乳腺癌高危因素
  • 乳腺癌与雌激素受体(ER)相关,而良性乳腺增生(BBD)、体重指数(BMI)、更年期、激素使用等危险因素会影响乳腺癌的发展;
  • 采用前瞻性数据分析危险因素与ER亚型的关系,用Cox回归计算风险比(HRs),Wald检验分析风险因素的影响程度;
  • BBD患者,ER阳性患者HRs更高;
  • 更年期患者及超重或肥胖的围绝经期患者,BMI对ER阳性患者影响更大;
  • 绝经后无论是否使用激素,BMI提高均增加乳腺癌患者HRs,且对ER阴性患者影响更大。
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Risk Factors That Increase Risk of Estrogen Receptor-Positive and -Negative Breast Cancer

雌激素受体阳性或阴性乳腺癌风险的危险因素

10.1093/jnci/djw276

2016-12-31, Article

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BACKGROUND: Risk factors may differentially influence development of estrogen receptor (ER)-positive vs -negative breast cancer. We examined associations with strong, prevalent risk factors by ER subtype.
METHODS: Of 1 279 443 women age 35 to 74 years participating in the Breast Cancer Surveillance Consortium, 14 969 developed ER-positive and 3617 developed ER-negative invasive breast cancer. We calculated hazard ratios (HRs) using Cox regression and compared ER subtype hazard ratios at representative ages or by menopausal status using Wald tests. All statistical tests were two-sided.
RESULTS: For women age 40 years, compared with no prior biopsy, ER-positive vs ER-negative HRs were 1.53 (95% CI = 1.30 to 1.81) vs 1.26 (95% CI = 0.90 to 1.76) for nonproliferative disease, 1.63 (95% CI = 1.23 to 2.17) vs 1.41 (95% CI = 0.78 to 2.57) for proliferative disease without atypia, and 4.47 (95% CI = 2.88 to 6.96) vs 0.20 (95% CI = 0.02 to 2.51) for proliferative disease with atypia. Benign disease proliferation risk was stronger for ER-positive than ER-negative cancer for women age 35 years (Wald P = .04), age 40 years (Wald P = .04), and age 50 years (Wald P = .06). Among pre/perimenopausal women, body mass index (BMI) had a stronger association with ER-negative than ER-positive cancer (obese II/III vs. normal weight: HR = 1.52, 95% CI = 1.19 to 1.94; vs 1.21, 95% CI = 1.08 to 1.36). Increasing BMI similarly increased ER-positive and ER-negative cancer risk among postmenopausal hormone users (Wald P = .15) and nonusers (Wald P = .08). Associations with ER subtype varied by race/ethnicity across all ages (P < .001) and by family history of breast cancer and breast density for specific ages.
CONCLUSIONS: Strength of risk factor associations differed by ER subtype. Separate risk models for ER subtypes may improve identification of women for targeted prevention strategies.

First Authors:
Karla Kerlikowske

Correspondence Authors:
Karla Kerlikowske

All Authors:
Karla Kerlikowske,Charlotte C Gard,Jeffrey A Tice,Elad Ziv,Steven R Cummings,Diana L Miglioretti,

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