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Elkum N, Aboussekhra A, Aboussekhra M, Aldalham H, Alshehri L, Alessy S, Al-Tweigeri T, Al-Zahrani AS. Molecular Subtypes of Breast Cancer in Arab Women: Distribution and Prognostic Insights. J Epidemiol Glob Health 2025; 15:36. [PMID: 40063309 PMCID: PMC11893967 DOI: 10.1007/s44197-025-00376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 02/19/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Understanding the ethnic molecular subtype characteristics of breast cancer (BC) in Saudi women is crucial for providing comprehensive prognostic information and optimizing patient outcomes, making it essential to study their distribution and impact on survival. METHODS This hospital-based cohort study analyzed clinic-pathological data from 1,035 Saudi women diagnosed with invasive BC and followed for 12 years, at King Faisal Specialist Hospital & Research Center. Cancers were classified into four molecular subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative. Survival outcomes were assessed using Kaplan-Meier survival curves and Cox proportional hazard models. RESULTS Luminal A was the most common molecular subtype (41.7%), followed by luminal B (23.4%), triple-negative (19.5%), and HER2-enriched (15.4%). Age at diagnosis, menopause, and tumor grade were significantly associated with subtypes (p < 0.05). Survival outcomes varied significantly (p = 0.0202), with luminal A and B showing the highest 5-year survival rates (~ 83%), triple-negative at 76.4% (hazard ratio: 1.55), and HER2-enriched tumors had the lowest at 69.1%, with a 1.75-fold higher risk of death. Advanced-stage cancers (III and IV) were strongly associated with increased mortality, with hazard ratios of 2.5 and 7.6, respectively, compared to early-stage disease. CONCLUSIONS Molecular subtypes and stage at diagnosis are key predictors of mortality in Saudi women with BC. The poor outcomes for HER2-enriched and TNBC subtypes highlight the need for timely diagnosis and targeted treatments, emphasizing the importance of personalized care and addressing ethnic variations in BC diagnosis.
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Affiliation(s)
- Naser Elkum
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia.
| | - Abdelilah Aboussekhra
- Cancer Biology and Experimental Therapeutics Section, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, KSA, Saudi Arabia
| | - Mouad Aboussekhra
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia
| | - Hanin Aldalham
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia
| | - Lama Alshehri
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia
| | - Saleh Alessy
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia
| | - Taher Al-Tweigeri
- Breast Cancer, Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, KSA, Saudi Arabia
| | - Ali Saeed Al-Zahrani
- Research and Innovation, GCC Cancer Control and Prevention, King Faisal Specialist Hospital and Research Center, PO BOX 3354, Riyadh, KSA, 11211, Saudi Arabia
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Ang BH, Teo SH, Ho WK. Systematic Review and Meta-Analysis of Lifestyle and Reproductive Factors Associated with Risk of Breast Cancer in Asian Women. Cancer Epidemiol Biomarkers Prev 2024; 33:1273-1285. [PMID: 39018331 PMCID: PMC7617425 DOI: 10.1158/1055-9965.epi-24-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/21/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts. METHODS We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations. RESULTS Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on premenopausal and postmenopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. While alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%, ≥24 kg/m2 among postmenopausal women) were predominant in Asians. CONCLUSIONS Our study shows that while the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary. IMPACT Our analysis underscores the importance of considering population-specific risk factor distributions when developing risk prediction tools for Asian populations.
