ML, Reynisdóttir GB, Glintborg B, Kristianslund E, Relas H, Aaltonen K, Nordström D, Kvien TK, Askling J. OP0222 THE INCIDENCE OF INTERSTITIAL LUNG DISEASE IN PSORIATIC ARTHRITIS COMPARED TO RHEUMATOID ARTHRITIS. DATA FROM OVER 89 000 BDMARD TREATMENT COURSES DERIVED FROM FIVE NORDIC REGISTERS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Interstitial lung disease (ILD) is an established extra-articular manifestation of rheumatoid arthritis (RA). Few studies have investigated the prevalence of ILD in patients with psoriatic arthritis (PsA). Methotrexate (MTX) is frequently used in the treatment of both RA and PsA and has been suggested to be a risk factor for the development of ILD. It is of interest to understand the interaction between disease and treatment in the development of ILD.Objectives:To compare the incidence of ILD between patient with PsA and RA treated with biologic disease modifying antirheumatic drugs (bDMARDS), with or without MTX as a co-medication.Methods:Cohorts of patients with RA and PsA starting bDMARD were identified in Nordic registers (Danish nationwide clinical register for patients with RA (DANBIO), Register on antirheumatic and biological therapy in Finland (ROB-FIN), Icelandic nationwide database of biologic therapy (ICEBIO), Norwegian Antirheumatic Drug Register (NOR-DMARD), and the Swedish Rheumatology Quality Register (SRQ)). Linkages to the National Patient Registers and to the Cause of Death Registers were performed in each country to identify cases of ILD. Each individual patient could contribute several treatment courses. ILD was identified as hospital or death certificate ICD10 codes of ILD (J84.1, J84.8, J84.9, J70.2, J70.3, J70.4, J99.0, J99.1, J99.8) given during the follow-up period which was defined as the treatment course duration, plus a 30-day wash-out period added to the end of treatment course period. MTX co-medication was specified as use of MTX at the start of bDMARD. Incidence rates (IR) for any ILD were calculated per 1000 person years at risk (PYR) for each country. The five cohorts were pooled and incidence rate ratios (IRR) for PsA vs. RA were calculated. Hazard ratios (HR) for any ILD in PsA vs. RA were estimated in Cox regression models adjusted for age, gender and repeated observations, and stratified for the use of MTX co-medication.Results:Overall 47 987 individual patients representing 89 239 bDMARD treatment courses and contributing 201 279 PYR were included in the study (Table 1). Methotrexate was reported as comedication in 29 916 (33.5 %) of the treatment courses (PsA vs. RA, 30.4 % vs 34.5 %). 970 cases of ILD were identified during the follow-up period. The risk of ILD was consistently lower in patients with PsA compared to patients with RA in all countries. In models stratified for co-medication the HR for ILD in PsA vs. RA was 0.34 (0.21-0.57) in patients treated with MTX and 0.26 (0.18-0.36) in patients not treated with MTX.Table 1.Interstitial lung disease in PsA vs. RA in five Nordic biologic registersDENMARKFINLANDICELANDNORWAYSWEDENRAPsARAPsARAPsARAPsARAPsANumber of individuals78293386494610916754701590999205966393Number of treatment courses17 07266408634184512808592379142738 27910 824Age baseline (SD)57.3 (13.1)49.0 (12.6)53.8 (13.4)48.8 (11.4)53.9 (14.2)50.1 (13.3)53.8 (13.7)48.7 (12.0)57.1 (13.7)50.6 (12.8)Female n (%)12 963 (76)3929 (59)6571 (76)933 (51)969 (76)551 (65)1815 (77)818 (57)29 635 (77)6162 (57)Number of PYR4023513986217984910451727994556265312033427412ILD-events within PYR2182213287232668028IR pr 1000 PYR5.41.66.11.61.50.77.02.35.71.0IRR PsA vs RA crude0.29 (0.18-0.45)0.27 (0.11-0.55)0.46 (0.05-2.42)0.32(0.11-0.78)0.18 (0.12-0.26)HR PsA vs RA0.31 (0.17-0.56)0.46 (0.22-0.96)0.62 (0.12-3.14)0.19 (0.06-0.54)0.25 (0.17-0.37)PYR: Patient years at risk, IR: Incidence rates, IRR: Incidence rate ratios, HR: Hazard RatiosConclusion:In these preliminary analyses, the incidence of ILD is lower in bDMARD treated PsA vs. RA patients, irrespective of co-medication with MTX. This indicates that the clinician should consider the rheumatological diagnosis when assessing the risk for future ILD in patients treated with bDMARDs and MTX.Acknowledgements:Partly funded by NordForsk and FOREUMDisclosure of Interests:Sella Aarrestad Provan Consultant of: Novartis, Grant/research support from: Boehringer-Ingelheim, Brigitte Michelsen: None declared, Lotta Ljung: None declared, Thorarinn Jonmundsson: None declared, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Daniela Di Giuseppe: None declared, Merete Lund Hetland Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Consultant of: Eli Lilly, Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Guðrún Björk Reynisdóttir: None declared, Bente Glintborg: None declared, Eirik kristianslund: None declared, Heikki Relas: None declared, Kalle Aaltonen: None declared, Dan Nordström Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB., Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi., Consultant of: AbbVie, Amgren, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Roche, Sandoz, Sanofi., Johan Askling Grant/research support from: Abbvie, BMS, Eli Lilly, Merck, Pfizer, Roche, Samsung Bioepis, and Sanofi
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Glintborg B, Lindström U, DI Giuseppe D, Aarrestad Provan S, Gudbjornsson B, Hetland ML, Michelsen B, Wallman JK, Aaltonen K, Hokkanen AM, Schjødt Jørgensen T, Hansen RL, Geirsson AJ, Grøn KL, Steen Krogh N, Askling J, Kristensen LE, Jacobsson LTH. FRI0275 ONE-YEAR TREATMENT RETENTION OF SECUKINUMAB VERSUS TUMOR NECROSIS FACTOR INHIBITORS IN SPONDYLOARTHRITIS. RESULTS FROM FIVE NORDIC BIOLOGIC REGISTRIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tumor necrosis factor inhibitors (TNFi) have been available for more than a decade for treatment of spondyloarthrtitis (SpA). Secukinumab (SEC) represents a new mode of action, but few studies have compared outcomes in patients(pts) treated with SEC vs TNFi – and the optimal treatment strategy in routine care remains to be established. Comparative studies between SEC and adalimumab (ADA) are ongoing.Objectives:To describe baseline characteristics and compare 1-yr treatment retention of SEC vs TNFi (ADA/certolizumab pegol(CLZ)/etanercept(ETN)/golimumab(GOL)/infliximab(IFX)) in SpA-pts from 5 Nordic countries.Methods:Observational, prospective cohort study. Pts with SpA (ankylosing spondylitis/non-radiographic axial SpA/undifferentiated SpA) starting SEC or any TNFi during 2015-2018 were identified in clinical rheumatology registries of the Nordic countries. Baseline characteristics were retrieved. Country-specific data were pooled. 1-yr treatment retention of SEC vs TNFi was assessed through crude survival probability curves, retention rates and adjusted Cox regression analyses (ADA reference). Analyses were stratified by line of bDMARD and TNFi type.Results:In total, 10692 treatment courses (834 SEC, 9858 TNFi) in 7952 patients were included. SEC was rarely used as 1stbDMARD (Table 1), whereas it was the drug most frequently used as 3rd+ line (Table 2). Baseline characteristics were numerically similar for SEC vs TNFi (Table 1).Table 1.Patient characteristics at treatment start1stline2ndline3rd+ lineSECTNFiSECTNFiSECTNFiN70518615626056082067Male, %535544534546Age, yrs45 (14)41 (14)45 (12)44 (13)47 (12)46 (13)BASDAI, mm45 (28)53 (22)52 (22)52 (24)63 (22)58 (24)Concomitant csDMARD, %182723232726Means (SD) unless otherwise statedTable 2.Table 2. 1-yr treatment retention (Kaplan Meier, Cox Regression)DrugRetentions rates, 1 yr % (95% CI)Adjusted* HR (95% CI) for discontinuation1stlineADA76 (73-79)1CLZ68 (63-72)1.4 (1.1-1.8)ETN74 (71-76)1.1 (0.9-1.3)GOL80 (77-84)0.8 (0.6-1.0)IFX65 (62-67)1.5 (1.3-1.8)SEC76 (62-85)0.9 (0.5-1.6)2ndlineADA72 (68-75)1CLZ58 (51-64)1.5 (1.2-1.9)ETN65 (61-68)1.2 (1.0-1.5)GOL73 (67-77)0.9 (0.7-1.2)IFX67 (63-71)1.2 (0.9-1.5)SEC67 (58-74)1.1 (0.8-1.5)3rd+ lineADA73 (68-77)1CLZ52 (46-57)2.0 (1.6-2.6)ETN65 (61-70)1.3 (1.0-1.6)GOL65 (60-70)1.3 (1.0-1.7)IFX61 (56-66)1.5 (1.2-1.9)SEC61 (57-65)1.4 (1.1-1.8)* by sex, baseline age, BASDAI, concomitant csDMARD (y/n/missing). Pts with missing baseline BASDAI (41-60%) excluded1-yr treatment retention varied between the TNFi (Figure,Table 2), with SEC showing retention rates comparable to ADA when used as 1stor 2ndline therapy. However, SEC retention was poorer than ADA when used as 3rd+ therapy, but comparable to retention of other TNFi.In adjusted Cox regression analyses, confidence intervals were wide and included 1 for SEC vs ADA (1st, 2ndline), whereas there was slightly poorer retention of SEC versus ADA when used as 3rd+ bDMARD (Table 2).Conclusion:These observational data in >10.000 biological treatment courses in SpA, showed that SEC was mainly used in bDMARD experienced pts. Baseline characteristics were similar in pts treated with SEC vs TNFi. The 1-yr retention for SEC was similar to that of the TNFi when used as 1stor 2ndline, but poorer than ADA regarding 3rd+ courses. Further analyses are planned to explore confounding by indication and channeling towards treatment.Acknowledgments:Glintborg/Lindström shared 1st author, Kristensten/Jacobsson shared last.Partly funded by NordForsk and FOREUMDisclosure of Interests:Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Ulf Lindström: None declared, Daniela Di Giuseppe: None declared, Sella Aarrestad Provan Consultant of: Novartis, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Kalle Aaltonen: None declared, Anna-Mari Hokkanen Grant/research support from: MSD, Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly, Rebekka L. Hansen: None declared, Arni Jon Geirsson: None declared, Kathrine L. Grøn Grant/research support from: BMS, Niels Steen Krogh: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer
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Glintborg B, Lindström U, Aaltonen K, Kristianslund EK, Gudbjornsson B, Chatzidionysiou K, Askling J, Nordström D, Hetland ML, Di Giuseppe D, Dreyer L, Kristensen LE, Jørgensen TS, Eklund K, Grondal G, Ernestam S, Joensuu J, Törmänen MRK, Skydsgaard H, Hagfors J, Kvien TK, Lie E, Fagerli K, Geirsson AJ, Jonsson H, Provan SA, Krogh NS, Jacobsson LTH. Biological treatment in ankylosing spondylitis in the Nordic countries during 2010–2016: a collaboration between five biological registries. Scand J Rheumatol 2018; 47:465-474. [DOI: 10.1080/03009742.2018.1444199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - EK Kristianslund
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - B Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - K Chatzidionysiou
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - D Nordström
- Department of Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - ML Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - D Di Giuseppe
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Dreyer
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - LE Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - TS Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - K Eklund
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - G Grondal
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - S Ernestam
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Joensuu
- Faculty of Pharmacy, University of Helsinki, Helsinki,Finland
| | - MRK Törmänen
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - H Skydsgaard
- The Danish Rheumatism Association, Copenhagen, Denmark
| | - J Hagfors
- Norwegian Rheumatism Association, Oslo, Norway
| | - TK Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Lie
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - K Fagerli
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - AJ Geirsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H Jonsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - SA Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Larsson AM, Jansson S, Bendahl PO, Baker S, Bergqvist M, Aaltonen K, Rydén L. Abstract P3-08-13: Serum thymidine kinase activity is an independent prognostic factor for progression-free and overall survival in women with metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Although prognosis and treatment of metastatic breast cancer (MBC) have improved over the last years, there is still an unmet clinical need for more precise prognostic and treatment monitoring tools. Liquid-based markers are preferred since they reflect real-time tumor progression and are not dependent on repeated invasive tissue biopsies. Thymidine kinase 1 (TK1) is an enzyme involved in nucleotide metabolism and has a fundamental role in the DNA synthesis. It can be used as a marker of cell proliferation rate and the TK1 activity has demonstrated correlations to prognosis and usefulness for treatment monitoring in different malignancies. The aim of this study was to determine serum TK1 activity (sTK1) levels measured with the DiviTum assay (Biovica, Sweden), in women with MBC scheduled for 1st line systemic therapy and to evaluate its potential for prediction of outcome and treatment monitoring.
Methods:
142 women with MBC scheduled for 1st line systemic treatment and included in a prospective monitoring trial (CTC-MBC, NCT01322893) were evaluated for sTK1 at baseline (BL) and during treatment at 1, 3 and 6 months. 132 patients had at least one follow-up sample. sTK1 activity levels were measured and correlations to important clinicopathological variables and prognosis (PFS and OS) at BL and during treatment were evaluated.
Results:
The median sTK1 level at BL was 391 u/L (range 10-35520 u/L). When comparing patients with high (above median) versus low (below median) sTK1 levels at BL, high sTK1 levels were found to be associated to worse performance status (p=0.001) and high number of metastatic sites (p=0.03). There was also a statistically significant association between high sTK1 levels and high Ki67 expression in biopsies from metastatic lesions (p=0.038). In univariable analyses high sTK1 levels correlated to worse PFS and OS (HRPFS-BL 2.32, p<0.001; HROS-BL 2.54, p<0.001) at BL. In multivariable analysis adjusted for clinically used prognostic factors, sTK1 was an independent prognostic factor for PFS and OS (HRPFS-BL 2.4, p<0.001; HROS-BL 2.0, p=0.01). During treatment, sTK1 was significantly associated with OS from each of the four time points and onwards (BL, 1, 3, 6 months) (HROS-1m 1.93, p=0.01; HROS-3m 2.35, p=0.02; HROS-6m 2.78, p=0.002) in univariable analysis. High sTK1 levels were also associated with impaired PFS (HRPFS-1m 1.48, p=0.06; HRPFS-3m 1.52, p=0.07; HRPFS-6m 2.03, p=0.009) and these associations were significant at BL and 6 months.
Discussion:
sTK1 activity level is an independent prognostic factor for PFS and OS in patients with MBC scheduled for 1st line systemic therapy. During treatment, sTK1 is prognostic for OS evaluated from all time-points up to 6 months. The sTK1 effects observed for PFS are slightly weaker, but still propose potential usefulness for treatment monitoring. Further, sTK1 levels correlate to Ki67 expression in metastatic lesions suggesting that it can be useful as a liquid-based real-time proliferation marker. In conclusion, these results are clinically relevant for prognostication and treatment monitoring in patients with MBC. Future studies of sTK1 are justified to further elucidate in what settings this marker is most useful.
Citation Format: Larsson A-M, Jansson S, Bendahl P-O, Baker S, Bergqvist M, Aaltonen K, Rydén L. Serum thymidine kinase activity is an independent prognostic factor for progression-free and overall survival in women with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-13.
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Affiliation(s)
- A-M Larsson
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - S Jansson
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - P-O Bendahl
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - S Baker
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - M Bergqvist
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - K Aaltonen
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
| | - L Rydén
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Biovica International AB, Uppsala, Sweden; Skåne University Hospital, Malmö, Sweden
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Loman N, Chen Y, Aaltonen K, Brueffer C, George AM, Zander L, Vallon-Christersson J, Häkkinen J, Förnvik D, Rigo R, Ehinger A, Malmberg M, Larsson C, Hegardt C, Borg Å, Rydén L, Saal LH. Abstract P2-02-09: Breast cancer subtype distribution and circulating tumor DNA in response to neoadjuvant chemotherapy: Experiences from a preoperative cohort within SCAN-B. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Preoperative chemotherapy in early breast cancer increases the rate of breast preservation and provides prognostic information. In the case of residual disease, a change in subtypes may be observed. Sensitive and reproducible biomarkers predicting treatment response early during the treatment course are needed in order to better exploit the potential benefit of an individualized preoperative treatment.
Material and Methods: In an ongoing prospective study within the population-based SCAN-B project (NCT02306096), patients undergoing preoperative chemotherapy for early or locally recurrent breast cancer have been treated with iv Epirubicin and Cyclophosphamide q3w x 3 in sequence with either Docetaxel q3w x 3 or Paclitaxel q1w x 9 with a preoperative intent. HER2-positive cases also received HER2-directed treatment. At baseline, patients were staged using sentinel node biopsy for clinically node-negative patients and CT scan for cytologically confirmed node-positive cases. A clinical core needle biopsy as well as tissue from the surgical specimen was collected for determination of conventional biomarkers including ER, PgR, HER2 and Ki67. Tumor biopsies for biomolecule-extraction and RNA-sequencing were taken using ultrasound guidance and collected fresh in RNAlater at baseline, after 2 treatment cycles, as well as at surgery. Blood plasma samples were collected at baseline, after one-, three-, and six- 3w treatment cycles, and post-surgery. Using RNA-sequencing data, somatic mutations were identified in the tumor biopsies and personalized analyses for circulating tumor DNA (ctDNA) were performed. A pathological complete remission (pCR) was defined as the complete disappearance of invasive breast cancer in the breast and axilla at time of definitive surgery. Subtyping was performed using modified St Gallen criteria (2013).
Results: Thus far, 45 patients aged 24-74 years have been included, of which 34 (76 %) were clinical stage 2 and 11 (24%) were stage 3. The subtype distribution at baseline was five Luminal A-like (11 %), 21 Luminal B-like (HER2 negative) (47 %), 8 HER2-positive (18 %) and 11 Triple-negative (ductal) (24 %). The rates of pCR in 38 operated cases to date were 0/3 Luminal A-like, 3/19 Luminal B-like (HER2 negative), 2/8 HER2-positive, and 4/7 Triple-negative (overall 24 % pCR rate). One patient did not undergo surgery due to clinically progressive disease. In 25 cases with evaluable residual disease at surgery, there was a shift in the subtype in 13 (52 %), the majority of which represented a transition from Luminal B to Luminal A. No Triple-negative cases underwent a change in subtype during treatment. Results of the ctDNA analyses will be presented at the meeting.
Discussion: We have established an infrastructure allowing for an extensive evaluation of preoperative chemotherapy in early breast cancer. The goal is to develop methods to refine response-guided treatment in early breast cancer using molecular responses in the tumor as well as in the blood circulation. The patients continue to be prospectively monitored with iterative ctDNA analyses during follow-up.
Citation Format: Loman N, Chen Y, Aaltonen K, Brueffer C, George AM, Zander L, Vallon-Christersson J, Häkkinen J, Förnvik D, Rigo R, Ehinger A, Malmberg M, Larsson C, Hegardt C, Borg Å, Rydén L, Saal LH. Breast cancer subtype distribution and circulating tumor DNA in response to neoadjuvant chemotherapy: Experiences from a preoperative cohort within SCAN-B [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-09.
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Affiliation(s)
- N Loman
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - Y Chen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - K Aaltonen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Brueffer
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - AM George
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - L Zander
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - J Vallon-Christersson
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - J Häkkinen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - D Förnvik
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - R Rigo
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - A Ehinger
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - M Malmberg
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Larsson
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Hegardt
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - Å Borg
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - L Rydén
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - LH Saal
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. Three out of four disease-modifying anti-rheumatic drug-naïve rheumatoid arthritis patients meet 28-joint Disease Activity Score remission at 12 months: results from the FIN-ERA cohort. Scand J Rheumatol 2017; 46:425-431. [DOI: 10.1080/03009742.2016.1266029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - J Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - P Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - T Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - P Ekman
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - L Pirilä
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - L Kuusalo
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Mali
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Puurtinen-Vilkki
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - S Kortelainen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - J Paltta
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - K Taimen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - K Laiho
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - S Nyrhinen
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - H Mäkinen
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - P Isomäki
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - T Uotila
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - K Aaltonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - T Sokka
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Aaltonen K, Rosenström T, Baryshnikov I, Karpov B, Melartin T, Näätänen P, Heikkinen M, Koivisto M, Suominen K, Joffe G, Isometsä E. A Mediation Analysis of Childhood Maltreatment and Suicidal Behavior among Patients with Depressive or Bipolar Disorders. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionSubstantial evidence supports association between childhood maltreatment and suicidal behaviour, however, a limited number of studies have examined psychological mechanisms mediating the relationship among patients with mood disorders.ObjectiveTo investigate directly the potential intermediating mechanisms between childhood maltreatment and suicidal behaviour among patients with mood disorders.AimsWe examine by formal mediation analyses, if:– the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits;– the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.MethodsDepressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki university psychiatric consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts.ResultsThe influence of childhood maltreatment on lifetime suicidal ideation and lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only 21% of the total effect on lifetime suicide ideation. The mediation effect was stronger for lifetime suicide attempts compared to ideation (P = 0.002) and independent of current depressive symptoms.ConclusionsThe mechanisms of the effect of childhood maltreatment on suicidal ideation and attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicide ideation.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Baryshnikov I, Suvisaari J, Aaltonen K, Koivisto M, Melartin T, Näätänen P, Suominen K, Karpov B, Heikkinen M, Oksanen J, Paunio T, Joffe G, Isometsä E. Self-reported psychosis-like experiences in patients with mood disorders. Eur Psychiatry 2017; 51:90-97. [PMID: 28797561 DOI: 10.1016/j.eurpsy.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Self-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. METHODS The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n=282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE. RESULTS PEs are common in patients with mood disorders. The "frequency of positive symptoms" score of CAPE-42 correlated strongly with total score of SPQ-B (rho=0.63; P<0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied from 0.37 to 0.56; P<0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (rφ varied from 0.2 to 0.5; P<0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the "frequency of positive symptoms" score of CAPE-42. CONCLUSIONS Several, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms.
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Affiliation(s)
- I Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - B Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Oksanen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland.
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Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Näätänen P, Koivisto M, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Isometsä E. Anxiety symptoms in a major mood and schizophrenia spectrum disorders. Eur Psychiatry 2016; 37:1-7. [PMID: 27447101 DOI: 10.1016/j.eurpsy.2016.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. METHODS The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. RESULTS Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P=0.010) and less often avoided anxiety-provoking situations (P=0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. CONCLUSIONS Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis.
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Affiliation(s)
- B Karpov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - I Baryshnikov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, Helsinki University Central Hospital, PO Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - K Suominen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland.
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. SAT0090 Three out of Every Four Patients with Dmard-Naive Early Rheumatoid Arthritis Meet DAS28 Remission at 12 Months in Finland. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baryshnikov I, Suvisaari J, Aaltonen K, Koivisto M, Näätänen P, Karpov B, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Joffe G, Isometsä E. Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders. Eur Psychiatry 2016; 33:37-44. [PMID: 26854985 DOI: 10.1016/j.eurpsy.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Distinguishing between symptoms of schizotypal (SPD) and borderline personality disorders (BPD) is often difficult due to their partial overlap and frequent co-occurrence. We investigated correlations in self-reported symptoms of SPD and BPD in questionnaires at the levels of both total scores and individual items, examining overlapping dimensions. METHODS Two questionnaires, the McLean Screening Instrument (MSI) for BPD and the Schizotypal Personality Questionnaire Brief (SPQ-B) for SPD, were filled in by patients with mood disorders (n=282) from specialized psychiatric care in a study of the Helsinki University Psychiatric Consortium. Correlation coefficients between total scores and individual items of the MSI and SPQ-B were estimated. Multivariate regression analysis (MRA) was conducted to examine the relationships between SPQ-B and MSI. RESULTS The Spearman's correlation between total scores of the MSI and SPQ-B was strong (rho=0.616, P<0.005). Items of MSI reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P<0.005) with items of SPQ. Items of MSI reflecting behavioural dysregulation correlated only weakly with items of SPQ. In MRA, depressive symptoms, sex and MSI were significant predictors of SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of MSI score. CONCLUSIONS Items reflecting cognitive-perceptual distortions and affective symptoms of BPD appear to overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPQ-B, and symptoms of anxiety features of MSI. Symptoms of behavioural dysregulation of BPD and interpersonal deficits of SPQ appear to be non-overlapping.
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Affiliation(s)
- I Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 166, 00271 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - B Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Department of Social Services and Health Care, Helsinki, Finland
| | - K Suominen
- City of Helsinki, Social Services and Healthcare, Helsinki, Finland; Aurora Hospital, P.O. Box 6800, 00099 Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, Mannerheimintie 166, 00271 Helsinki, Finland.
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Nordgren H, Aaltonen K, Sironen T, Kinnunen P, Kivistö I, Raunio-Saarnisto M, Moisander-Jylhä AM, Korpela J, Kokkonen UM, Hetzel U, Sukura A, Vapalahti O. Fur Animal Epidemic Necrotic Pyoderma. J Comp Pathol 2016. [DOI: 10.1016/j.jcpa.2015.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Knuuttila A, Aaltonen K, Virtala AMK, Henttonen H, Isomursu M, Leimann A, Maran T, Saarma U, Timonen P, Vapalahti O, Sironen T. Aleutian mink disease virus in free-ranging mustelids in Finland – a cross-sectional epidemiological and phylogenetic study. J Gen Virol 2015; 96:1423-1435. [DOI: 10.1099/vir.0.000081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/02/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- A. Knuuttila
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - K. Aaltonen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - A.-M. K. Virtala
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - H. Henttonen
- Natural Resources Institute Finland, Vantaa Unit, Finland
| | - M. Isomursu
- Finnish Food Safety Authority, Production Animal and Wildlife Health Research Unit, Oulu, Finland
| | - A. Leimann
- Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - T. Maran
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Species Conservation Lab, Tallinn Zoological Gardens, Tallinn, Estonia
| | - U. Saarma
- Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - P. Timonen
- Natural Resources Institute Finland, Oulu Unit, Finland
| | - O. Vapalahti
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - T. Sironen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Michailidou K, Beesley J, Lindstrom S, Canisius S, Dennis J, Lush MJ, Maranian MJ, Bolla MK, Wang Q, Shah M, Perkins BJ, Czene K, Eriksson M, Darabi H, Brand JS, Bojesen SE, Nordestgaard BG, Flyger H, Nielsen SF, Rahman N, Turnbull C, Fletcher O, Peto J, Gibson L, dos-Santos-Silva I, Chang-Claude J, Flesch-Janys D, Rudolph A, Eilber U, Behrens S, Nevanlinna H, Muranen TA, Aittomäki K, Blomqvist C, Khan S, Aaltonen K, Ahsan H, Kibriya MG, Whittemore AS, John EM, Malone KE, Gammon MD, Santella RM, Ursin G, Makalic E, Schmidt DF, Casey G, Hunter DJ, Gapstur SM, Gaudet MM, Diver WR, Haiman CA, Schumacher F, Henderson BE, Le Marchand L, Berg CD, Chanock SJ, Figueroa J, Hoover RN, Lambrechts D, Neven P, Wildiers H, van Limbergen E, Schmidt MK, Broeks A, Verhoef S, Cornelissen S, Couch FJ, Olson JE, Hallberg E, Vachon C, Waisfisz Q, Meijers-Heijboer H, Adank MA, van der Luijt RB, Li J, Liu J, Humphreys K, Kang D, Choi JY, Park SK, Yoo KY, Matsuo K, Ito H, Iwata H, Tajima K, Guénel P, Truong T, Mulot C, Sanchez M, Burwinkel B, Marme F, Surowy H, Sohn C, Wu AH, Tseng CC, Van Den Berg D, Stram DO, González-Neira A, Benitez J, Zamora MP, Perez JIA, Shu XO, Lu W, Gao YT, Cai H, Cox A, Cross SS, Reed MWR, Andrulis IL, Knight JA, Glendon G, Mulligan AM, Sawyer EJ, Tomlinson I, Kerin MJ, Miller N, Lindblom A, Margolin S, Teo SH, Yip CH, Taib NAM, Tan GH, Hooning MJ, Hollestelle A, Martens JWM, Collée JM, Blot W, Signorello LB, Cai Q, Hopper JL, Southey MC, Tsimiklis H, Apicella C, Shen CY, Hsiung CN, Wu PE, Hou MF, Kristensen VN, Nord S, Alnaes GIG, Giles GG, Milne RL, McLean C, Canzian F, Trichopoulos D, Peeters P, Lund E, Sund M, Khaw KT, Gunter MJ, Palli D, Mortensen LM, Dossus L, Huerta JM, Meindl A, Schmutzler RK, Sutter C, Yang R, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Hartman M, Miao H, Chia KS, Chan CW, Fasching PA, Hein A, Beckmann MW, Haeberle L, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Ashworth A, Orr N, Schoemaker MJ, Swerdlow AJ, Brinton L, Garcia-Closas M, Zheng W, Halverson SL, Shrubsole M, Long J, Goldberg MS, Labrèche F, Dumont M, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Brauch H, Hamann U, Brüning T, Radice P, Peterlongo P, Manoukian S, Bernard L, Bogdanova NV, Dörk T, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Devilee P, Tollenaar RAEM, Seynaeve C, Van Asperen CJ, Jakubowska A, Lubinski J, Jaworska K, Huzarski T, Sangrajrang S, Gaborieau V, Brennan P, McKay J, Slager S, Toland AE, Ambrosone CB, Yannoukakos D, Kabisch M, Torres D, Neuhausen SL, Anton-Culver H, Luccarini C, Baynes C, Ahmed S, Healey CS, Tessier DC, Vincent D, Bacot F, Pita G, Alonso MR, Álvarez N, Herrero D, Simard J, Pharoah PPDP, Kraft P, Dunning AM, Chenevix-Trench G, Hall P, Easton DF. Genome-wide association analysis of more than 120,000 individuals identifies 15 new susceptibility loci for breast cancer. Nat Genet 2015; 47:373-80. [PMID: 25751625 PMCID: PMC4549775 DOI: 10.1038/ng.3242] [Citation(s) in RCA: 427] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023]
Abstract
Genome-wide association studies (GWAS) and large-scale replication studies have identified common variants in 79 loci associated with breast cancer, explaining ∼14% of the familial risk of the disease. To identify new susceptibility loci, we performed a meta-analysis of 11 GWAS, comprising 15,748 breast cancer cases and 18,084 controls together with 46,785 cases and 42,892 controls from 41 studies genotyped on a 211,155-marker custom array (iCOGS). Analyses were restricted to women of European ancestry. We generated genotypes for more than 11 million SNPs by imputation using the 1000 Genomes Project reference panel, and we identified 15 new loci associated with breast cancer at P < 5 × 10(-8). Combining association analysis with ChIP-seq chromatin binding data in mammary cell lines and ChIA-PET chromatin interaction data from ENCODE, we identified likely target genes in two regions: SETBP1 at 18q12.3 and RNF115 and PDZK1 at 1q21.1. One association appears to be driven by an amino acid substitution encoded in EXO1.