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Affiliation(s)
- Boon Hong Ang
- Cancer Research Malaysia, Level 1, Subang Jaya Medical CentreSouth Tower, No. 1, Jalan SS 12/1A, 47500Subang Jaya, Selangor Darul Ehsan, Malaysia
| | - Soo-Hwang Teo
- Cancer Research Malaysia, Level 1, Subang Jaya Medical CentreSouth Tower, No. 1, Jalan SS 12/1A, 47500Subang Jaya, Selangor Darul Ehsan, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, 50603Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Weang-Kee Ho
- Cancer Research Malaysia, Level 1, Subang Jaya Medical CentreSouth Tower, No. 1, Jalan SS 12/1A, 47500Subang Jaya, Selangor Darul Ehsan, Malaysia
- Faculty of Science and Engineering, School of Mathematical Sciences, University of Nottingham Malaysia, Jalan Broga , 43500Semenyih, Selangor Darul Ehsan, Malaysia
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Kumar N, Ehsan S, Banerjee S, Fernandez Perez C, Lhuilier I, Neuner J, Friebel-Klingner T, Fayanju OM, Nair B, Niinuma SA, Nampoothiri S, McCarthy AM. The unique risk factor profile of triple-negative breast cancer: a comprehensive meta-analysis. J Natl Cancer Inst 2024; 116:1210-1219. [PMID: 38445713 PMCID: PMC11308168 DOI: 10.1093/jnci/djae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) has a poor prognosis compared with other breast cancer subtypes. This systematic review and meta-analysis examines whether known risk factors for breast cancer are also associated with TNBC in adult women. METHODS EMBASE, Medline, SCOPUS, and gray literature were queried with no limit on the date or language of publication. The exposures of interest included parity, breastfeeding, duration of breastfeeding, age at menarche, age at first live birth, oral contraceptive (OC) use, duration of OC use, use of menopausal hormone therapy (MHT), family history, body mass index (BMI), alcohol use, smoking, and breast density. The main outcome of interest was TNBC. Study quality was determined using the Newcastle-Ottawa scale for case control studies and cohort studies. We estimated weighted odds ratios from random effects models to study the exposure-outcome associations. Protocol was registered under the number: PROSPERO 2021 CRD42021254594. RESULTS Thirty-three studies were included. Family history, longer duration of OC use, and higher breast density were significantly associated with increased risk for TNBC, whereas later age at menarche, later age at first birth, and breastfeeding were protective against TNBC. Parity, MHT, alcohol, smoking, and BMI were not significantly associated with TNBC overall, but higher parity was associated with higher risk among Black women. CONCLUSION Our findings highlight that TNBC has a distinct risk factor profile compared with overall breast cancer. This can be the foundational work in identification of actionable TNBC risk factors to improve prevention and early detection of these poor prognosis breast tumors.
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Affiliation(s)
- Nitya Kumar
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, Bahrain
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shahana Banerjee
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudia Fernandez Perez
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Lhuilier
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jillian Neuner
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tara Friebel-Klingner
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Oluwadamilola M Fayanju
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bindhu Nair
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, Bahrain
| | - Sara Anjum Niinuma
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, Bahrain
| | | | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Flaherty RL, Sflomos G, Brisken C. Is There a Special Role for Ovarian Hormones in the Pathogenesis of Lobular Carcinoma? Endocrinology 2024; 165:bqae031. [PMID: 38551031 PMCID: PMC10988861 DOI: 10.1210/endocr/bqae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 04/04/2024]
Abstract
Lobular carcinoma represent the most common special histological subtype of breast cancer, with the majority classed as hormone receptor positive. Rates of invasive lobular carcinoma in postmenopausal women have been seen to increase globally, while other hormone receptor-positive breast cancers proportionally have not followed the same trend. This has been linked to exposure to exogenous ovarian hormones such as hormone replacement therapy. Reproductive factors resulting in increased lifetime exposure to endogenous ovarian hormones have also been linked to an increased risk of lobular breast cancer, and taken together, these data make a case for the role of ovarian hormones in the genesis and progression of the disease. In this review, we summarize current understanding of the epidemiological associations between ovarian hormones and lobular breast cancer and highlight mechanistic links that may underpin the etiology and biology.