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Affiliation(s)
- Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Beesley
- Department of Genetics, QIMR (Queensland Institute for Medical Research) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sara Lindstrom
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sander Canisius
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael J Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mel J Maranian
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Barbara J Perkins
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stig E Bojesen
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [3] Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [3] Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F Nielsen
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Nazneen Rahman
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorna Gibson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Flesch-Janys
- 1] Department of Cancer Epidemiology/Clinical Cancer Registry, University Clinic Hamburg-Eppendorf, Hamburg, Germany. [2] Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Eilber
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Sofia Khan
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Habibul Ahsan
- 1] Center for Cancer Epidemiology and Prevention, University of Chicago, Chicago, Illinois, USA. [2] Department of Health Studies, University of Chicago, Chicago, Illinois, USA. [3] Department of Medicine, University of Chicago, Chicago, Illinois, USA. [4] Department of Human Genetics, University of Chicago, Chicago, Illinois, USA. [5] Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Muhammad G Kibriya
- 1] Center for Cancer Epidemiology and Prevention, University of Chicago, Chicago, Illinois, USA. [2] Department of Health Studies, University of Chicago, Chicago, Illinois, USA
| | - Alice S Whittemore
- 1] Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, Stanford, California, USA. [2] Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Esther M John
- 1] Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, Stanford, California, USA. [2] Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA. [3] Department of Epidemiology, Cancer Prevention Institute of California, Fremont, California, USA
| | - Kathleen E Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Enes Makalic
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, Melbourne, Victoria, Australia
| | - Daniel F Schmidt
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, Melbourne, Victoria, Australia
| | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Christine D Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Diether Lambrechts
- 1] Vesalius Research Center, VIB, Leuven, Belgium. [2] Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Erik van Limbergen
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Senno Verhoef
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Sten Cornelissen
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Quinten Waisfisz
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Muriel A Adank
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Rob B van der Luijt
- Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daehee Kang
- 1] Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. [2] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [3] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Ji-Yeob Choi
- 1] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [2] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sue K Park
- 1] Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. [2] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [3] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine, Seoul, Korea
| | - Keitaro Matsuo
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Tajima
- Epidemiology Center for Disease Control and Prevention, Mie University Hospital, Tsu, Japan
| | - Pascal Guénel
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Thérèse Truong
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Claire Mulot
- Université Paris Sorbonne Cité, UMRS 775, INSERM, Paris, France
| | - Marie Sanchez
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Barbara Burwinkel
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Marme
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Harald Surowy
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chiu-chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anna González-Neira
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Javier Benitez
- 1] Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. [2] Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - M Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Xiao-Ou Shu
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Changning, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Hui Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Angela Cox
- 1] Sheffield Cancer Research Centre, University of Sheffield, Sheffield, UK. [2] Department of Oncology, University of Sheffield, Sheffield, UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Malcolm W R Reed
- 1] Sheffield Cancer Research Centre, University of Sheffield, Sheffield, UK. [2] Department of Oncology, University of Sheffield, Sheffield, UK
| | - Irene L Andrulis
- 1] Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada. [2] Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julia A Knight
- 1] Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada. [2] Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- 1] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. [2] Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Elinor J Sawyer
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Ian Tomlinson
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Michael J Kerin
- Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Nicola Miller
- Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Soo Hwang Teo
- 1] Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Malaysia. [2] Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Gie-Hooi Tan
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - John W M Martens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - William Blot
- 1] Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. [2] International Epidemiology Institute, Rockville, Maryland, USA
| | - Lisa B Signorello
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Qiuyin Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Tsimiklis
- Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chen-Yang Shen
- 1] Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [2] Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [3] School of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Pei-Ei Wu
- 1] Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [2] Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ming-Feng Hou
- 1] Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan. [2] Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Vessela N Kristensen
- 1] Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway. [2] Institute of Clinical Medicine, University of Oslo, Oslo, Norway. [3] Department of Clinical Molecular Biology (EpiGen), University of Oslo, Oslo, Norway
| | - Silje Nord
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Grethe I Grenaker Alnaes
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Graham G Giles
- 1] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. [2] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Roger L Milne
- 1] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. [2] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimitrios Trichopoulos
- 1] Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece. [3] Hellenic Health Foundation, Athens, Greece
| | - Petra Peeters
- 1] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. [2] Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - Kay-Tee Khaw
- School of Clinical Medicine, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | | | - Laure Dossus
- 1] INSERM Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France. [2] Université Paris-Sud, Villejuif, France
| | - Jose-Maria Huerta
- Department of Epidemiology, Consejería de Sanidad y Política Social, CIBER de Epidemiología y Salud Pública, Murcia, Spain
| | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Rita K Schmutzler
- 1] Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany. [2] Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany. [3] Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Rongxi Yang
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kenneth Muir
- 1] Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK. [2] Institute of Population Health, University of Manchester, Manchester, UK
| | - Artitaya Lophatananon
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | | | - Mikael Hartman
- 1] Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. [2] Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ching Wan Chan
- Division of General Surgery, National University Health System, Singapore
| | - Peter A Fasching
- 1] Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany. [2] Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Hermann Brenner
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aida Karina Dieffenbach
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Nick Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Anthony J Swerdlow
- 1] Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK. [2] Division of Breast Cancer Research, Institute of Cancer Research, London, UK
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Montserrat Garcia-Closas
- 1] Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK. [2] Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Wei Zheng
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sandra L Halverson
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Martha Shrubsole
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jirong Long
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mark S Goldberg
- 1] Department of Medicine, McGill University, Montreal, Quebec, Canada. [2] Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - France Labrèche
- 1] Département de Santé Environnementale et Santé au Travail, Ecole de Santé Publique, Université de Montréal, Montreal, Quebec, Canada. [2] Département de Médecine Sociale et Préventive, Ecole de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Martine Dumont
- 1] Centre Hospitalier Universitaire de Québec Research Center, Quebec City, Quebec, Canada. [2] Department of Molecular Medicine, Laval University, Quebec City, Quebec, Canada
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | | | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Hiltrud Brauch
- 1] German Cancer Consortium (DKTK), Heidelberg, Germany. [2] Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany. [3] University of Tübingen, Tübingen, Germany. [4] German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Paolo Peterlongo
- Fondazione Istituto FIRC (Italian Foundation for Cancer Research) di Oncologia Molecolare (IFOM), Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Loris Bernard
- 1] Department of Experimental Oncology, Istituto Europeo di Oncologia, Milan, Italy. [2] Cogentech Cancer Genetic Test Laboratory, Milan, Italy
| | - Natalia V Bogdanova
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Arto Mannermaa
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- 1] Cancer Center, Kuopio University Hospital, Kuopio, Finland. [2] Central Finland Hospital District, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Veli-Matti Kosma
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Jaana M Hartikainen
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Peter Devilee
- 1] Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert A E M Tollenaar
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Christi J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda E Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Ohio State University, Columbus, Ohio, USA
| | | | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, Institute of Radioisotopes and Radiodiagnostic Products (IRRP), National Centre for Scientific Research 'Demokritos', Aghia Paraskevi Attikis, Athens, Greece
| | - Maria Kabisch
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diana Torres
- 1] Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] Institute of Human Genetics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California-Irvine, Irvine, California, USA
| | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Shahana Ahmed
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Catherine S Healey
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Daniel C Tessier
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Daniel Vincent
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Francois Bacot
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Guillermo Pita
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - M Rosario Alonso
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Nuria Álvarez
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Daniel Herrero
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Jacques Simard
- 1] Centre Hospitalier Universitaire de Québec Research Center, Quebec City, Quebec, Canada. [2] Department of Molecular Medicine, Laval University, Quebec City, Quebec, Canada
| | - Paul P D P Pharoah
- 1] Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [2] Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Georgia Chenevix-Trench
- Department of Genetics, QIMR (Queensland Institute for Medical Research) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Douglas F Easton
- 1] Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [2] Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
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Lin WY, Camp NJ, Ghoussaini M, Beesley J, Michailidou K, Hopper JL, Apicella C, Southey MC, Stone J, Schmidt MK, Broeks A, Van't Veer LJ, Th Rutgers EJ, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Fasching PA, Haeberle L, Ekici AB, Beckmann MW, Peto J, Dos-Santos-Silva I, Fletcher O, Johnson N, Bolla MK, Wang Q, Dennis J, Sawyer EJ, Cheng T, Tomlinson I, Kerin MJ, Miller N, Marmé F, Surowy HM, Burwinkel B, Guénel P, Truong T, Menegaux F, Mulot C, Bojesen SE, Nordestgaard BG, Nielsen SF, Flyger H, Benitez J, Zamora MP, Arias Perez JI, Menéndez P, González-Neira A, Pita G, Alonso MR, Alvarez N, Herrero D, Anton-Culver H, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Meindl A, Lichtner P, Schmutzler RK, Müller-Myhsok B, Brauch H, Brüning T, Ko YD, Tessier DC, Vincent D, Bacot F, Nevanlinna H, Aittomäki K, Blomqvist C, Khan S, Matsuo K, Ito H, Iwata H, Horio A, Bogdanova NV, Antonenkova NN, Dörk T, Lindblom A, Margolin S, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Wu AH, Tseng CC, Van Den Berg D, Stram DO, Neven P, Wauters E, Wildiers H, Lambrechts D, Chang-Claude J, Rudolph A, Seibold P, Flesch-Janys D, Radice P, Peterlongo P, Manoukian S, Bonanni B, Couch FJ, Wang X, Vachon C, Purrington K, Giles GG, Milne RL, Mclean C, Haiman CA, Henderson BE, Schumacher F, Le Marchand L, Simard J, Goldberg MS, Labrèche F, Dumont M, Teo SH, Yip CH, Hassan N, Vithana EN, Kristensen V, Zheng W, Deming-Halverson S, Shrubsole MJ, Long J, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Kauppila S, Andrulis IL, Knight JA, Glendon G, Tchatchou S, Devilee P, Tollenaar RAEM, Seynaeve C, Van Asperen CJ, García-Closas M, Figueroa J, Lissowska J, Brinton L, Czene K, Darabi H, Eriksson M, Brand JS, Hooning MJ, Hollestelle A, Van Den Ouweland AMW, Jager A, Li J, Liu J, Humphreys K, Shu XO, Lu W, Gao YT, Cai H, Cross SS, Reed MWR, Blot W, Signorello LB, Cai Q, Pharoah PDP, Perkins B, Shah M, Blows FM, Kang D, Yoo KY, Noh DY, Hartman M, Miao H, Chia KS, Putti TC, Hamann U, Luccarini C, Baynes C, Ahmed S, Maranian M, Healey CS, Jakubowska A, Lubinski J, Jaworska-Bieniek K, Durda K, Sangrajrang S, Gaborieau V, Brennan P, Mckay J, Slager S, Toland AE, Yannoukakos D, Shen CY, Hsiung CN, Wu PE, Ding SL, Ashworth A, Jones M, Orr N, Swerdlow AJ, Tsimiklis H, Makalic E, Schmidt DF, Bui QM, Chanock SJ, Hunter DJ, Hein R, Dahmen N, Beckmann L, Aaltonen K, Muranen TA, Heikkinen T, Irwanto A, Rahman N, Turnbull CA, Waisfisz Q, Meijers-Heijboer HEJ, Adank MA, Van Der Luijt RB, Hall P, Chenevix-Trench G, Dunning A, Easton DF, Cox A. Identification and characterization of novel associations in the CASP8/ALS2CR12 region on chromosome 2 with breast cancer risk. Hum Mol Genet 2015; 24:285-98. [PMID: 25168388 PMCID: PMC4334820 DOI: 10.1093/hmg/ddu431] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/30/2014] [Accepted: 08/20/2014] [Indexed: 11/14/2022] Open
Abstract
Previous studies have suggested that polymorphisms in CASP8 on chromosome 2 are associated with breast cancer risk. To clarify the role of CASP8 in breast cancer susceptibility, we carried out dense genotyping of this region in the Breast Cancer Association Consortium (BCAC). Single-nucleotide polymorphisms (SNPs) spanning a 1 Mb region around CASP8 were genotyped in 46 450 breast cancer cases and 42 600 controls of European origin from 41 studies participating in the BCAC as part of a custom genotyping array experiment (iCOGS). Missing genotypes and SNPs were imputed and, after quality exclusions, 501 typed and 1232 imputed SNPs were included in logistic regression models adjusting for study and ancestry principal components. The SNPs retained in the final model were investigated further in data from nine genome-wide association studies (GWAS) comprising in total 10 052 case and 12 575 control subjects. The most significant association signal observed in European subjects was for the imputed intronic SNP rs1830298 in ALS2CR12 (telomeric to CASP8), with per allele odds ratio and 95% confidence interval [OR (95% confidence interval, CI)] for the minor allele of 1.05 (1.03-1.07), P = 1 × 10(-5). Three additional independent signals from intronic SNPs were identified, in CASP8 (rs36043647), ALS2CR11 (rs59278883) and CFLAR (rs7558475). The association with rs1830298 was replicated in the imputed results from the combined GWAS (P = 3 × 10(-6)), yielding a combined OR (95% CI) of 1.06 (1.04-1.08), P = 1 × 10(-9). Analyses of gene expression associations in peripheral blood and normal breast tissue indicate that CASP8 might be the target gene, suggesting a mechanism involving apoptosis.
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Affiliation(s)
- Wei-Yu Lin
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan County 333, Taiwan
| | - Nicola J Camp
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108-1266, USA
| | - Maya Ghoussaini
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | | | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health
| | | | - Jennifer Stone
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Laura J Van't Veer
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Emiel J Th Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Kenneth Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK Institute of Population Health, University of Manchester, Manchester M13 9QQ, UK
| | - Artitaya Lophatananon
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK
| | | | - Peter A Fasching
- University Breast Center Franconia, Department of Gynecology and Obstetrics David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California, Los Angeles, CA 90095, USA
| | - Lothar Haeberle
- University Breast Center Franconia, Department of Gynecology and Obstetrics
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen D-91054, Germany
| | | | - Julian Peto
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Isabel Dos-Santos-Silva
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | | | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Elinor J Sawyer
- Division of Cancer Studies, Kings College London, Guy's Hospital, London SE1 9RT, UK
| | - Timothy Cheng
- Wellcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK
| | - Michael J Kerin
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Nicola Miller
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Frederik Marmé
- Department of Obstetrics and Gynecology National Center for Tumor Diseases, University of Heidelberg, Heidelberg 69117, Germany
| | - Harald M Surowy
- Department of Obstetrics and Gynecology Molecular Epidemiology Group
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology Molecular Epidemiology Group
| | - Pascal Guénel
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Thérèse Truong
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Florence Menegaux
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Claire Mulot
- Université Paris Sorbonne Cité, UMR-S775 Inserm, Paris 75015, France
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Sune F Nielsen
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Javier Benitez
- Human Genetics Group, Human Cancer Genetics Program Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia 28029, Spain
| | - M Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid 28046, Spain
| | | | - Primitiva Menéndez
- Servicio de Anatomía Patológica, Hospital Monte Naranco, Oviedo 33012, Spain
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Guillermo Pita
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - M Rosario Alonso
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Nuria Alvarez
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Daniel Herrero
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Irvine, CA 92697, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research
| | | | | | - Peter Lichtner
- Insitute of Human Genetics, Technische Universität München, Munich D-80333, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, 50932 Cologne, Germany
| | | | - Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart 70376, Germany University of Tübingen, Tübingen 72074, Germany German Cancer Consortium (DKTK)
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum D-44789, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn 53113, Germany
| | - Daniel C Tessier
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Daniel Vincent
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Francois Bacot
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Sofia Khan
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Keitaro Matsuo
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka 812-8582, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Akiyo Horio
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Natalia V Bogdanova
- Department of Obstetrics and Gynaecology Department of Radiation Oncology, Hannover Medical School, Hannover 30625, Germany
| | - Natalia N Antonenkova
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk 223040, Belarus
| | - Thilo Dörk
- Department of Obstetrics and Gynaecology
| | | | | | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Oncology, University of Eastern Finland, Kuopio 70210, Finland Cancer Center, Kuopio University Hospital, Kuopio 70029, Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Jaana M Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick Neven
- University Hospital Gashuisberg, Leuven 3000, Belgium
| | - Els Wauters
- Vesalius Research Center (VRC), VIB, Leuven 3000, Belgium Department of Oncology
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB, Leuven 3000, Belgium Laboratory for Translational Genetics, Department of Oncology
| | | | | | | | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine
| | - Paolo Peterlongo
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan 20139, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan 20133, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Milan 20141, Italy
| | | | | | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Catriona Mclean
- Anatomical Pathology, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Jacques Simard
- Centre Hospitalier Universitaire de Québec Research Centre and Laval University, Quebec City, QC, Canada G1V 4G2
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, QC, Canada H3A 0G4 Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1
| | - France Labrèche
- Départements de Santé Environnementale et Santé au Travail et de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada H3T 1J4
| | - Martine Dumont
- Centre Hospitalier Universitaire de Québec Research Centre and Laval University, Quebec City, QC, Canada G1V 4G2
| | - Soo Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | - Norhashimah Hassan
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | | | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo 0372, Norway Faculty of Medicine (Faculty Division Ahus), University of Oslo (UiO), Oslo 0316, Norway
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Sandra Deming-Halverson
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, Northern Finland Laboratory Centre NordLab
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, Northern Finland Laboratory Centre NordLab
| | | | - Saila Kauppila
- Department of Pathology, Oulu University Hospital, University of Oulu, Oulu 90570, Finland
| | - Irene L Andrulis
- Ontario Cancer Genetics Network Department of Molecular Genetics
| | - Julia A Knight
- Prosserman Centre for Health Research Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 2J7
| | | | - Sandrine Tchatchou
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology
| | | | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Christi J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Montserrat García-Closas
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research Division of Genetics and Epidemiology
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw 02-781, Poland
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Maartje J Hooning
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Antoinette Hollestelle
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Ans M W Van Den Ouweland
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam 3075 EA, The Netherlands
| | - Agnes Jager
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Jingmei Li
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai 220025, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Simon S Cross
- Department of Neuroscience, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Malcolm W R Reed
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK
| | - William Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA International Epidemiology Institute, Rockville, MD 20850, USA
| | - Lisa B Signorello
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA International Epidemiology Institute, Rockville, MD 20850, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Barbara Perkins
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Fiona M Blows
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Daehee Kang
- Department of Preventive Medicine Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 151-742, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine, Seoul 110-799, Korea
| | | | - Mikael Hartman
- Saw Swee Hock School of Public Health Department of Surgery, Yong Loo Lin School of Medicine National University Health System, Singapore 119228, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health National University Health System, Singapore 119228, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health National University Health System, Singapore 119228, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | | | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Shahana Ahmed
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Mel Maranian
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Catherine S Healey
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | | | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | | | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon 69372, France
| | - James Mckay
- International Agency for Research on Cancer, Lyon 69372, France
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Amanda E Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, IRRP, National Centre for Scientific Research 'Demokritos', Aghia Paraskevi Attikis, Athens 153 10, Greece
| | - Chen-Yang Shen
- Institute of Biomedical Sciences College of Public Health, China Medical University, Taichung 40402, Taiwan
| | | | - Pei-Ei Wu
- Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Shian-Ling Ding
- Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei 11529, Taiwan
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research
| | | | - Nick Orr
- Breakthrough Breast Cancer Research Centre and Division of Breast Cancer Research, The Institute of Cancer Research, London SW3 6JB, UK
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology Division of Breast Cancer Research
| | | | - Enes Makalic
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Daniel F Schmidt
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Quang M Bui
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - David J Hunter
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne 50923, Germany
| | - Norbert Dahmen
- Department of Psychiatry, University of Mainz, Mainz 55122, Germany
| | - Lars Beckmann
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne 50670, Germany
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | | | | | - Quinten Waisfisz
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Hanne E J Meijers-Heijboer
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Muriel A Adank
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Rob B Van Der Luijt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | | | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Angela Cox
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK
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21
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Khan S, Greco D, Michailidou K, Milne RL, Muranen TA, Heikkinen T, Aaltonen K, Dennis J, Bolla MK, Liu J, Hall P, Irwanto A, Humphreys K, Li J, Czene K, Chang-Claude J, Hein R, Rudolph A, Seibold P, Flesch-Janys D, Fletcher O, Peto J, dos Santos Silva I, Johnson N, Gibson L, Aitken Z, Hopper JL, Tsimiklis H, Bui M, Makalic E, Schmidt DF, Southey MC, Apicella C, Stone J, Waisfisz Q, Meijers-Heijboer H, Adank MA, van der Luijt RB, Meindl A, Schmutzler RK, Müller-Myhsok B, Lichtner P, Turnbull C, Rahman N, Chanock SJ, Hunter DJ, Cox A, Cross SS, Reed MWR, Schmidt MK, Broeks A, Veer LJVAN, Hogervorst FB, Fasching PA, Schrauder MG, Ekici AB, Beckmann MW, Bojesen SE, Nordestgaard BG, Nielsen SF, Flyger H, Benitez J, Zamora PM, Perez JIA, Haiman CA, Henderson BE, Schumacher F, Le Marchand L, Pharoah PDP, Dunning AM, Shah M, Luben R, Brown J, Couch FJ, Wang X, Vachon C, Olson JE, Lambrechts D, Moisse M, Paridaens R, Christiaens MR, Guénel P, Truong T, Laurent-Puig P, Mulot C, Marme F, Burwinkel B, Schneeweiss A, Sohn C, Sawyer EJ, Tomlinson I, Kerin MJ, Miller N, Andrulis IL, Knight JA, Tchatchou S, Mulligan AM, Dörk T, Bogdanova NV, Antonenkova NN, Anton-Culver H, Darabi H, Eriksson M, Garcia-Closas M, Figueroa J, Lissowska J, Brinton L, Devilee P, Tollenaar RAEM, Seynaeve C, van Asperen CJ, Kristensen VN, Slager S, Toland AE, Ambrosone CB, Yannoukakos D, Lindblom A, Margolin S, Radice P, Peterlongo P, Barile M, Mariani P, Hooning MJ, Martens JWM, Collée JM, Jager A, Jakubowska A, Lubinski J, Jaworska-Bieniek K, Durda K, Giles GG, McLean C, Brauch H, Brüning T, Ko YD, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Swerdlow A, Ashworth A, Orr N, Jones M, Simard J, Goldberg MS, Labrèche F, Dumont M, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Kataja V, Kosma VM, Hartikainen JM, Mannermaa A, Hamann U, Chenevix-Trench G, Blomqvist C, Aittomäki K, Easton DF, Nevanlinna H. MicroRNA related polymorphisms and breast cancer risk. PLoS One 2014; 9:e109973. [PMID: 25390939 PMCID: PMC4229095 DOI: 10.1371/journal.pone.0109973] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
Abstract
Genetic variations, such as single nucleotide polymorphisms (SNPs) in microRNAs (miRNA) or in the miRNA binding sites may affect the miRNA dependent gene expression regulation, which has been implicated in various cancers, including breast cancer, and may alter individual susceptibility to cancer. We investigated associations between miRNA related SNPs and breast cancer risk. First we evaluated 2,196 SNPs in a case-control study combining nine genome wide association studies (GWAS). Second, we further investigated 42 SNPs with suggestive evidence for association using 41,785 cases and 41,880 controls from 41 studies included in the Breast Cancer Association Consortium (BCAC). Combining the GWAS and BCAC data within a meta-analysis, we estimated main effects on breast cancer risk as well as risks for estrogen receptor (ER) and age defined subgroups. Five miRNA binding site SNPs associated significantly with breast cancer risk: rs1045494 (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.88-0.96), rs1052532 (OR 0.97; 95% CI: 0.95-0.99), rs10719 (OR 0.97; 95% CI: 0.94-0.99), rs4687554 (OR 0.97; 95% CI: 0.95-0.99, and rs3134615 (OR 1.03; 95% CI: 1.01-1.05) located in the 3' UTR of CASP8, HDDC3, DROSHA, MUSTN1, and MYCL1, respectively. DROSHA belongs to miRNA machinery genes and has a central role in initial miRNA processing. The remaining genes are involved in different molecular functions, including apoptosis and gene expression regulation. Further studies are warranted to elucidate whether the miRNA binding site SNPs are the causative variants for the observed risk effects.