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Affiliation(s)
- Renée L Flaherty
- Division of Breast Cancer Research, The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
| | - George Sflomos
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Cathrin Brisken
- Division of Breast Cancer Research, The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
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Naeimzadeh Y, Ilbeigi S, Dastsooz H, Rafiee Monjezi M, Mansoori Y, Tabei SMB. Protooncogenic Role of ARHGAP11A and ARHGAP11B in Invasive Ductal Carcinoma: Two Promising Breast Cancer Biomarkers. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8236853. [PMID: 38046902 PMCID: PMC10689071 DOI: 10.1155/2023/8236853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/22/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023]
Abstract
Invasive duct carcinoma (IDC) is one of the most common types of breast cancer (BC) in women worldwide, with a high risk of malignancy, metastasis, recurrence, and death. So far, molecular patterns among IDC cases have not been fully defined. However, extensive evidence has shown that dysregulated Rho family small GTPases (Rho GTPases) including Rho GTPase activating proteins (RhoGAPs) have important roles in the invasive features of IDCs. In the current study, we analyzed the expression levels of two RhoGAP genes, ARHGAP11A and ARHGAP11B, in The Cancer Genome Atlas (TCGA) breast cancer (BRCA) and also our 51 IDC tumors compared to their matched normal tissues using quantitative polymerase chain reaction (qPCR). Our TCGA data analysis revealed higher expression of ARHGAP11A and ARHGAP11B in various cancers comprising BCs. Also, we found correlations between these genes and other genes in TCGA-BRCA. Moreover, our methylation analysis showed that their promotor methylation had a negative correlation with their overexpression. QPCR revealed their significant upregulation in our tumor samples. Furthermore, we found that the expression level of ARHGAP11A was considerably lower in women who were breastfeeding. Moreover, it had overexpression in cases who had regular menstrual cycles and early age (younger than 14) at menarche. However, ARHGAP11B had a higher expression in HER2-positive tumors versus HER2-positive and ER-positive tumors. Our study found possible protooncogenic roles for these genes and their involvement in IDC pathogenesis and malignancy. Therefore, they can be considered novel prognostic and diagnostic biomarkers for IDC.
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Affiliation(s)
- Y. Naeimzadeh
- School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Ilbeigi
- Walther-Straub Institute, Ludwig-Maximilians-Universität München, Munich, Germany
| | - H. Dastsooz
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
- Candiolo, C/o IRCCS, IIGM-Italian Institute for Genomic Medicine, Turin, Italy
- Candiolo Cancer (IT), FPO-IRCCS, Candiolo Cancer Institute, Turin, Italy
| | - M. Rafiee Monjezi
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Y. Mansoori
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - S. M. B. Tabei
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Mao X, Omeogu C, Karanth S, Joshi A, Meernik C, Wilson L, Clark A, Deveaux A, He C, Johnson T, Barton K, Kaplan S, Akinyemiju T. Association of reproductive risk factors and breast cancer molecular subtypes: a systematic review and meta-analysis. BMC Cancer 2023; 23:644. [PMID: 37430191 DOI: 10.1186/s12885-023-11049-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes. METHODS Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals. RESULTS A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use. CONCLUSION Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.
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Affiliation(s)
- Xihua Mao
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Shama Karanth
- UF Health Cancer Canter, University of Florida, Gainesville, FL, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Clare Meernik
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Lauren Wilson
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Amy Clark
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Chunyan He
- The Cancer Prevention and Control Research Program, University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Tisha Johnson
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Karen Barton
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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Barańska A, Dolar-Szczasny J, Kanadys W, Kinik W, Ceglarska D, Religioni U, Rejdak R. Oral Contraceptive Use and Breast Cancer Risk According to Molecular Subtypes Status: A Systematic Review and Meta-Analysis of Case-Control Studies. Cancers (Basel) 2022; 14:cancers14030574. [PMID: 35158842 PMCID: PMC8833678 DOI: 10.3390/cancers14030574] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
We conducted a systematic review and meta-analysis to investigate the effect of oral contraceptives (OCs) on risk of breast cancer (BrCa) by status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). We searched the MEDLINE (PubMed), Embase and the Cochrane Library database and bibliographies of pertinent articles published up to 2020. Therein, we identified nineteen eligible case-control studies which provided data by breast cancer subtypes: ER-positive (ER+), ER-negative (ER−), HER2-positive (HER2+) and Triplet-negative (TN). Summary risk estimates (pooled OR [pOR]) and 95% confidence intervals (CIs) were calculated using fixed/random effects models. The summary meta-analysis showed that over-use of OCs led to significant increased risk of TNBrCa (OR = 1.37, 95% CI; 1.13 to 1.67, p = 0.002), as well as of ER−BrCa (OR = 1.20, 95% CI: 1.03 to 1.40, p = 0.019). There was also a significant reduction in the risk of ER+BrCa (OR = O.92, 95% CI: 0.86 to 0.99, p = 0.026,) and a slight reduction in the risk of HER2+BrCa (OR = 0.95, 95% CI; 0.79 to 1.14, p = 0.561) after taking OCs. Meta-analysis indicated that OC use has different impacts on risk of breast cancer subtypes defined by receptor status. The identified differences between individual subtypes of breast cancer may reflect different mechanisms of carcinogenesis.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland
- Correspondence:
| | - Joanna Dolar-Szczasny
- Department of General and Pediatric Ophtalmology, Medical University of Lublin, 20-070 Lublin, Poland; (J.D.-S.); (R.R.)
| | | | - Wiktoria Kinik
- Science Popularization Centre, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Dorota Ceglarska
- Subunit, Primary Health Care Center Provita, 20-093 Lublin, Poland;
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland;
- National Institute of Public Health-National Institute of Hygiene, Warsaw School of Economics, 02-554 Warsaw, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophtalmology, Medical University of Lublin, 20-070 Lublin, Poland; (J.D.-S.); (R.R.)
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Xie F, Liu L, Yang H, Liu M, Wang S, Guo J, Yu L, Zhou F, Wang F, Xiang Y, Yu Z, Wang S. OUP accepted manuscript. Oncologist 2022; 27:e1-e8. [PMID: 35305101 PMCID: PMC8842323 DOI: 10.1093/oncolo/oyab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Fei Xie
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Houpu Yang
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Miao Liu
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Siyuan Wang
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jiajia Guo
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Fei Zhou
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- Zhigang Yu, Department of Breast Surgery, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan, Shandong 250033, People’s Republic of China. Tel: +86-531-8587-5048;
| | - Shu Wang
- Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China
- Corresponding author: Shu Wang, Department of Breast Center, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng, Beijing 100044, People’s Republic of China. Tel: +86-10-8832-4010;
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Li C, Fan Z, Lin X, Cao M, Song F, Song F. Parity and risk of developing breast cancer according to tumor subtype: A systematic review and meta-analysis. Cancer Epidemiol 2021; 75:102050. [PMID: 34706325 DOI: 10.1016/j.canep.2021.102050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical breast cancer subtypes are categorized basing on the expression of hormone receptors and overexpression of the human epidermal growth factor receptor 2 (HER2). It is still unclear whether parity impact the risk of different breast cancer subtypes. METHODS We searched eight mainstream databases for published epidemiologic studies that assessed the relationship between parity and risk of breast cancer subtypes up to January 12, 2021. Parity number were unified into nulliparity and ever parity. The random-effects or fixed-effect models were used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) among different subtypes. Restricted cubic spline analysis with four knots was applied to determine the relationship of parity number and risk of breast cancer subtypes. RESULTS We pooled sixteen case-control and four cohort studies, and performed an analysis including 7795 luminal A, 3576 luminal B, 1794 HER2-overexpressing, and 5192 triple-negative breast cancer cases among 1135131 participants. The combined ORs for ever parity versus nulliparity indicated a 34% reduction in luminal A risk (OR=0.66, 95% CI: 0.56-0.78), and a 29% reduction in luminal B risk (OR=0.71, 95% CI: 0.63-0.81), there was no significant association in HER2-overexpressing or TNBC risk. In the dose-response analysis, we observed a potentially non-linear and gradually increasing protective relationship between the number of parity and luminal breast cancer risk. CONCLUSIONS The effect of parity on breast cancer seems to vary among breast tumor subtypes, and it plays a protective role in luminal breast cancer.