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Affiliation(s)
- Sofia Khan
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Dario Greco
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Roger L. Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Taru A. Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jingmei Li
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nichola Johnson
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Lorna Gibson
- Department of Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zoe Aitken
- Department of Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Helen Tsimiklis
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Enes Makalic
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Daniel F. Schmidt
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa C. Southey
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Stone
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Muriel A. Adank
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Rob B. van der Luijt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Rita K. Schmutzler
- Division of Molecular Gyneco-Oncology, Department of Gynaecology and Obstetrics, University Hospital of Cologne, Cologne, Germany
- Center of Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | | | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Clare Turnbull
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, United Kingdom
| | - Nazneen Rahman
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, United Kingdom
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - David J. Hunter
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Angela Cox
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, United Kingdom
| | - Simon S. Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Malcolm W. R. Reed
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, United Kingdom
| | - Marjanka K. Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | | | - Frans B. Hogervorst
- Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Peter A. Fasching
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Cancer Erlangen-EMN, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California Los Angeles, California, United States of America
| | - Michael G. Schrauder
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Cancer Erlangen-EMN, Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Cancer Erlangen-EMN, Erlangen, Germany
| | - Stig E. Bojesen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sune F. Nielsen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Javier Benitez
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Pilar M. Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | - Jose I. A. Perez
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Oviedo, Spain
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Brian E. Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Paul D. P. Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Robert Luben
- Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Judith Brown
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB, Leuven, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Matthieu Moisse
- Vesalius Research Center (VRC), VIB, Leuven, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Robert Paridaens
- Oncology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Pascal Guénel
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- University Paris-Sud, UMRS 1018, Villejuif, France
| | - Thérèse Truong
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- University Paris-Sud, UMRS 1018, Villejuif, France
| | | | - Claire Mulot
- Université Paris Sorbonne Cité, UMR-S775 Inserm, Paris, France
| | - Frederick Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Elinor J. Sawyer
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Michael J. Kerin
- Clinical Science Institute, University Hospital Galway, Galway, Ireland
| | - Nicola Miller
- Clinical Science Institute, University Hospital Galway, Galway, Ireland
| | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julia A. Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sandrine Tchatchou
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Thilo Dörk
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | | | | | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Irvine, California, United States of America
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Montserrat Garcia-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands
| | | | - Vessela N. Kristensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology (EpiGen), University of Oslo, Oslo, Norway
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | | | | | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Amanda E. Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | | | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, IRRP, National Centre for Scientific Research "Demokritos", Aghia Paraskevi Attikis, Athens, Greece
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Paolo Peterlongo
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Monica Barile
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Paolo Mariani
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
- Cogentech Cancer Genetic Test Laboratory, Milan, Italy
| | - Maartje J. Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John W. M. Martens
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska-Bieniek
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Postgraduate School of Molecular Medicine, Warsaw Medical University, Warsaw, Poland
| | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Catriona McLean
- Anatomical Pathology, The Alfred Hospital, Melbourne, Australia
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany
| | - The GENICA Network
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anthony Swerdlow
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Nick Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Michael Jones
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Jacques Simard
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Laval University, Quebec, Canada
| | - Mark S. Goldberg
- Department of Medicine, McGill University, Montreal, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - France Labrèche
- Départements de Santé Environnementale et Santé au Travail et de Médecine Sociale et Préventive, Université de Montréal, Montreal, Quebec, Canada
| | - Martine Dumont
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Laval University, Quebec, Canada
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | | | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Jaana M. Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Ali AMG, Schmidt MK, Bolla MK, Wang Q, Gago-Dominguez M, Castelao JE, Carracedo A, Garzón VM, Bojesen SE, Nordestgaard BG, Flyger H, Chang-Claude J, Vrieling A, Rudolph A, Seibold P, Nevanlinna H, Muranen TA, Aaltonen K, Blomqvist C, Matsuo K, Ito H, Iwata H, Horio A, John EM, Sherman M, Lissowska J, Figueroa J, Garcia-Closas M, Anton-Culver H, Shah M, Hopper JL, Trichopoulou A, Bueno-de-Mesquita B, Krogh V, Weiderpass E, Andersson A, Clavel-Chapelon F, Dossus L, Fagherazzi G, Peeters PH, Olsen A, Wishart GC, Easton DF, Borgquist S, Overvad K, Barricarte A, González CA, Sánchez MJ, Amiano P, Riboli E, Key T, Pharoah PD. Alcohol consumption and survival after a breast cancer diagnosis: a literature-based meta-analysis and collaborative analysis of data for 29,239 cases. Cancer Epidemiol Biomarkers Prev 2014; 23:934-45. [PMID: 24636975 PMCID: PMC4542077 DOI: 10.1158/1055-9965.epi-13-0901] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence for an association of alcohol consumption with prognosis after a diagnosis of breast cancer has been inconsistent. We have reviewed and summarized the published evidence and evaluated the association using individual patient data from multiple case cohorts. METHODS A MEDLINE search to identify studies published up to January 2013 was performed. We combined published estimates of survival time for "moderate drinkers" versus nondrinkers. An analysis of individual participant data using Cox regression was carried out using data from 11 case cohorts. RESULTS We identified 11 published studies suitable for inclusion in the meta-analysis. Moderate postdiagnosis alcohol consumption was not associated with overall survival [HR, 0.95; 95% confidence interval (CI), 0.85-1.05], but there was some evidence of better survival associated with prediagnosis consumption (HR, 0.80; 95% CI, 0.73-0.88). Individual data on alcohol consumption for 29,239 cases with 4,839 deaths were available from the 11 case cohorts, all of which had data on estrogen receptor (ER) status. For women with ER-positive disease, there was little evidence that pre- or postdiagnosis alcohol consumption is associated with breast cancer-specific mortality, with some evidence of a negative association with all-cause mortality. On the basis of a single study, moderate postdiagnosis alcohol intake was associated with a small reduction in breast cancer-specific mortality for women with ER-negative disease. There was no association with prediagnosis intake for women with ER-negative disease. CONCLUSION There was little evidence that pre- or post-diagnosis alcohol consumption is associated with breast cancer-specific mortality for women with ER-positive disease. There was weak evidence that moderate post-diagnosis alcohol intake is associated with a small reduction in breast cancer-specific mortality in ER-negative disease. IMPACT Considering the totality of the evidence, moderate postdiagnosis alcohol consumption is unlikely to have a major adverse effect on the survival of women with breast cancer.
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Affiliation(s)
- Alaa M G Ali
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Marjanka K Schmidt
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Manjeet K Bolla
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Qin Wang
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - M Gago-Dominguez
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - J Esteban Castelao
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Angel Carracedo
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Victor Muñoz Garzón
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Stig E Bojesen
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Børge G Nordestgaard
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Henrik Flyger
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Jenny Chang-Claude
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Alina Vrieling
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Anja Rudolph
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Petra Seibold
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Heli Nevanlinna
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Taru A Muranen
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Kirsimari Aaltonen
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Carl Blomqvist
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Keitaro Matsuo
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Hidemi Ito
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Hiroji Iwata
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Akiyo Horio
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Esther M John
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Mark Sherman
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Jolanta Lissowska
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Jonine Figueroa
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Montserrat Garcia-Closas
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Hoda Anton-Culver
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Mitul Shah
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - John L Hopper
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Antonia Trichopoulou
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Bas Bueno-de-Mesquita
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Vittorio Krogh
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Elisabete Weiderpass
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Anne Andersson
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Françoise Clavel-Chapelon
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Laure Dossus
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Guy Fagherazzi
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Petra H Peeters
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Anja Olsen
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Gordon C Wishart
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Douglas F Easton
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Signe Borgquist
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Kim Overvad
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Aurelio Barricarte
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Carlos A González
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - María-José Sánchez
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Pilar Amiano
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Elio Riboli
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Tim Key
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
| | - Paul D Pharoah
- Authors' Affiliations: Department of Public Health and Primary Care, University of Cambridge; Department of Public Health and Primary Care and Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge; Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge; Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton and Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London; School of Public Health, Imperial College London, London; and Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt; Divisions of Psychosocial Research and Epidemiology and Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam; Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Institute for Public Health and the Environment, Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela; Oncology and Genetics Unit, University Hospital of Vigo, Galicia Health Service (SERGAS); Radiotherapy Department, University Hospital of Vigo, Vigo; Navarre Public Health Institute, Pamplona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP); Chief Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona; Andalusian School of Public Health, Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid; Public Health D
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French J, Ghoussaini M, Edwards S, Meyer K, Michailidou K, Ahmed S, Khan S, Maranian M, O’Reilly M, Hillman K, Betts J, Carroll T, Bailey P, Dicks E, Beesley J, Tyrer J, Maia AT, Beck A, Knoblauch N, Chen C, Kraft P, Barnes D, González-Neira A, Alonso M, Herrero D, Tessier D, Vincent D, Bacot F, Luccarini C, Baynes C, Conroy D, Dennis J, Bolla M, Wang Q, Hopper J, Southey M, Schmidt M, Broeks A, Verhoef S, Cornelissen S, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Fasching P, Loehberg C, Ekici A, Beckmann M, Peto J, dos Santos Silva I, Johnson N, Aitken Z, Sawyer E, Tomlinson I, Kerin M, Miller N, Marme F, Schneeweiss A, Sohn C, Burwinkel B, Guénel P, Truong T, Laurent-Puig P, Menegaux F, Bojesen S, Nordestgaard B, Nielsen S, Flyger H, Milne R, Zamora M, Arias Perez J, Benitez J, Anton-Culver H, Brenner H, Müller H, Arndt V, Stegmaier C, Meindl A, Lichtner P, Schmutzler R, Engel C, Brauch H, Hamann U, Justenhoven C, Aaltonen K, Heikkilä P, Aittomäki K, Blomqvist C, Matsuo K, Ito H, Iwata H, Sueta A, Bogdanova N, Antonenkova N, Dörk T, Lindblom A, Margolin S, Mannermaa A, Kataja V, Kosma VM, Hartikainen J, Wu A, Tseng CC, Van Den Berg D, Stram D, Lambrechts D, Peeters S, Smeets A, Floris G, Chang-Claude J, Rudolph A, Nickels S, Flesch-Janys D, Radice P, Peterlongo P, Bonanni B, Sardella D, Couch F, Wang X, Pankratz V, Lee A, Giles G, Severi G, Baglietto L, Haiman C, Henderson B, Schumacher F, Le Marchand L, Simard J, Goldberg M, Labrèche F, Dumont M, Teo S, Yip C, Ng CH, Vithana E, Kristensen V, Zheng W, Deming-Halverson S, Shrubsole M, Long J, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Andrulis I, Knight J, Glendon G, Mulligan A, Devilee P, Seynaeve C, García-Closas M, Figueroa J, Chanock S, Lissowska J, Czene K, Klevebring D, Schoof N, Hooning M, Martens J, Collée J, Tilanus-Linthorst M, Hall P, Li J, Liu J, Humphreys K, Shu XO, Lu W, Gao YT, Cai H, Cox A, Balasubramanian S, Blot W, Signorello L, Cai Q, Pharoah P, Healey C, Shah M, Pooley K, Kang D, Yoo KY, Noh DY, Hartman M, Miao H, Sng JH, Sim X, Jakubowska A, Lubinski J, Jaworska-Bieniek K, Durda K, Sangrajrang S, Gaborieau V, McKay J, Toland A, Ambrosone C, Yannoukakos D, Godwin A, Shen CY, Hsiung CN, Wu PE, Chen ST, Swerdlow A, Ashworth A, Orr N, Schoemaker M, Ponder B, Nevanlinna H, Brown M, Chenevix-Trench G, Easton D, Dunning A. Functional variants at the 11q13 risk locus for breast cancer regulate cyclin D1 expression through long-range enhancers. Am J Hum Genet 2013; 92:489-503. [PMID: 23540573 PMCID: PMC3617380 DOI: 10.1016/j.ajhg.2013.01.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022] Open
Abstract
Analysis of 4,405 variants in 89,050 European subjects from 41 case-control studies identified three independent association signals for estrogen-receptor-positive tumors at 11q13. The strongest signal maps to a transcriptional enhancer element in which the G allele of the best candidate causative variant rs554219 increases risk of breast cancer, reduces both binding of ELK4 transcription factor and luciferase activity in reporter assays, and may be associated with low cyclin D1 protein levels in tumors. Another candidate variant, rs78540526, lies in the same enhancer element. Risk association signal 2, rs75915166, creates a GATA3 binding site within a silencer element. Chromatin conformation studies demonstrate that these enhancer and silencer elements interact with each other and with their likely target gene, CCND1.