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Affiliation(s)
- Chenyang Li
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology in Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Zeyu Fan
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology in Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Xiao Lin
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology in Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Mingli Cao
- Department of Chronic Diseases, Hexi District Center for Disease Control and Prevention, Tianjin 300211, People's Republic of China
| | - Fangfang Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology in Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology in Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China.
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Allouch S, Gupta I, Malik S, Al Farsi HF, Vranic S, Al Moustafa AE. Breast Cancer During Pregnancy: A Marked Propensity to Triple-Negative Phenotype. Front Oncol 2021; 10:580345. [PMID: 33425733 PMCID: PMC7786283 DOI: 10.3389/fonc.2020.580345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022] Open
Abstract
Breast and cervical cancers comprise 50% of all cancers during pregnancy. In particular, gestational breast cancer is considered one of the most aggressive types of cancers, which is a rare but fatal disease. However, the incidence of this type of cancer is increasing over the years and its prevalence is expected to rise further as more women delay childbearing. Breast cancer occurring after pregnancy is generally triple negative with specific characterizations of a poorer prognosis and outcome. On the other hand, it has been pointed out that this cancer is associated with a specific group of genes which can be used as precise targets to manage this deadly disease. Indeed, combination therapies consisting of gene-based agents with other cancer therapeutics is presently under consideration. We herein review recent progress in understanding the development of breast cancer during pregnancy and their unique subtype of triple negative which is the hallmark of this type of breast cancer.
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Affiliation(s)
- Soumaya Allouch
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ishita Gupta
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
| | - Shaza Malik
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ala-Eddin Al Moustafa
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical Research Center, Qatar University, Doha, Qatar
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11
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Zevallos A, Bravo L, Bretel D, Paez K, Infante U, Cárdenas N, Alvarado H, Posada AM, Pinto JA. The hispanic landscape of triple negative breast cancer. Crit Rev Oncol Hematol 2020; 155:103094. [PMID: 33027724 DOI: 10.1016/j.critrevonc.2020.103094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is a heterogeneous and complex disease characterized by the absence of immunohistochemical expression of estrogen receptor, progesterone receptor and HER2. These breast tumors present an aggressive biology and offer few opportunities to be treated with targeted therapy resulting in bad disease outcomes. The epidemiology of TNBC is intriguing where the understanding of its biology has progressed quickly. One of the peculiarities of this type of cancer is a high prevalence in Afrodescendants and Hispanic patients compared to Caucasian women. In this review we describe some features of TNBC, focusing in the Hispanic population, such as epidemiological, clinicopathological features and molecular features and the correlation between TNBC prevalence and the human development index.
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Affiliation(s)
- Alejandra Zevallos
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Leny Bravo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Denisse Bretel
- Grupo de Estudios Clínicos Oncológicos Peruano, GECOPERU, Lima, Peru
| | - Kevin Paez
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | - Ulises Infante
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | - Nadezhda Cárdenas
- Escuela de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica, Peru
| | - Hober Alvarado
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | | | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud - AUNA, Lima, Peru.
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12
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Reproductive Risk Factors Associated with Breast Cancer Molecular Subtypes among Young Women in Northern China. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5931529. [PMID: 32337260 PMCID: PMC7166267 DOI: 10.1155/2020/5931529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/29/2022]
Abstract
Purpose Accumulated evidence suggests that reproductive factors are related to different breast cancer subtypes, but most studies on these relationships are mainly focused on middle-aged and older patients, and it remains unclear how reproductive factors impact different subtypes of breast cancer in young women. Methods We assessed the relationships between fertility factors and luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative breast cancer (TNBC) subtypes in 3792 patients and 4182 controls aged 20–70 years. Data on the reproductive history of the study participants were acquired through face-to-face interviews and questionnaires. We conducted case-control comparisons among tumor subtypes based on estrogen receptor (ER), progesterone receptor (PR), and HER2 statuses using unconditional polychotomous multivariate logistic regression models to compute odds ratios (ORs) and 95% confidence intervals (CIs). Results Parity was inversely related to both luminal A and luminal B subtypes in young women and older women (all Ptrend < 0.05). Later age at first full-term birth was inversely related to the luminal A subtype (Ptrend < 0.05) in young women but correlated with an increased risk of the luminal A subtype (Ptrend < 0.05) in older women. Parous Chinese women 40 years old or younger who breastfed for 12 months or longer had a lower risk of luminal B and TNBC subtypes than women who never breastfed (OR = 0.55, 95% CI 0.36-0.84 and OR = 0.52, 95% CI 0.28-0.99, respectively). Conclusions Our results implied that parity exerted a strong protective effect against luminal A and luminal B subtype breast cancer in young Chinese women, and long-term breastfeeding obviously decreased the risk of luminal B and TNBC subtypes in this population.
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13
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Rojas-Lima E, Gamboa-Loira B, Cebrián ME, Rothenberg SJ, López-Carrillo L. A cumulative index of exposure to endogenous estrogens and breast cancer by molecular subtypes in northern Mexican women. Breast Cancer Res Treat 2020; 180:791-800. [PMID: 32086656 DOI: 10.1007/s10549-020-05562-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate breast cancer (BC) molecular subtypes association with reproductive characteristics and an index of cumulative exposure to endogenous estrogens (EEI) in Mexican women. METHODS We performed a study of incident cases and population controls in northern Mexico. We included BC cases with tumor molecular classification in their medical records (n = 509), and classified them as HR+/HER2- (ER+ and/or PR+ and HER2-) (n = 289), HER2+ (HR+ or HR-) (n = 117) or triple negative (TN) (n = 103). We matched controls (n = 1030) by age and place of residence with index cases. Women were interviewed about their reproductive history, from which the EEI was developed. We used logistic regression models to estimate BC molecular subtypes associations with reproductive characteristics and EEI. RESULTS The EEI was higher in all subtypes compared to controls (Median HR+/HER2- 27.25, HER2+ 26.8, TN 24.2 vs. controls 22.8 years, p < 0.05), and was associated with HR+/HER2- (ORT3 vs. T1 = 2.58, 95% CI 1.77-3.55, p-trend < 0.001) and HER2+ (ORT3 vs. T1 = 4.17, 95% CI 2.15-8.08, p-trend < 0.001) BC. Additionally, HR+/HER2- tumors were positively associated with age at first pregnancy and age at menopause, and negatively with age at menarche, parity and breastfeeding. The HER2+ subtype was associated in the same direction as HR+/HER2- tumors with all the reproductive characteristics except for age at menarche. TN tumors were negatively associated with parity and breastfeeding. CONCLUSION Endogenous estrogens exposure throughout Mexican women reproductive life may contribute to the development of all but TN BC, however, these findings should be confirmed in other Hispanic populations.