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MESH Headings
- Binding Sites
- Breast Neoplasms/genetics
- Case-Control Studies
- Cell Line, Tumor
- Chromatin/chemistry
- Chromatin/genetics
- Chromatin Immunoprecipitation
- Chromosomes, Human, Pair 11/genetics
- Cyclin D1/genetics
- Cyclin D1/metabolism
- Electrophoretic Mobility Shift Assay
- Enhancer Elements, Genetic/genetics
- Female
- GATA3 Transcription Factor/antagonists & inhibitors
- GATA3 Transcription Factor/genetics
- GATA3 Transcription Factor/metabolism
- Gene Expression Regulation, Neoplastic
- Humans
- Luciferases/metabolism
- Polymorphism, Single Nucleotide/genetics
- Promoter Regions, Genetic/genetics
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Silencer Elements, Transcriptional/genetics
- ets-Domain Protein Elk-4/antagonists & inhibitors
- ets-Domain Protein Elk-4/genetics
- ets-Domain Protein Elk-4/metabolism
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Affiliation(s)
- Juliet D. French
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Maya Ghoussaini
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Stacey L. Edwards
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Kerstin B. Meyer
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Kyriaki Michailidou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Shahana Ahmed
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Sofia Khan
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Mel J. Maranian
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Martin O’Reilly
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Kristine M. Hillman
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Joshua A. Betts
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Thomas Carroll
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Peter J. Bailey
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Ed Dicks
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Jonathan Beesley
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland 4029, Australia
| | - Jonathan Tyrer
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Ana-Teresa Maia
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Andrew Beck
- Harvard Medical School and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Nicholas W. Knoblauch
- Harvard Medical School and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Constance Chen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02215, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02215, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02215, USA
| | - Daniel Barnes
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - M. Rosario Alonso
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Daniel Herrero
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Daniel C. Tessier
- Centre d’innovation Génome Québec et Université McGill, Montréal, QC H3A 0G1, Canada
| | - Daniel Vincent
- Centre d’innovation Génome Québec et Université McGill, Montréal, QC H3A 0G1, Canada
| | - Francois Bacot
- Centre d’innovation Génome Québec et Université McGill, Montréal, QC H3A 0G1, Canada
| | - Craig Luccarini
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Caroline Baynes
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Don Conroy
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Joe Dennis
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Manjeet K. Bolla
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Qin Wang
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - John L. Hopper
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Marjanka K. Schmidt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Annegien Broeks
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Senno Verhoef
- Family Cancer Clinic, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Sten Cornelissen
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Kenneth Muir
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | | | | | | | - Peter A. Fasching
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Christian R. Loehberg
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, Friedrich Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Julian Peto
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Isabel dos Santos Silva
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Nichola Johnson
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
| | - Zoe Aitken
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Elinor J. Sawyer
- Division of Cancer Studies, NIHR Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London, London SE1 9RT, UK
| | - Ian Tomlinson
- Welcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK
| | - Michael J. Kerin
- Surgery, Clinical Science Institute, Galway University Hospital and National University of Ireland, Galway, Ireland
| | - Nicola Miller
- Surgery, Clinical Science Institute, Galway University Hospital and National University of Ireland, Galway, Ireland
| | - Frederik Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, 69115 Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, 69120 Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, 69115 Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, 69120 Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, 69115 Heidelberg, Germany
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology, University of Heidelberg, 69115 Heidelberg, Germany
- Molecular Epidemiology Group, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Pascal Guénel
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer Team, 94807 Villejuif, France
- University Paris-Sud, UMRS 1018, 94807 Villejuif, France
| | - Thérèse Truong
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer Team, 94807 Villejuif, France
- University Paris-Sud, UMRS 1018, 94807 Villejuif, France
| | - Pierre Laurent-Puig
- Université Paris Sorbonne Cité, UMR-S775 INSERM, 75270 Paris Cedex 06, France
| | - Florence Menegaux
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer Team, 94807 Villejuif, France
- University Paris-Sud, UMRS 1018, 94807 Villejuif, France
| | - Stig E. Bojesen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
| | - Børge G. Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
| | - Sune F. Nielsen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, 2730 Herlev, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen, 2730 Herlev, Denmark
| | - Roger L. Milne
- Genetic & Molecular Epidemiology Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - M. Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid 28046, Spain
| | | | - Javier Benitez
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, Irvine, CA 92697, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heiko Müller
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, 81675 Munich, Germany
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Rita K. Schmutzler
- Division of Molecular Gyneco-Oncology, Department of Gynaecology and Obstetrics, University Cologne, 50931 Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04107 Leipzig, Germany
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- University of Tübingen, 72074 Tübingen, Germany
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christina Justenhoven
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- University of Tübingen, 72074 Tübingen, Germany
| | - The GENICA Network
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- University of Tübingen, 72074 Tübingen, Germany
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, 53113 Bonn, Germany
- Institute and Outpatient Clinic of Occupational Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), 44789 Bochum, Germany
- Institute of Pathology, Medical Faculty of the University of Bonn, 53123 Bonn, Germany
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki 00029, Finland
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Aiko Sueta
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Natalia V. Bogdanova
- Department of Obstetrics and Gynaecology, Hannover Medical School, 30625 Hannover, Germany
- Department of Radiation Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Natalia N. Antonenkova
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, 223040 Minsk, Belarus
| | - Thilo Dörk
- Department of Obstetrics and Gynaecology, Hannover Medical School, 30625 Hannover, Germany
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Arto Mannermaa
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, 70211 Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, 70211 Kuopio, Finland
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, 70211 Kuopio, Finland
- Cancer Center, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Veli-Matti Kosma
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, 70211 Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jaana M. Hartikainen
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, 70211 Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, 70211 Kuopio, Finland
| | | | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Chiu-chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Daniel O. Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, 3000 Leuven, Belgium
- Vesalius Research Center (VRC), VIB, 3000 Leuven, Belgium
| | - Stephanie Peeters
- Multidisciplinary Breast Center, University Hospital Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Center, University Hospital Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Giuseppe Floris
- Multidisciplinary Breast Center, University Hospital Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Nickels
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dieter Flesch-Janys
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori (INT), 20133 Milan, Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, 20139 Milan, Italy
| | - Paolo Peterlongo
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori (INT), 20133 Milan, Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, 20139 Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia, 20141 Milan, Italy
| | - Domenico Sardella
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, 20139 Milan, Italy
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vernon S. Pankratz
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Adam Lee
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - Graham G. Giles
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria 3010, Australia
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria 3053, Australia
| | - Gianluca Severi
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria 3010, Australia
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria 3053, Australia
| | - Laura Baglietto
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria 3010, Australia
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria 3053, Australia
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Brian E. Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii, Honolulu, HI 96813, USA
| | - Jacques Simard
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec and Laval University, Québec City, QC G1V 4G2, Canada
| | - Mark S. Goldberg
- Department of Medicine, McGill University, Montreal, QC H3A 1A1, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC H3A 1A1, Canada
| | - France Labrèche
- Département de médecine sociale et préventive, Département de santé environnementale et santé au travail, Université de Montréal, Montreal, QC H3A 3C2, Canada
| | - Martine Dumont
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec and Laval University, Québec City, QC G1V 4G2, Canada
| | - Soo Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, 47500 Selangor, Malaysia
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - Char-Hong Ng
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, 0310 Oslo, Norway
- Faculty of Medicine (Faculty Division Ahus), University of Oslo, 0318 Oslo, Norway
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Sandra Deming-Halverson
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Martha Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Genetics and Biocenter Oulu, University of Oulu, Oulu University Hospital, 90014 Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Genetics and Biocenter Oulu, University of Oulu, Oulu University Hospital, 90014 Oulu, Finland
| | - Arja Jukkola-Vuorinen
- Department of Oncology, Oulu University Hospital, University of Oulu, 90014 Oulu, Finland
| | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, 90014 Oulu, Finland
| | - Irene L. Andrulis
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
- Ontario Cancer Genetics Network, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Julia A. Knight
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
| | - Gord Glendon
- Ontario Cancer Genetics Network, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
| | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, 3075 EA Rotterdam, the Netherlands
- Department of Medical Oncology, Erasmus University Medical Center, 3075 EA Rotterdam, the Netherlands
| | - Montserrat García-Closas
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research and Breakthrough Breast Cancer Research Centre, London SM2 5NG, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London SW3 6JB, UK
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, 02-781 Warsaw, Poland
| | - Kamila Czene
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17 177, Sweden
| | - Daniel Klevebring
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17 177, Sweden
| | - Nils Schoof
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17 177, Sweden
| | - Maartje J. Hooning
- Department of Medical Oncology, Erasmus University Medical Center, 3075 EA Rotterdam, the Netherlands
| | - John W.M. Martens
- Department of Medical Oncology, Erasmus University Medical Center, 3075 EA Rotterdam, the Netherlands
| | - J. Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, 3008 AE Rotterdam, the Netherlands
| | | | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17 177, Sweden
| | - Jingmei Li
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Keith Humphreys
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17 177, Sweden
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai 200032, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Angela Cox
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield S10 2RX, UK
| | - Sabapathy P. Balasubramanian
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield S10 2RX, UK
| | - William Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
- International Epidemiology Institute, Rockville, MD 20850, USA
| | - Lisa B. Signorello
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
- International Epidemiology Institute, Rockville, MD 20850, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Paul D.P. Pharoah
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Catherine S. Healey
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Mitul Shah
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Karen A. Pooley
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Daehee Kang
- Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Dong-Young Noh
- Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597, Singapore
| | - Jen-Hwei Sng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Xueling Sim
- Centre for Molecular Epidemiology, National University of Singapore, Singapore 117597, Singapore
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, u. Polabska 4, 70-115 Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, u. Polabska 4, 70-115 Szczecin, Poland
| | - Katarzyna Jaworska-Bieniek
- Department of Genetics and Pathology, Pomeranian Medical University, u. Polabska 4, 70-115 Szczecin, Poland
- Postgraduate School of Molecular Medicine, Warsaw Medical University, ul. Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, u. Polabska 4, 70-115 Szczecin, Poland
| | | | - Valerie Gaborieau
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - James McKay
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Amanda E. Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, IRRP, National Centre for Scientific Research “Demokritos,” Athens 15310, Greece
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Chen-Yang Shen
- Colleague of Public Health, China Medical University, Taichong 40402, Taiwan, ROC
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, ROC
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, ROC
| | - Pei-Ei Wu
- Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, ROC
| | - Shou-Tung Chen
- Department of Surgery, Changhua Christian Hospital, Changhua City, Changhua county 500, Taiwan, ROC
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, Institute of Cancer Research and Breakthrough Breast Cancer Research Centre, London SM2 5NG, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London SW3 6JB, UK
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
| | - Nick Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London SW3 6JB, UK
| | - Minouk J. Schoemaker
- Division of Genetics and Epidemiology, Institute of Cancer Research and Breakthrough Breast Cancer Research Centre, London SM2 5NG, UK
| | - Bruce A.J. Ponder
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Melissa A. Brown
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Georgia Chenevix-Trench
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland 4029, Australia
| | - Douglas F. Easton
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Alison M. Dunning
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
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24
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Michailidou K, Hall P, Gonzalez-Neira A, Ghoussaini M, Dennis J, Milne RL, Schmidt MK, Chang-Claude J, Bojesen SE, Bolla MK, Wang Q, Dicks E, Lee A, Turnbull C, Rahman N, Fletcher O, Peto J, Gibson L, Dos Santos Silva I, Nevanlinna H, Muranen TA, Aittomäki K, Blomqvist C, Czene K, Irwanto A, Liu J, Waisfisz Q, Meijers-Heijboer H, Adank M, van der Luijt RB, Hein R, Dahmen N, Beckman L, Meindl A, Schmutzler RK, Müller-Myhsok B, Lichtner P, Hopper JL, Southey MC, Makalic E, Schmidt DF, Uitterlinden AG, Hofman A, Hunter DJ, Chanock SJ, Vincent D, Bacot F, Tessier DC, Canisius S, Wessels LFA, Haiman CA, Shah M, Luben R, Brown J, Luccarini C, Schoof N, Humphreys K, Li J, Nordestgaard BG, Nielsen SF, Flyger H, Couch FJ, Wang X, Vachon C, Stevens KN, Lambrechts D, Moisse M, Paridaens R, Christiaens MR, Rudolph A, Nickels S, Flesch-Janys D, Johnson N, Aitken Z, Aaltonen K, Heikkinen T, Broeks A, Veer LJV, van der Schoot CE, Guénel P, Truong T, Laurent-Puig P, Menegaux F, Marme F, Schneeweiss A, Sohn C, Burwinkel B, Zamora MP, Perez JIA, Pita G, Alonso MR, Cox A, Brock IW, Cross SS, Reed MWR, Sawyer EJ, Tomlinson I, Kerin MJ, Miller N, Henderson BE, Schumacher F, Le Marchand L, Andrulis IL, Knight JA, Glendon G, Mulligan AM, Lindblom A, Margolin S, Hooning MJ, Hollestelle A, van den Ouweland AMW, Jager A, Bui QM, Stone J, Dite GS, Apicella C, Tsimiklis H, Giles GG, Severi G, Baglietto L, Fasching PA, Haeberle L, Ekici AB, Beckmann MW, Brenner H, Müller H, Arndt V, Stegmaier C, Swerdlow A, Ashworth A, Orr N, Jones M, Figueroa J, Lissowska J, Brinton L, Goldberg MS, Labrèche F, Dumont M, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Brauch H, Hamann U, Brüning T, Radice P, Peterlongo P, Manoukian S, Bonanni B, Devilee P, Tollenaar RAEM, Seynaeve C, van Asperen CJ, Jakubowska A, Lubinski J, Jaworska K, Durda K, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Bogdanova NV, Antonenkova NN, Dörk T, Kristensen VN, Anton-Culver H, Slager S, Toland AE, Edge S, Fostira F, Kang D, Yoo KY, Noh DY, Matsuo K, Ito H, Iwata H, Sueta A, Wu AH, Tseng CC, Van Den Berg D, Stram DO, Shu XO, Lu W, Gao YT, Cai H, Teo SH, Yip CH, Phuah SY, Cornes BK, Hartman M, Miao H, Lim WY, Sng JH, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Shen CY, Hsiung CN, Wu PE, Ding SL, Sangrajrang S, Gaborieau V, Brennan P, McKay J, Blot WJ, Signorello LB, Cai Q, Zheng W, Deming-Halverson S, Shrubsole M, Long J, Simard J, Garcia-Closas M, Pharoah PDP, Chenevix-Trench G, Dunning AM, Benitez J, Easton DF. Large-scale genotyping identifies 41 new loci associated with breast cancer risk. Nat Genet 2013; 45:353-61, 361e1-2. [PMID: 23535729 PMCID: PMC3771688 DOI: 10.1038/ng.2563] [Citation(s) in RCA: 836] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 01/30/2013] [Indexed: 12/14/2022]
Abstract
Breast cancer is the most common cancer among women. Common variants at 27 loci have been identified as associated with susceptibility to breast cancer, and these account for ∼9% of the familial risk of the disease. We report here a meta-analysis of 9 genome-wide association studies, including 10,052 breast cancer cases and 12,575 controls of European ancestry, from which we selected 29,807 SNPs for further genotyping. These SNPs were genotyped in 45,290 cases and 41,880 controls of European ancestry from 41 studies in the Breast Cancer Association Consortium (BCAC). The SNPs were genotyped as part of a collaborative genotyping experiment involving four consortia (Collaborative Oncological Gene-environment Study, COGS) and used a custom Illumina iSelect genotyping array, iCOGS, comprising more than 200,000 SNPs. We identified SNPs at 41 new breast cancer susceptibility loci at genome-wide significance (P < 5 × 10(-8)). Further analyses suggest that more than 1,000 additional loci are involved in breast cancer susceptibility.
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Affiliation(s)
- Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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25
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Garcia-Closas M, Couch FJ, Lindstrom S, Michailidou K, Schmidt MK, Brook MN, orr N, Rhie SK, Riboli E, Feigelson HS, Le Marchand L, Buring JE, Eccles D, Miron P, Fasching PA, Brauch H, Chang-Claude J, Carpenter J, Godwin AK, Nevanlinna H, Giles GG, Cox A, Hopper JL, Bolla MK, Wang Q, Dennis J, Dicks E, Howat WJ, Schoof N, Bojesen SE, Lambrechts D, Broeks A, Andrulis IL, Guénel P, Burwinkel B, Sawyer EJ, Hollestelle A, Fletcher O, Winqvist R, Brenner H, Mannermaa A, Hamann U, Meindl A, Lindblom A, Zheng W, Devillee P, Goldberg MS, Lubinski J, Kristensen V, Swerdlow A, Anton-Culver H, Dörk T, Muir K, Matsuo K, Wu AH, Radice P, Teo SH, Shu XO, Blot W, Kang D, Hartman M, Sangrajrang S, Shen CY, Southey MC, Park DJ, Hammet F, Stone J, Veer LJV, Rutgers EJ, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Peto J, Schrauder MG, Ekici AB, Beckmann MW, Silva IDS, Johnson N, Warren H, Tomlinson I, Kerin MJ, Miller N, Marme F, Schneeweiss A, Sohn C, Truong T, Laurent-Puig P, Kerbrat P, Nordestgaard BG, Nielsen SF, Flyger H, Milne RL, Perez JIA, Menéndez P, Müller H, Arndt V, Stegmaier C, Lichtner P, Lochmann M, Justenhoven C, Ko YD, Muranen TA, Aittomäki K, Blomqvist C, Greco D, Heikkinen T, Ito H, Iwata H, Yatabe Y, Antonenkova NN, Margolin S, Kataja V, Kosma VM, Hartikainen JM, Balleine R, Tseng CC, Van Den Berg D, Stram DO, Neven P, Dieudonné AS, Leunen K, Rudolph A, Nickels S, Flesch-Janys D, Peterlongo P, Peissel B, Bernard L, Olson JE, Wang X, Stevens K, Severi G, Baglietto L, Mclean C, Coetzee GA, Feng Y, Henderson BE, Schumacher F, Bogdanova NV, Labrèche F, Dumont M, Yip CH, Taib NAM, Cheng CY, Shrubsole M, Long J, Pylkäs K, Jukkola-Vuorinen A, Kauppila S, knight JA, Glendon G, Mulligan AM, Tollenaar RAEM, Seynaeve CM, Kriege M, Hooning MJ, Van den Ouweland AMW, Van Deurzen CHM, Lu W, Gao YT, Cai H, Balasubramanian SP, Cross SS, Reed MWR, Signorello L, Cai Q, Shah M, Miao H, Chan CW, Chia KS, Jakubowska A, Jaworska K, Durda K, Hsiung CN, Wu PE, Yu JC, Ashworth A, Jones M, Tessier DC, González-Neira A, Pita G, Alonso MR, Vincent D, Bacot F, Ambrosone CB, Bandera EV, John EM, Chen GK, Hu JJ, Rodriguez-gil JL, Bernstein L, Press MF, Ziegler RG, Millikan RM, Deming-Halverson SL, Nyante S, Ingles SA, Waisfisz Q, Tsimiklis H, Makalic E, Schmidt D, Bui M, Gibson L, Müller-Myhsok B, Schmutzler RK, Hein R, Dahmen N, Beckmann L, Aaltonen K, Czene K, Irwanto A, Liu J, Turnbull C, Rahman N, Meijers-Heijboer H, Uitterlinden AG, Rivadeneira F, Olswold C, Slager S, Pilarski R, Ademuyiwa F, Konstantopoulou I, Martin NG, Montgomery GW, Slamon DJ, Rauh C, Lux MP, Jud SM, Bruning T, Weaver J, Sharma P, Pathak H, Tapper W, Gerty S, Durcan L, Trichopoulos D, Tumino R, Peeters PH, Kaaks R, Campa D, Canzian F, Weiderpass E, Johansson M, Khaw KT, Travis R, Clavel-Chapelon F, Kolonel LN, Chen C, Beck A, Hankinson SE, Berg CD, Hoover RN, Lissowska J, Figueroa JD, Chasman DI, Gaudet MM, Diver WR, Willett WC, Hunter DJ, Simard J, Benitez J, Dunning AM, Sherman ME, Chenevix-Trench G, Chanock SJ, Hall P, Pharoah PDP, Vachon C, Easton DF, Haiman CA, Kraft P. Genome-wide association studies identify four ER negative-specific breast cancer risk loci. Nat Genet 2013; 45:392-8, 398e1-2. [PMID: 23535733 PMCID: PMC3771695 DOI: 10.1038/ng.2561] [Citation(s) in RCA: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 01/29/2013] [Indexed: 12/14/2022]
Abstract
Estrogen receptor (ER)-negative tumors represent 20-30% of all breast cancers, with a higher proportion occurring in younger women and women of African ancestry. The etiology and clinical behavior of ER-negative tumors are different from those of tumors expressing ER (ER positive), including differences in genetic predisposition. To identify susceptibility loci specific to ER-negative disease, we combined in a meta-analysis 3 genome-wide association studies of 4,193 ER-negative breast cancer cases and 35,194 controls with a series of 40 follow-up studies (6,514 cases and 41,455 controls), genotyped using a custom Illumina array, iCOGS, developed by the Collaborative Oncological Gene-environment Study (COGS). SNPs at four loci, 1q32.1 (MDM4, P = 2.1 × 10(-12) and LGR6, P = 1.4 × 10(-8)), 2p24.1 (P = 4.6 × 10(-8)) and 16q12.2 (FTO, P = 4.0 × 10(-8)), were associated with ER-negative but not ER-positive breast cancer (P > 0.05). These findings provide further evidence for distinct etiological pathways associated with invasive ER-positive and ER-negative breast cancers.