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Affiliation(s)
- Elodia Rojas-Lima
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Brenda Gamboa-Loira
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Mariano E Cebrián
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, C.P. 07360, Mexico City, Mexico
| | - Stephen J Rothenberg
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Lizbeth López-Carrillo
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
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14
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Zhang L, Huang Y, Feng Z, Wang X, Li H, Song F, Liu L, Li J, Zheng H, Wang P, Song F, Chen K. Comparison of breast cancer risk factors among molecular subtypes: A case-only study. Cancer Med 2019; 8:1882-1892. [PMID: 30761775 PMCID: PMC6488156 DOI: 10.1002/cam4.2012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Abstract
Epidemiological studies have a clear definition of the risk factors for breast cancer. However, it is unknown whether the distribution of these factors differs among breast cancer subtypes. We conducted a hospital‐based case‐only study consisting of 8067 breast cancer patients basing on the Tianjin Cohort of Breast Cancer Cases. Major breast cancer subtypes including luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)‐enriched and basal‐like were defined by estrogen receptor, progesterone receptor, HER2, and Ki‐67 status. Variables including demographic characteristics, reproductive factors, lifestyle habits, imaging examination, and clinicopathologic data were collected for patients. Chi‐square test and one‐way analysis of variance were used to compare the distributions of variables among the four breast cancer subtypes. Multivariate logistic regression was used to estimate the odds ratios and associated 95% confidence intervals where luminal A patients served as the reference group. Overall, more commonality rather than heterogeneity on the distributions of factors was found between the four molecular subtypes of breast cancer. The proportion of overweight and obesity were lower in HER2‐enriched subtype. Women with age at menarche ≤13 years were more likely to be found in basal‐like subtype. Postmenopausal women were more frequent in HER2‐enriched and basal‐like subtypes. Women with benign breast disease and higher breast density were more common in HER2‐enriched subtype. Risk factor scoring showed that total risk scores were similar among the four subtypes. HER2‐enriched and basal‐like subtypes were more frequently diagnosed with large tumors. Calcification was more likely to be found in luminal B and HER2‐enriched subtypes, whereas less distributed in basal‐like subtype. Most of the breast cancer risk factors were similarly distributed among the four major breast cancer subtypes; commonality is predominant.
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Affiliation(s)
- Liwen Zhang
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Yubei Huang
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Ziwei Feng
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Xin Wang
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Haixin Li
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.,Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Department of Cancer Biobank, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Fangfang Song
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Luyang Liu
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Junxian Li
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Hong Zheng
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Peishan Wang
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Fengju Song
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Kexin Chen
- Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
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15
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Nafissi N, Faraji M, Hosseini M, Shojaee L, Ziaei F, Akbari ME, Mousavie SH. Relationships between Reproductive Risk Factors for Breast Cancer and Tumor Molecular Subtypes. Asian Pac J Cancer Prev 2018; 19:1767-1770. [PMID: 30049185 PMCID: PMC6165646 DOI: 10.22034/apjcp.2018.19.7.1767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Due to wide clinical differences in the various pathological types of breast cancer and also close associations between disease prognosis and molecular subtypes, relationships of the latter with traditional risk factors have been suggested. Hence, the present study aimed to assess any associations. Methods: This bi-center cross-sectional study was performed on 800 consecutive women with known breast cancer referred to two Comprehensive Cancer Centers in Tehran between 2006 and 2016. Baseline information related to reproductive risk profiles as well as pathological tumor diagnosis and molecular subtypes determined using immunohistochemical analysis by immune-staining for ER, PR, and HER2 molecules were collected by reviewing hospital records. Results: Of 800 samples included for immunohistochemical analysis, 314 (39.3%) were diagnosed as of Luminal A subtype, 107 (13.4%) as Luminal B subtype, 153 (19.1%) as HER-2 over-expressing, and 226 (28.3%) as triple negative. Among all reproductive risk factors initially assessed, young age was associated with HER-2 over-expression, greater tumor size and a history of abortion with the luminal B subtype, lower age at pregnancy with the luminal A subtype, and lower gravidity and a shorter duration of breastfeeding with the triple negative subtype. Conclusion: Each molecular subtype of breast cancer in our population may be associated with specific reproductive risk factors.
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MESH Headings
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/etiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/etiology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Cross-Sectional Studies
- Female
- Follow-Up Studies
- Humans
- Iran
- Middle Aged
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Reproductive History
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Affiliation(s)
- Nahid Nafissi
- Department of Breast Surgery, Iran University of Medical Science, Rasool-Akram Hospital, Tehran, Iran.