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Affiliation(s)
- Montserrat Garcia-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Fergus J Couch
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Lindstrom
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Mark N Brook
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | - Nick orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Suhn Kyong Rhie
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Elio Riboli
- School of Public Health, Imperial College, London, UK
| | | | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii, Honolulu, Hawaii, USA
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Diana Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Penelope Miron
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jane Carpenter
- Australian Breast Cancer Tissue Bank, University of Sydney at the Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Graham G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Cox
- Cancer Research UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, UK
| | - John L Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ed Dicks
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Will J Howat
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK
| | - Nils Schoof
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stig E Bojesen
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB, Leuven, Belgium
- Department of Oncology, University of Leuven, Leuven, Belgium
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Irene L Andrulis
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Ontario Cancer Genetics Network, Fred A. Litwin Center for Cancer Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Pascal Guénel
- University Paris–Sud, Unité Mixte de Recherche Scientifique (UMRS) 1018, Villejuif, France
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), Environmental Epidemiology of Cancer, Villejuif, France
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- Molecular Epidemiology Group, DKFZ, Heidelberg, Germany
| | - Elinor J Sawyer
- Division of Cancer Studies, National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ National Health Service (NHS) Foundation Trust in partnership with King’s College London, London, UK
| | - Antoinette Hollestelle
- Department of Medical Oncology, Erasmus University Medical Center–Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Genetics, Biocenter Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Arto Mannermaa
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, DKFZ, Heidelberg, Germany
| | - Alfons Meindl
- Division for Gynaecological Tumor Genetics, Clinic of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Wei Zheng
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peter Devillee
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
- Faculty of Medicine (Faculty Division Ahus), Universitetet i Oslo, Oslo, Norway
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California–Irvine, Irvine, California, USA
| | - Thilo Dörk
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | - Kenneth Muir
- Warwick Medical School, Warwick University, Coventry, UK
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori (INT), Milan, Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Soo Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - William Blot
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- International Epidemiology Institute, Rockville, Maryland, USA
| | - Daehee Kang
- Seoul National University College of Medicine, Seoul, Korea
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Chen-Yang Shen
- Colleague of Public Health, China Medical University, Taichong, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Melissa C Southey
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel J Park
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fleur Hammet
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Stone
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Van’t Veer
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Emiel J Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | | | | | - Julian Peto
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
| | - Isabel dos Santos Silva
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nichola Johnson
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Helen Warren
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Michael J Kerin
- Department of Surgery, Clinical Science Institute, University Hospital and National University of Ireland, Galway, Ireland
| | - Nicola Miller
- Department of Surgery, Clinical Science Institute, University Hospital and National University of Ireland, Galway, Ireland
| | - Federick Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Therese Truong
- University Paris–Sud, Unité Mixte de Recherche Scientifique (UMRS) 1018, Villejuif, France
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), Environmental Epidemiology of Cancer, Villejuif, France
| | | | - Pierre Kerbrat
- Centre Eugène Marquis, Department of Medical Oncology, Rennes, France
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sune F Nielsen
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roger L Milne
- Genetic & Molecular Epidemiology Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | | | - Heiko Müller
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | | | - Peter Lichtner
- Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Magdalena Lochmann
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Christina Justenhoven
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Bonn, Johanniter Krankenhaus, Bonn, Germany
| | | | - Taru A Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Dario Greco
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Natalia N Antonenkova
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Veli-Matti Kosma
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Jaana M Hartikainen
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Rosemary Balleine
- Western Sydney Local Health District, Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | | | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Anne-Sophie Dieudonné
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Karin Leunen
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Nickels
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Clinic Hamburg-Eppendorf, Hamburg, Germany
- Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Paolo Peterlongo
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori (INT), Milan, Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS INT, Milan, Italy
| | - Loris Bernard
- Department of Experimental Oncology, Istituto Europeo di Oncologia, Milan, Italy
- Cogentech Cancer Genetic Test Laboratory, Milan, Italy
| | - Janet E Olson
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Xianshu Wang
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen Stevens
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona Mclean
- Department of Anatomical Pathology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerhard A Coetzee
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ye Feng
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Natalia V Bogdanova
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - France Labrèche
- Département de Médecine Sociale et Préventive, Département de Santé Environnementale et Santé au Travail, Université de Montréal, Montreal, Quebec, Canada
| | - Martine Dumont
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec and Laval University, Quebec City, Quebec, Canada
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
| | - Ching-Yu Cheng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Singapore Eye Research Institute, National University of Singapore, Singapore
| | - Martha Shrubsole
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jirong Long
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Genetics, Biocenter Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Saila Kauppila
- Department of Pathology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Julia A knight
- Ontario Cancer Genetics Network, Fred A. Litwin Center for Cancer Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gord Glendon
- Ontario Cancer Genetics Network, Fred A. Litwin Center for Cancer Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Caroline M Seynaeve
- Department of Medical Oncology, Erasmus University Medical Center–Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Mieke Kriege
- Department of Medical Oncology, Erasmus University Medical Center–Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center–Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | | | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Hui Cai
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sabapathy P Balasubramanian
- Cancer Research UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Malcolm W R Reed
- Cancer Research UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, UK
| | - Lisa Signorello
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Qiuyin Cai
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ching Wan Chan
- Department of Surgery, National University Health System, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Pei-Ei Wu
- Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jyh-Cherng Yu
- Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Michael Jones
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | - Daniel C Tessier
- McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada
| | - Anna González-Neira
- Human Genotyping Unit–CEGEN, Human Cancer Genetics Programme, CNIO, Madrid, Spain
| | - Guillermo Pita
- Human Genotyping Unit–CEGEN, Human Cancer Genetics Programme, CNIO, Madrid, Spain
| | - M Rosario Alonso
- Human Genotyping Unit–CEGEN, Human Cancer Genetics Programme, CNIO, Madrid, Spain
| | - Daniel Vincent
- McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada
| | - Francois Bacot
- McGill University and Génome Québec Innovation Centre, Montreal, Québec, Canada
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Elisa V Bandera
- The Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, California, USA
- Department of Health Research and Policy, Division of Epidemiology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Gary K Chen
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jorge L Rodriguez-gil
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Science, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Michael F Press
- Department of Pathology, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Regina G Ziegler
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert M Millikan
- Department of Epidemiology, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sandra L Deming-Halverson
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah Nyante
- Department of Epidemiology, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sue A Ingles
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Quinten Waisfisz
- Section of Oncogenetics, Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Helen Tsimiklis
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Enes Makalic
- School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Schmidt
- School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Minh Bui
- School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lorna Gibson
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Bertram Müller-Myhsok
- Statistical Genetics Research Group, Max Planck Institute of Psychiatry, Munich, Germany
| | - Rita K Schmutzler
- Centre of Hereditary Breast and Ovarian Cancer, University Hospital, Cologne, Germany
- Centre of Integrated Oncology, University Hospital, Cologne, Germany
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- PMV (Primärmedizinische Versorgung) Research Group, Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Norbert Dahmen
- Department of Psychiatry, University of Mainz, Mainz, Germany
| | - Lars Beckmann
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | | | - Nazneen Rahman
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | - Hanne Meijers-Heijboer
- Section of Oncogenetics, Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Andre G Uitterlinden
- Department of Internal Medicine and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Curtis Olswold
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan Slager
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Pilarski
- Department of Internal Medicine, James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | | | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory, Institute of Radioisotopes and Radiodiagnostic Products (IRRP), National Centre for Scientific Research Demokritos, Aghia Paraskevi Attikis, Athens, Greece
| | - Nicholas G Martin
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Grant W Montgomery
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Dennis J Slamon
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Medicine, Division of Hematology and Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Erlangen, Germany
| | - Thomas Bruning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bochum, Germany
| | - Joellen Weaver
- Biosample Repository, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Priyanka Sharma
- Division of Hematology and Oncology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Harsh Pathak
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Will Tapper
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sue Gerty
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lorraine Durcan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dimitrios Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry, Histopathology Unit Civile MPArezzo Hospital, Ragusa, Italy
| | - Petra H Peeters
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniele Campa
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Federico Canzian
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Mattias Johansson
- Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
| | - Ruth Travis
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Françoise Clavel-Chapelon
- University Paris–Sud, Unité Mixte de Recherche Scientifique (UMRS) 1018, Villejuif, France
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), Environmental Epidemiology of Cancer, Villejuif, France
| | - Laurence N Kolonel
- Département de Médecine Sociale et Préventive, Département de Santé Environnementale et Santé au Travail, Université de Montréal, Montreal, Quebec, Canada
| | - Constance Chen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Andy Beck
- Department of Pathology, Beth Israel DeaconessMedical Center, Boston, Massachusetts, USA
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan E Hankinson
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Christine D Berg
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert N Hoover
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jonine D Figueroa
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - David J Hunter
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Jacques Simard
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec and Laval University, Quebec City, Quebec, Canada
| | - Javier Benitez
- Human Genotyping Unit–CEGEN, Human Cancer Genetics Programme, CNIO, Madrid, Spain
- Human Genetics Group, CNIO, Madrid, Spain
- Centro de Investigacion en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Mark E Sherman
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Georgia Chenevix-Trench
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Stephen J Chanock
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Celine Vachon
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Aaltonen K, Ahola E, Martikainen J, Hiilamo H. Social Assistance Payments for Medical Expenditure in Helsinki, Finland in 2008-2010. Res Social Adm Pharm 2012. [DOI: 10.1016/j.sapharm.2012.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Konsti J, Lundin M, Linder N, Haglund C, Blomqvist C, Nevanlinna H, Aaltonen K, Nordling S, Lundin J. Effect of image compression and scaling on automated scoring of immunohistochemical stainings and segmentation of tumor epithelium. Diagn Pathol 2012; 7:29. [PMID: 22436596 PMCID: PMC3375185 DOI: 10.1186/1746-1596-7-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/21/2012] [Indexed: 11/20/2022] Open
Abstract
Background Digital whole-slide scanning of tissue specimens produces large images demanding increasing storing capacity. To reduce the need of extensive data storage systems image files can be compressed and scaled down. The aim of this article is to study the effect of different levels of image compression and scaling on automated image analysis of immunohistochemical (IHC) stainings and automated tumor segmentation. Methods Two tissue microarray (TMA) slides containing 800 samples of breast cancer tissue immunostained against Ki-67 protein and two TMA slides containing 144 samples of colorectal cancer immunostained against EGFR were digitized with a whole-slide scanner. The TMA images were JPEG2000 wavelet compressed with four compression ratios: lossless, and 1:12, 1:25 and 1:50 lossy compression. Each of the compressed breast cancer images was furthermore scaled down either to 1:1, 1:2, 1:4, 1:8, 1:16, 1:32, 1:64 or 1:128. Breast cancer images were analyzed using an algorithm that quantitates the extent of staining in Ki-67 immunostained images, and EGFR immunostained colorectal cancer images were analyzed with an automated tumor segmentation algorithm. The automated tools were validated by comparing the results from losslessly compressed and non-scaled images with results from conventional visual assessments. Percentage agreement and kappa statistics were calculated between results from compressed and scaled images and results from lossless and non-scaled images. Results Both of the studied image analysis methods showed good agreement between visual and automated results. In the automated IHC quantification, an agreement of over 98% and a kappa value of over 0.96 was observed between losslessly compressed and non-scaled images and combined compression ratios up to 1:50 and scaling down to 1:8. In automated tumor segmentation, an agreement of over 97% and a kappa value of over 0.93 was observed between losslessly compressed images and compression ratios up to 1:25. Conclusions The results of this study suggest that images stored for assessment of the extent of immunohistochemical staining can be compressed and scaled significantly, and images of tumors to be segmented can be compressed without compromising computer-assisted analysis results using studied methods. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2442925476534995
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Affiliation(s)
- Juho Konsti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
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Broeks A, Schmidt MK, Sherman ME, Couch FJ, Hopper JL, Dite GS, Apicella C, Smith LD, Hammet F, Southey MC, Van 't Veer LJ, de Groot R, Smit VTHBM, Fasching PA, Beckmann MW, Jud S, Ekici AB, Hartmann A, Hein A, Schulz-Wendtland R, Burwinkel B, Marme F, Schneeweiss A, Sinn HP, Sohn C, Tchatchou S, Bojesen SE, Nordestgaard BG, Flyger H, Ørsted DD, Kaur-Knudsen D, Milne RL, Pérez JIA, Zamora P, Rodríguez PM, Benítez J, Brauch H, Justenhoven C, Ko YD, Hamann U, Fischer HP, Brüning T, Pesch B, Chang-Claude J, Wang-Gohrke S, Bremer M, Karstens JH, Hillemanns P, Dörk T, Nevanlinna HA, Heikkinen T, Heikkilä P, Blomqvist C, Aittomäki K, Aaltonen K, Lindblom A, Margolin S, Mannermaa A, Kosma VM, Kauppinen JM, Kataja V, Auvinen P, Eskelinen M, Soini Y, Chenevix-Trench G, Spurdle AB, Beesley J, Chen X, Holland H, Lambrechts D, Claes B, Vandorpe T, Neven P, Wildiers H, Flesch-Janys D, Hein R, Löning T, Kosel M, Fredericksen ZS, Wang X, Giles GG, Baglietto L, Severi G, McLean C, Haiman CA, Henderson BE, Le Marchand L, Kolonel LN, Alnæs GG, Kristensen V, Børresen-Dale AL, Hunter DJ, Hankinson SE, Andrulis IL, Mulligan AM, O'Malley FP, Devilee P, Huijts PEA, Tollenaar RAEM, Van Asperen CJ, Seynaeve CS, Chanock SJ, Lissowska J, Brinton L, Peplonska B, Figueroa J, Yang XR, Hooning MJ, Hollestelle A, Oldenburg RA, Jager A, Kriege M, Ozturk B, van Leenders GJLH, Hall P, Czene K, Humphreys K, Liu J, Cox A, Connley D, Cramp HE, Cross SS, Balasubramanian SP, Reed MWR, Dunning AM, Easton DF, Humphreys MK, Caldas C, Blows F, Driver K, Provenzano E, Lubinski J, Jakubowska A, Huzarski T, Byrski T, Cybulski C, Gorski B, Gronwald J, Brennan P, Sangrajrang S, Gaborieau V, Shen CY, Hsiung CN, Yu JC, Chen ST, Hsu GC, Hou MF, Huang CS, Anton-Culver H, Ziogas A, Pharoah PDP, Garcia-Closas M. Low penetrance breast cancer susceptibility loci are associated with specific breast tumor subtypes: findings from the Breast Cancer Association Consortium. Hum Mol Genet 2011; 20:3289-303. [PMID: 21596841 PMCID: PMC3140824 DOI: 10.1093/hmg/ddr228] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 01/23/2023] Open
Abstract
Breast cancers demonstrate substantial biological, clinical and etiological heterogeneity. We investigated breast cancer risk associations of eight susceptibility loci identified in GWAS and two putative susceptibility loci in candidate genes in relation to specific breast tumor subtypes. Subtypes were defined by five markers (ER, PR, HER2, CK5/6, EGFR) and other pathological and clinical features. Analyses included up to 30 040 invasive breast cancer cases and 53 692 controls from 31 studies within the Breast Cancer Association Consortium. We confirmed previous reports of stronger associations with ER+ than ER- tumors for six of the eight loci identified in GWAS: rs2981582 (10q26) (P-heterogeneity = 6.1 × 10(-18)), rs3803662 (16q12) (P = 3.7 × 10(-5)), rs13281615 (8q24) (P = 0.002), rs13387042 (2q35) (P = 0.006), rs4973768 (3p24) (P = 0.003) and rs6504950 (17q23) (P = 0.002). The two candidate loci, CASP8 (rs1045485, rs17468277) and TGFB1 (rs1982073), were most strongly related with the risk of PR negative tumors (P = 5.1 × 10(-6) and P = 4.1 × 10(-4), respectively), as previously suggested. Four of the eight loci identified in GWAS were associated with triple negative tumors (P ≤ 0.016): rs3803662 (16q12), rs889312 (5q11), rs3817198 (11p15) and rs13387042 (2q35); however, only two of them (16q12 and 2q35) were associated with tumors with the core basal phenotype (P ≤ 0.002). These analyses are consistent with different biological origins of breast cancers, and indicate that tumor stratification might help in the identification and characterization of novel risk factors for breast cancer subtypes. This may eventually result in further improvements in prevention, early detection and treatment.
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Affiliation(s)
- Annegien Broeks
- Department of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Kimbung S, Aaltonen K, Gruvberger-Saal S, Berglund P, Hedenfalk I. Abstract P6-15-04: Targeting the PI3K Pathway Enhances the Effect of PARP-1 Inhibition in BRCA1 Deficient Breast Cancer Cells. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-15-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Available targeted therapies have improved the prognosis for many women diagnosed with breast cancer. However, more than 15% of cases do not benefit from these targeted agents. Amongst these are tumours with Breast cancer 1 (BRCA1) dysfunction, triple-negative and basal-like breast cancers, which remain a treatment challenge and are associated with a poor outcome. New approaches to specifically target these groups of breast tumors are needed. The DNA damage repair defects associated with lack of BRCA1 confers sensitivity to poly-(ADP-ribose) polymerase 1 (PARP-1) inhibitors. Furthermore, most BRCA1 mutated tumours do not express the phosphatase and tensin homolog (PTEN) implying activation of the phosphatidylinositol-3 kinase (PI3K) pathway which promotes cell survival and resistance to apoptosis. The aim of this study was to investigate if co-targeting the PI3K pathway can improve the response of BRCA1 mutated cells to PARP-1 inhibition.
Material and methods:, Two BRCA1 and PTEN deficient breast cancer cell lines; MDA-MB-436 and SUM149, were treated with the PARP-1 inhibitor AG14361 (1-(4-dimethylaminomethyl-phenyl)-8-9-dihydro-7H-2,7,9a-benzo[cd]azulen-6-one) and the PI3K inhibitor LY294002 (2-(4-morpholinyl)-8-phenyl-chromone), as single agents and in combination. Cytotoxicity was estimated using the sulpho-rhodamine B assay while cell cycle phase distribution and DNA integrity were analyzed by flow cytometry.
Results: AG14361 induced DNA damage leading to G2/M arrest and decreased viability. LY294002, on the other hand, affected the cell cycle by arresting cells in G1. Importantly, combining AG14361 with LY294002 further decreased survival (P<0.001) with a concomitant decrease in G2/M (P<0.05).
Discussion: This observation may indicate a combination specific up-regulation of apoptosis and suggests that LY294002 potentiates the effects of AG14361. Our results may represent an improved selective targeted treatment strategy for BRCA1 deficient breast cancers and other cancers with DNA damage repair defects and activated PI3K signalling.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-15-04.
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Abstract
Thirty-two patients with relapsing glioma were treated with temozolomide in two university hospitals in Finland. One patient (3%) had complete response and 9 (28%) partial response, with 8 patients (25%) showing stable disease. Median progression-free survival for these 18 patients (56%) was 7 months (range 2-11+). The remaining either had progressive disease (25%) or only clinical evaluation (19%). Karnofsky score improved in 34% of patients and decreased in 3%. Symptoms were alleviated in 44% and deteriorated in 9%. Grade 3-4 toxicity was detected in 9% of the patients. Only 4% of the days in treatment were spent in hospital. An average 1.8 neuroradiological investigations, 6.9 laboratory visits, and 5.3 visits to the oncologist were made. This study confirms that temozolomide has positive effects on the outcome of often heavily pretreated glioma patients. High drug costs are compensated by prolonged home care and even the possibility to maintain working capacity.
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Affiliation(s)
- Hanna O Mäenpää
- Department of Oncology, Helsinki University Central Hospital, Finland.
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Gaudet MM, Milne RL, Cox A, Camp NJ, Goode EL, Humphreys MK, Dunning AM, Morrison J, Giles GG, Severi G, Baglietto L, English DR, Couch FJ, Olson JE, Wang X, Chang-Claude J, Flesch-Janys D, Abbas S, Salazar R, Mannermaa A, Kataja V, Kosma VM, Lindblom A, Margolin S, Heikkinen T, Kämpjärvi K, Aaltonen K, Nevanlinna H, Bogdanova N, Coinac I, Schürmann P, Dörk T, Bartram CR, Schmutzler RK, Tchatchou S, Burwinkel B, Brauch H, Torres D, Hamann U, Justenhoven C, Ribas G, Arias JI, Benitez J, Bojesen SE, Nordestgaard BG, Flyger HL, Peto J, Fletcher O, Johnson N, Dos Santos Silva I, Fasching PA, Beckmann MW, Strick R, Ekici AB, Broeks A, Schmidt MK, van Leeuwen FE, Van't Veer LJ, Southey MC, Hopper JL, Apicella C, Haiman CA, Henderson BE, Le Marchand L, Kolonel LN, Kristensen V, Grenaker Alnaes G, Hunter DJ, Kraft P, Cox DG, Hankinson SE, Seynaeve C, Vreeswijk MPG, Tollenaar RAEM, Devilee P, Chanock S, Lissowska J, Brinton L, Peplonska B, Czene K, Hall P, Li Y, Liu J, Balasubramanian S, Rafii S, Reed MWR, Pooley KA, Conroy D, Baynes C, Kang D, Yoo KY, Noh DY, Ahn SH, Shen CY, Wang HC, Yu JC, Wu PE, Anton-Culver H, Ziogoas A, Egan K, Newcomb P, Titus-Ernstoff L, Trentham Dietz A, Sigurdson AJ, Alexander BH, Bhatti P, Allen-Brady K, Cannon-Albright LA, Wong J, Chenevix-Trench G, Spurdle AB, Beesley J, Pharoah PDP, Easton DF, Garcia-Closas M. Five polymorphisms and breast cancer risk: results from the Breast Cancer Association Consortium. Cancer Epidemiol Biomarkers Prev 2009; 18:1610-6. [PMID: 19423537 DOI: 10.1158/1055-9965.epi-08-0745] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have suggested that minor alleles for ERCC4 rs744154, TNF rs361525, CASP10 rs13010627, PGR rs1042838, and BID rs8190315 may influence breast cancer risk, but the evidence is inconclusive due to their small sample size. These polymorphisms were genotyped in more than 30,000 breast cancer cases and 30,000 controls, primarily of European descent, from 30 studies in the Breast Cancer Association Consortium. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) as a measure of association. We found that the minor alleles for these polymorphisms were not related to invasive breast cancer risk overall in women of European descent: ECCR4 per-allele OR (95% CI) = 0.99 (0.97-1.02), minor allele frequency = 27.5%; TNF 1.00 (0.95-1.06), 5.0%; CASP10 1.02 (0.98-1.07), 6.5%; PGR 1.02 (0.99-1.06), 15.3%; and BID 0.98 (0.86-1.12), 1.7%. However, we observed significant between-study heterogeneity for associations with risk for single-nucleotide polymorphisms (SNP) in CASP10, PGR, and BID. Estimates were imprecise for women of Asian and African descent due to small numbers and lower minor allele frequencies (with the exception of BID SNP). The ORs for each copy of the minor allele were not significantly different by estrogen or progesterone receptor status, nor were any significant interactions found between the polymorphisms and age or family history of breast cancer. In conclusion, our data provide persuasive evidence against an overall association between invasive breast cancer risk and ERCC4 rs744154, TNF rs361525, CASP10 rs13010627, PGR rs1042838, and BID rs8190315 genotypes among women of European descent.
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Affiliation(s)
- Mia M Gaudet
- Department of Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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Heikkinen T, Kärkkäinen H, Aaltonen K, Milne RL, Heikkilä P, Aittomäki K, Blomqvist C, Nevanlinna H. The breast cancer susceptibility mutation PALB2 1592delT is associated with an aggressive tumor phenotype. Clin Cancer Res 2009; 15:3214-22. [PMID: 19383810 DOI: 10.1158/1078-0432.ccr-08-3128] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the effect of the breast cancer susceptibility mutation PALB2 1592delT on tumor phenotype and patient survival. EXPERIMENTAL DESIGN We defined the PALB2 mutation status in 947 familial and 1,274 sporadic breast cancer patients and 1,079 population controls, and compared tumor characteristics and survival in mutation carriers relative to other familial and sporadic cases and to 79 BRCA1 and 104 BRCA2 mutation carrier cases. RESULTS The PALB2 1592delT mutation was found in 19 familial [2.0%; odds ratio, 11.03; 95% confidence interval (95% CI), 2.65-97.78; P < 0.0001] and eight sporadic patients (0.6%; odds ratio, 3.40; 95% CI, 0.68-32.95; P = 0.1207) compared with two (0.2%) control individuals. Tumors of the PALB2 mutation carriers presented triple negative (estrogen receptor negative/progesterone receptor negative/HER negative) phenotype more often (54.5%; P < 0.0001) than those of other familial (12.2%) or sporadic (9.4%) breast cancer patients. They were also more often of higher grade (P = 0.0027 and P = 0.0017, respectively) and had higher expression of Ki67 (P = 0.0004 and P = 0.0490, respectively). Carrying a PALB2 mutation was also associated with reduced survival, especially in familial cases (hazard ratio, 2.30; 95% CI, 1.01-5.24; P = 0.0466) and among familial patients with HER2-negative tumors (hazard ratio, 4.57; 95% CI, 1.96-10.64; P = 0.0004). Carrying a BRCA2 mutation was also found to be an independent predictor of poor survival at 10-year follow-up (P = 0.04). CONCLUSIONS The PALB2 1592delT mutation has a strong effect on familial breast cancer risk. The tumors rising in patients carrying this mutation manifest a phenotype associated with aggressive disease. Our results also suggest a significant impact of carrying a BRCA2 mutation on long-term breast cancer survival.
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Affiliation(s)
- Tuomas Heikkinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
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Johnatty SE, Couch FJ, Fredericksen Z, Tarrell R, Spurdle AB, Beesley J, Chen X, Gschwantler-Kaulich D, Singer CF, Fuerhauser C, Fink-Retter A, Domchek SM, Nathanson KL, Pankratz VS, Lindor NM, Godwin AK, Caligo MA, Hopper J, Southey MC, Giles GG, Justenhoven C, Brauch H, Hamann U, Ko YD, Heikkinen T, Aaltonen K, Aittomäki K, Blomqvist C, Nevanlinna H, Hall P, Czene K, Liu J, Peock S, Cook M, Platte R, Gareth Evans D, Lalloo F, Eeles R, Pichert G, Eccles D, Davidson R, Cole T, Cook J, Douglas F, Chu C, Hodgson S, Paterson J, Hogervorst FBL, Rookus MA, Seynaeve C, Wijnen J, Vreeswijk M, Ligtenberg M, van der Luijt RB, van Os TAM, Gille HJP, Blok MJ, Issacs C, Humphreys MK, McGuffog L, Healey S, Sinilnikova O, Antoniou AC, Easton DF, Chenevix-Trench G. No evidence that GATA3 rs570613 SNP modifies breast cancer risk. Breast Cancer Res Treat 2008; 117:371-9. [PMID: 19082709 DOI: 10.1007/s10549-008-0257-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 11/14/2008] [Indexed: 11/28/2022]
Abstract
GATA-binding protein 3 (GATA3) is a transcription factor that is crucial to mammary gland morphogenesis and differentiation of progenitor cells, and has been suggested to have a tumor suppressor function. The rs570613 single nucleotide polymorphism (SNP) in intron 4 of GATA3 was previously found to be associated with a reduction in breast cancer risk in the Cancer Genetic Markers of Susceptibility project and in pooled analysis of two case-control studies from Norway and Poland (P (trend) = 0.004), with some evidence for a stronger association with estrogen receptor (ER) negative tumours [Garcia-Closas M et al. (2007) Cancer Epidemiol Biomarkers Prev 16:2269-2275]. We genotyped GATA3 rs570613 in 6,388 cases and 4,995 controls from the Breast Cancer Association Consortium (BCAC) and 5,617 BRCA1 and BRCA2 carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). We found no association between this SNP and breast cancer risk in BCAC cases overall (OR(per-allele) = 1.00, 95% CI 0.94-1.05), in ER negative BCAC cases (OR(per-allele) = 1.02, 95% CI 0.91-1.13), in BRCA1 mutation carriers RR(per-allele) = 0.99, 95% CI 0.90-1.09) or BRCA2 mutation carriers (RR(per-allele) = 0.93, 95% CI 0.80-1.07). We conclude that there is no evidence that either GATA3 rs570613, or any variant in strong linkage disequilibrium with it, is associated with breast cancer risk in women.
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Affiliation(s)
- Sharon E Johnatty
- Cancer and Cell Biology, Queensland Institute of Medical Research, c/o Royal Brisbane Hospital Post Office, Herston, Brisbane, QLD 4029, Australia
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Bartkova J, Tommiska J, Oplustilova L, Aaltonen K, Tamminen A, Heikkinen T, Mistrik M, Aittomäki K, Blomqvist C, Heikkilä P, Lukas J, Nevanlinna H, Bartek J. Aberrations of the MRE11-RAD50-NBS1 DNA damage sensor complex in human breast cancer: MRE11 as a candidate familial cancer-predisposing gene. Mol Oncol 2008; 2:296-316. [PMID: 19383352 PMCID: PMC5527773 DOI: 10.1016/j.molonc.2008.09.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 09/11/2008] [Accepted: 09/14/2008] [Indexed: 02/07/2023] Open
Abstract
The MRE11, RAD50, and NBS1 genes encode proteins of the MRE11-RAD50-NBS1 (MRN) complex critical for proper maintenance of genomic integrity and tumour suppression; however, the extent and impact of their cancer-predisposing defects, and potential clinical value remain to be determined. Here, we report that among a large series of approximately 1000 breast carcinomas, around 3%, 7% and 10% tumours showed aberrantly reduced protein expression for RAD50, MRE11 and NBS1, respectively. Such defects were more frequent among the ER/PR/ERBB2 triple-negative and higher-grade tumours, among familial (especially BRCA1/BRCA2-associated) rather than sporadic cases, and the NBS1 defects correlated with shorter patients' survival. The BRCA1-associated and ER/PR/ERBB2 triple-negative tumours also showed high incidence of constitutively active DNA damage signalling (gammaH2AX) and p53 aberrations. Sequencing the RAD50, MRE11 and NBS1 genes of 8 patients from non-BRCA1/2 breast cancer families whose tumours showed concomitant reduction/loss of all three MRN-complex proteins revealed two germline mutations in MRE11: a missense mutation R202G and a truncating mutation R633STOP (R633X). Gene transfer and protein analysis of cell culture models with mutant MRE11 implicated various destabilization patterns among the MRN complex proteins including NBS1, the abundance of which was restored by re-expression of wild-type MRE11. We propose that germline mutations qualify MRE11 as a novel candidate breast cancer susceptibility gene in a subset of non-BRCA1/2 families. Our data have implications for the concept of the DNA damage response as an intrinsic anti-cancer barrier, various components of which become inactivated during cancer progression and also represent the bulk of breast cancer susceptibility genes discovered to date.
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Affiliation(s)
- Jirina Bartkova
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
| | - Johanna Tommiska
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital (HUCH), FI-00029 Helsinki, Finland
| | - Lenka Oplustilova
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
- Laboratory of Genome Integrity, Palacky University, Olomouc, Czech Republic
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital (HUCH), FI-00029 Helsinki, Finland
- Department of Oncology, HUCH, Helsinki, Finland
| | - Anitta Tamminen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital (HUCH), FI-00029 Helsinki, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital (HUCH), FI-00029 Helsinki, Finland
| | - Martin Mistrik
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
- Laboratory of Genome Integrity, Palacky University, Olomouc, Czech Republic
| | | | - Carl Blomqvist
- Department of Oncology, HUCH, Helsinki, Finland
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Jiri Lukas
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
| | - Heli Nevanlinna
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital (HUCH), FI-00029 Helsinki, Finland
| | - Jiri Bartek
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
- Laboratory of Genome Integrity, Palacky University, Olomouc, Czech Republic
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Bartkova J, Tommiska J, Oplustilova L, Aaltonen K, Tamminen A, Heikkinen T, Mistrik M, Aittomäki K, Blomqvist C, Heikkilä P, Lukas J, Nevanlinna H, Bartek J. Aberrations of the MRE11-RAD50-NBS1 DNA damage sensor complex in human breast cancer: MRE11 as a candidate familial cancer-predisposing gene. Mol Oncol 2008. [PMID: 19383352 DOI: 10.1016/molonc.2008.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The MRE11, RAD50, and NBS1 genes encode proteins of the MRE11-RAD50-NBS1 (MRN) complex critical for proper maintenance of genomic integrity and tumour suppression; however, the extent and impact of their cancer-predisposing defects, and potential clinical value remain to be determined. Here, we report that among a large series of approximately 1000 breast carcinomas, around 3%, 7% and 10% tumours showed aberrantly reduced protein expression for RAD50, MRE11 and NBS1, respectively. Such defects were more frequent among the ER/PR/ERBB2 triple-negative and higher-grade tumours, among familial (especially BRCA1/BRCA2-associated) rather than sporadic cases, and the NBS1 defects correlated with shorter patients' survival. The BRCA1-associated and ER/PR/ERBB2 triple-negative tumours also showed high incidence of constitutively active DNA damage signalling (gammaH2AX) and p53 aberrations. Sequencing the RAD50, MRE11 and NBS1 genes of 8 patients from non-BRCA1/2 breast cancer families whose tumours showed concomitant reduction/loss of all three MRN-complex proteins revealed two germline mutations in MRE11: a missense mutation R202G and a truncating mutation R633STOP (R633X). Gene transfer and protein analysis of cell culture models with mutant MRE11 implicated various destabilization patterns among the MRN complex proteins including NBS1, the abundance of which was restored by re-expression of wild-type MRE11. We propose that germline mutations qualify MRE11 as a novel candidate breast cancer susceptibility gene in a subset of non-BRCA1/2 families. Our data have implications for the concept of the DNA damage response as an intrinsic anti-cancer barrier, various components of which become inactivated during cancer progression and also represent the bulk of breast cancer susceptibility genes discovered to date.
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Affiliation(s)
- Jirina Bartkova
- Institute Cancer Biology and Centre for Genotoxic Stress Research, Danish Cancer Society, Copenhagen, Denmark
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Aaltonen K, Blomqvist C, Amini RM, Eerola H, Aittomäki K, Heikkilä P, Nevanlinna H. Familial breast cancers without mutations in BRCA1 or BRCA2 have low cyclin E and high cyclin D1 in contrast to cancers in BRCA mutation carriers. Clin Cancer Res 2008; 14:1976-83. [PMID: 18381935 DOI: 10.1158/1078-0432.ccr-07-4100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We analyzed the expression of critical cell cycle regulators cyclin E and cyclin D1 in familial breast cancer, focusing on BRCA mutation-negative tumors. Cyclin E expression in tumors of BRCA1 or BRCA2 carriers is higher, and cyclin D1 expression lower, than in sporadic tumors. In familial non-BRCA1/2 tumors, cyclin E and cyclin D1 expression has not been studied. EXPERIMENTAL DESIGN Cyclin E and cyclin D1 immunohistochemical expression was studied in tissue microarrays consisting of 53 BRCA1, 58 BRCA2, 798 familial non-BRCA1/2, and 439 sporadic breast tumors. RESULTS In univariate analysis, BRCA1 tumors had significantly more frequently high cyclin E (88%) and low cyclin D1 (84%) expression than sporadic (54% and 49%, respectively) or familial non-BRCA1/2 (38% and 45%, respectively) tumors. BRCA2 tumors had significantly more frequently low cyclin D1 expression (68%) than sporadic or familial non-BRCA1/2 tumors and significantly more frequently high cyclin E expression than familial non-BRCA1/2 tumors. In a logistic regression model, cyclin expression, early age of onset, and estrogen receptor (ER) and human epidermal growth factor receptor-2 (HER2) status were the independent factors most clearly distinguishing tumors of BRCA1 mutation carriers from other familial breast cancers. High cyclin E and low cyclin D1 expression were also independent predictors of BRCA2 mutation when compared with familial non-BRCA1/2 tumors. Most interestingly, lower frequency of high cyclin E expression independently distinguished familial non-BRCA1/2 tumors also from sporadic ones. CONCLUSIONS Cyclin E and cyclin D1 expression distinguishes non-BRCA1/2 tumors from both sporadic and BRCA1- and BRCA2-associated tumors and may reflect different predisposition and pathogenesis in these groups.
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Affiliation(s)
- Kirsimari Aaltonen
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
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Fagerholm R, Hofstetter B, Tommiska J, Aaltonen K, Vrtel R, Syrjäkoski K, Kallioniemi A, Kilpivaara O, Mannermaa A, Kosma VM, Uusitupa M, Eskelinen M, Kataja V, Aittomäki K, von Smitten K, Heikkilä P, Lukas J, Holli K, Bartkova J, Blomqvist C, Bartek J, Nevanlinna H. NAD(P)H:quinone oxidoreductase 1 NQO1*2 genotype (P187S) is a strong prognostic and predictive factor in breast cancer. Nat Genet 2008; 40:844-53. [PMID: 18511948 DOI: 10.1038/ng.155] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/09/2008] [Indexed: 01/17/2023]
Abstract
NQO1 guards against oxidative stress and carcinogenesis and stabilizes p53. We find that a homozygous common missense variant (NQO1(*)2, rs1800566(T), NM_000903.2:c.558C>T) that disables NQO1 strongly predicts poor survival among two independent series of women with breast cancer (P = 0.002, N = 1,005; P = 0.005, N = 1,162), an effect particularly evident after anthracycline-based adjuvant chemotherapy with epirubicin (P = 7.52 x 10(-6)) and in p53-aberrant tumors (P = 6.15 x 10(-5)). Survival after metastasis was reduced among NQO1(*)2 homozygotes, further implicating NQO1 deficiency in cancer progression and treatment resistance. Consistently, response to epirubicin was impaired in NQO1(*)2-homozygous breast carcinoma cells in vitro, reflecting both p53-linked and p53-independent roles of NQO1. We propose a model of defective anthracycline response in NQO1-deficient breast tumors, along with increased genomic instability promoted by elevated reactive oxygen species (ROS), and suggest that the NQO1 genotype is a prognostic and predictive marker for breast cancer.
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Affiliation(s)
- Rainer Fagerholm
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, FI-00029 Helsinki, Finland
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Heinonen M, Fagerholm R, Aaltonen K, Kilpivaara O, Aittomäki K, Blomqvist C, Heikkilä P, Haglund C, Nevanlinna H, Ristimäki A. Prognostic role of HuR in hereditary breast cancer. Clin Cancer Res 2008; 13:6959-63. [PMID: 18056170 DOI: 10.1158/1078-0432.ccr-07-1432] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE HuR is an mRNA-binding protein that enhances the stability of certain transcripts and can regulate their translation. Elevated cytoplasmic expression of HuR protein has been linked to carcinogenesis and is associated with reduced survival in breast, ovarian, and gastric adenocarcinomas. EXPERIMENTAL DESIGN Here, we have explored the relevance of HuR in familial breast cancer. Tumor samples were collected from patients with identified BRCA1 (n = 51) or BRCA2 (n = 47) mutations or familial non-BRCA1/2 cases (n = 525), and analyzed by immunohistochemistry. RESULTS Among familial non-BRCA1/2 breast cancer patients, cytoplasmic HuR protein expression was present in 39.4% of the cases and was associated with estrogen receptor negativity, progesterone receptor negativity, p53 positivity, high tumor grade, and ductal type of the tumor. In multivariate analysis, cytoplasmic HuR expression was an independent marker of reduced survival in the non-BRCA1/2 group along with tumor size >2 cm, lymph node metastasis, and high histologic grade. In patients with BRCA1 or BRCA2 mutations, cytoplasmic HuR expression was more frequent (62.7% for BRCA1 and 61.7% for BRCA2) than in the non-BRCA1/2 group, but in BRCA-mutated subgroups cytoplasmic HuR expression did not associate with survival. CONCLUSIONS Our results show that HuR is an important prognostic factor in familial breast cancer patients and may contribute to carcinogenesis in this disease.
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Affiliation(s)
- Mira Heinonen
- Department of Pathology/HUSLAB and Haartman Institute, Helsinki University Central Hospital, Finland
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Onay UV, Aaltonen K, Briollais L, Knight JA, Pabalan N, Kilpivaara O, Andrulis IL, Blomqvist C, Nevanlinna H, Ozcelik H. Combined effect of CCND1 and COMT polymorphisms and increased breast cancer risk. BMC Cancer 2008; 8:6. [PMID: 18194538 PMCID: PMC2254632 DOI: 10.1186/1471-2407-8-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 01/14/2008] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Estrogens are crucial tumorigenic hormones, which impact the cell growth and proliferation during breast cancer development. Estrogens are metabolized by a series of enzymes including COMT, which converts catechol estrogens into biologically non-hazardous methoxyestrogens. Several studies have also shown the relationship between estrogen and cell cycle progression through activation of CCND1 transcription. METHODS In this study, we have investigated the independent and the combined effects of commonly occurring CCND1 (Pro241Pro, A870G) and COMT (Met108/158Val) polymorphisms to breast cancer risk in two independent Caucasian populations from Ontario (1228 breast cancer cases and 719 population controls) and Finland (728 breast cancer cases and 687 population controls). Both COMT and CCND1 polymorphisms have been previously shown to impact on the enzymatic activity of the coded proteins. RESULTS Here, we have shown that the high enzymatic activity genotype of CCND1High (AA) was associated with increased breast cancer risk in both the Ontario [OR: 1.3, 95%CI (1.0-1.69)] and the Finland sample [OR: 1.4, 95%CI (1.01-1.84)]. The heterozygous COMTMedium (MetVal) and the high enzymatic activity of COMTHigh (ValVal) genotype was also associated with breast cancer risk in Ontario cases, [OR: 1.3, 95%CI (1.07-1.68)] and [OR: 1.4, 95%CI (1.07-1.81)], respectively. However, there was neither a statistically significant association nor increased trend of breast cancer risk with COMTHigh (ValVal) genotypes in the Finland cases [OR: 1.0, 95%CI (0.73-1.39)]. In the combined analysis, the higher activity alleles of the COMT and CCND1 is associated with increased breast cancer risk in both Ontario [OR: 2.22, 95%CI (1.49-3.28)] and Finland [OR: 1.73, 95%CI (1.08-2.78)] populations studied. The trend test was statistically significant in both the Ontario and Finland populations across the genotypes associated with increasing enzymatic activity. CONCLUSION Using two independent Caucasian populations, we have shown a stronger combined effect of the two commonly occurring CCND1 and COMT genotypes in the context of breast cancer predisposition.
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Affiliation(s)
- Ummiye V Onay
- Fred A, Litwin Centre for Cancer Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Amini RM, Aaltonen K, Nevanlinna H, Carvalho R, Salonen L, Heikkilä P, Blomqvist C. Mast cells and eosinophils in invasive breast carcinoma. BMC Cancer 2007; 7:165. [PMID: 17727696 PMCID: PMC2048965 DOI: 10.1186/1471-2407-7-165] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 08/29/2007] [Indexed: 12/20/2022] Open
Abstract
Background Inflammatory cells in the tumour stroma has gained increasing interest recently. Thus, we aimed to study the frequency and prognostic impact of stromal mast cells and tumour infiltrating eosinophils in invasive breast carcinomas. Methods Tissue microarrays containing 234 cases of invasive breast cancer were prepared and analysed for the presence of stromal mast cells and eosinophils. Tumour infiltrating eosinophils were counted on hematoxylin-eosin slides. Immunostaining for tryptase was done and the total number of mast cells were counted and correlated to the proliferation marker Ki 67, positivity for estrogen and progesterone receptors, clinical parameters and clinical outcome. Results Stromal mast cells were found to correlate to low grade tumours and estrogen receptor positivity. There was a total lack of eosinophils in breast cancer tumours. Conclusion A high number of mast cells in the tumours correlated to low-grade tumours and estrogen receptor positivity. Eosinophils are not tumour infiltrating in breast cancers.
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Affiliation(s)
- Rose-Marie Amini
- Department of Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Kirsimari Aaltonen
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Laura Salonen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Oncology, Radiology and Clinical Immunology, Uppsala University Hospital, Uppsala, Sweden
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Ahlin C, Aaltonen K, Amini RM, Nevanlinna H, Fjällskog ML, Blomqvist C. Ki67 and cyclin A as prognostic factors in early breast cancer. What are the optimal cut-off values? Histopathology 2007; 51:491-8. [PMID: 17711446 DOI: 10.1111/j.1365-2559.2007.02798.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS To find the optimal cut-off values for cyclin A and Ki67 in early breast cancer tumours and to evaluate their prognostic values. METHODS AND RESULTS Tissue microarray (TMA) slides were constructed from 570 T1-4 N0-1 M0 breast cancer tumours. The TMA slides were stained for cyclin A and Ki67 using immunohistochemistry with commercial antibodies. To investigate the optimal cut-off values for cyclin A, Ki67 average and maximum values the material was split into two parts at cut-offs defined by dividing it into deciles. For each cut-off value the relative risk (RR) for metastasis-free survival (MFS) and overall survival (OS) was calculated comparing patients with high versus low cyclin A or Ki67 expression. When using a cut-off value around the seventh decile, cyclin A and Ki67 score correlated with the highest RR ratio for MFS in the chemotherapy-naïve subgroup. Among patients having received adjuvant chemotherapy, no statistically significant differences in MFS or OS were found. CONCLUSIONS The optimal cut-off value for cyclin A average is 8% and for cyclin A maximum value 11%; for Ki67 the corresponding values are 15% and 22%. Additional studies are needed to verify these results.
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Affiliation(s)
- C Ahlin
- Department of Oncology, Orebro University Hospital, Orebro, Sweden.
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Cox A, Dunning AM, Garcia-Closas M, Balasubramanian S, Reed MWR, Pooley KA, Scollen S, Baynes C, Ponder BAJ, Chanock S, Lissowska J, Brinton L, Peplonska B, Southey MC, Hopper JL, McCredie MRE, Giles GG, Fletcher O, Johnson N, dos Santos Silva I, Gibson L, Bojesen SE, Nordestgaard BG, Axelsson CK, Torres D, Hamann U, Justenhoven C, Brauch H, Chang-Claude J, Kropp S, Risch A, Wang-Gohrke S, Schürmann P, Bogdanova N, Dörk T, Fagerholm R, Aaltonen K, Blomqvist C, Nevanlinna H, Seal S, Renwick A, Stratton MR, Rahman N, Sangrajrang S, Hughes D, Odefrey F, Brennan P, Spurdle AB, Chenevix-Trench G, Beesley J, Mannermaa A, Hartikainen J, Kataja V, Kosma VM, Couch FJ, Olson JE, Goode EL, Broeks A, Schmidt MK, Hogervorst FBL, Van't Veer LJ, Kang D, Yoo KY, Noh DY, Ahn SH, Wedrén S, Hall P, Low YL, Liu J, Milne RL, Ribas G, Gonzalez-Neira A, Benitez J, Sigurdson AJ, Stredrick DL, Alexander BH, Struewing JP, Pharoah PDP, Easton DF. A common coding variant in CASP8 is associated with breast cancer risk. Nat Genet 2007; 39:352-8. [PMID: 17293864 DOI: 10.1038/ng1981] [Citation(s) in RCA: 392] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 01/17/2007] [Indexed: 01/30/2023]
Abstract
The Breast Cancer Association Consortium (BCAC) has been established to conduct combined case-control analyses with augmented statistical power to try to confirm putative genetic associations with breast cancer. We genotyped nine SNPs for which there was some prior evidence of an association with breast cancer: CASP8 D302H (rs1045485), IGFBP3 -202 C --> A (rs2854744), SOD2 V16A (rs1799725), TGFB1 L10P (rs1982073), ATM S49C (rs1800054), ADH1B 3' UTR A --> G (rs1042026), CDKN1A S31R (rs1801270), ICAM5 V301I (rs1056538) and NUMA1 A794G (rs3750913). We included data from 9-15 studies, comprising 11,391-18,290 cases and 14,753-22,670 controls. We found evidence of an association with breast cancer for CASP8 D302H (with odds ratios (OR) of 0.89 (95% confidence interval (c.i.): 0.85-0.94) and 0.74 (95% c.i.: 0.62-0.87) for heterozygotes and rare homozygotes, respectively, compared with common homozygotes; P(trend) = 1.1 x 10(-7)) and weaker evidence for TGFB1 L10P (OR = 1.07 (95% c.i.: 1.02-1.13) and 1.16 (95% c.i.: 1.08-1.25), respectively; P(trend) = 2.8 x 10(-5)). These results demonstrate that common breast cancer susceptibility alleles with small effects on risk can be identified, given sufficiently powerful studies.
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Affiliation(s)
- Angela Cox
- Sheffield University Medical School, Sheffield S10 2RX, UK
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Aaltonen K, Ahlin C, Amini RM, Salonen L, Fjällskog ML, Heikkilä P, Nevanlinna H, Blomqvist C. Reliability of cyclin A assessment on tissue microarrays in breast cancer compared to conventional histological slides. Br J Cancer 2006; 94:1697-702. [PMID: 16670718 PMCID: PMC2361315 DOI: 10.1038/sj.bjc.6603147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cyclin A has in some studies been associated with poor breast cancer survival, although all studies have not confirmed this. Its prognostic significance in breast cancer needs evaluation in larger studies. Tissue microarray (TMA) technique allows a simultaneous analysis of large amount of tumours on a single microscopic slide. This makes a rapid screening of molecular markers in large amount of tumours possible. Because only a small tissue sample of each tumour is punched on an array, the question has arisen about the representativeness of TMA when studying markers that are expressed in only a small proportion of cells. For this reason, we wanted to compare cyclin A expression on TMA and on traditional large sections. Two breast cancer TMAs were constructed of 200 breast tumours diagnosed between 1997–1998. TMA slides and traditional large section slides of these 200 tumours were stained with cyclin A antibody and analysed by two independent readers. The reproducibility of the two readers’ results was good or even very good, with kappa values 0.71–0.87. The agreement of TMA and large section results was good with kappa value 0.62–0.75. Cyclin A overexpression was significantly (P<0.001) associated with oestrogen receptor and progesterone receptor negativity and high grade both on TMA and large sections. Cyclin A overexpression was significantly associated with poor metastasis-free survival both on TMA and large sections. The relative risks for metastasis were similar on TMA and large sections. This study suggests that TMA technique could be useful to study histological correlations and prognostic significance of cyclin A on breast cancer on a large scale.
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Affiliation(s)
- K Aaltonen
- Department of Oncology, Helsinki University Central Hospital, PO Box 180, FIN 00290 HUS, Finland.
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Abstract
Falling asleep as a means of ending migraine attack was studied in 133 4-16-year-old children in out-patient settings. Children registered 999 migraine attacks in headache diaries using a visual analogue scale (VAS) in 409 attacks and a five-face scale in 590 attacks. The distribution of maximal pain intensity was similar on both scales; on VAS 88% assigned grades between 63 and 100, and on the face scale 93% assigned grades of 4 or 5. Children fell asleep during 33% of the attacks (n = 329), in 64% of these within the first hour (n = 209). Of the children, 68% (n = 91) had fallen asleep at least once during an attack. Falling asleep was more common in children under 8 years of age than in older children. In those under 8 years, 62% (95% confidence interval (CI) 49-75%) of attacks were resolved by sleep, in those aged 8-12 years 34% (26-41%), and in children >12 years 24% (15-33%) (ANOVA, P<0.0001). Pain was relieved without sleep in 43% (n = 431) of attacks, in 38% of these (n = 383) within the first 4 h. The data on migraine resolution were missing for 24% (n = 239) of the attacks, most often because the attack exceeded the 5-h observation period. This study confirms that migraine attacks in children are extremely painful and often resolve during an interval of sleep in children under 8 years of age.
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Affiliation(s)
- K Aaltonen
- Hospital for Children and Adolescents, Department of Clinical Pharmacology, University of Helsinki, Finland.
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