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16
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Jeong SH, An YS, Choi JY, Park B, Kang D, Lee MH, Han W, Noh DY, Yoo KY, Park SK. Risk Reduction of Breast Cancer by Childbirth, Breastfeeding, and Their Interaction in Korean Women: Heterogeneous Effects Across Menopausal Status, Hormone Receptor Status, and Pathological Subtypes. J Prev Med Public Health 2018; 50:401-410. [PMID: 29207445 PMCID: PMC5717332 DOI: 10.3961/jpmph.17.152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype. Methods BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breastfeeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs). Results BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity<0.001), and pathological subtype (p-heterogeneity<0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity<0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58). Conclusions This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%.
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Affiliation(s)
- Seok Hun Jeong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Suk An
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Yeob Choi
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Young Noh
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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17
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John EM, Hines LM, Phipps AI, Koo J, Longacre TA, Ingles SA, Baumgartner KB, Slattery ML, Wu AH. Reproductive history, breast-feeding and risk of triple negative breast cancer: The Breast Cancer Etiology in Minorities (BEM) study. Int J Cancer 2018; 142:2273-2285. [PMID: 29330856 PMCID: PMC5893409 DOI: 10.1002/ijc.31258] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 02/03/2023]
Abstract
Few risk factors have been identified for triple negative breast cancer (TNBC) which lacks expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). This more aggressive subtype disproportionately affects some racial/ethnic minorities and is associated with lower survival. We pooled data from three population-based studies (558 TNBC and 5,111 controls) and examined associations of TNBC risk with reproductive history and breast-feeding. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression. For younger women, aged <50 years, TNBC risk was increased two-fold for parous women who never breast-fed compared to nulliparous women (OR = 2.02, 95% CI = 1.12-3.63). For younger parous women, longer duration of lifetime breast-feeding was associated with a borderline reduced risk (≥24 vs. 0 months: OR = 0.52, 95% CI = 0.26-1.04, Ptrend = 0.06). Considering the joint effect of parity and breast-feeding, risk was increased two-fold for women with ≥3 full-term pregnancies (FTPs) and no or short-term (<12 months) breast-feeding compared to women with 1-2 FTPs and breast-feeding ≥12 months (OR = 2.56, 95% CI = 1.22-5.35). None of these associations were observed among older women (≥50 years). Differences in reproductive patterns possibly contribute to the ethnic differences in TNBC incidence. Among controls aged <50 years, the prevalence of no or short-term breast-feeding and ≥3 FTPs was highest for Hispanics (22%), followed by African Americans (18%), Asian Americans (15%) and non-Hispanic whites (6%). Breast-feeding is a modifiable behavioral factor that may lower TNBC risk and mitigate the effect of FTPs in women under age 50 years.
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Affiliation(s)
- Esther M. John
- Cancer Prevention Institute of California, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Lisa M. Hines
- University of Colorado at Colorado Springs, Department of Biology, Colorado Springs, CO 80918
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA 98195
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA 94538
| | - Teri A. Longacre
- Department of Pathology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Sue A. Ingles
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
| | - Kathy B. Baumgartner
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | | | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
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18
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Jerônimo AFDA, Weller M. Differential Association of the Lifestyle-Related Risk Factors Smoking and Obesity with Triple Negative Breast Cancer in a Brazilian Population. Asian Pac J Cancer Prev 2017; 18:1585-1593. [PMID: 28669172 PMCID: PMC6373799 DOI: 10.22034/apjcp.2017.18.6.1585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: A longer lifespan and changing lifestyle-related and reproductive risk factors have led to an increased incidence of breast cancer in Brazil. There have been few studies about associations of specific risk factors with molecular subtypes of the disease. The aim of the present study was to identify factors that modulate the risk of triple negative breast cancer. Materials and Methods: A case-case analysis was performed. Data for 236 breast cancer patients from two reference centres in North-eastern Brazil were applied to assess the association of risk factors with triple negative breast cancer relative to the luminal A subtype. Molecular subtypes were defined by expression status of hormone receptors and amplification of HER2. Nominal logistic regression was used to estimate odds ratios and to generate a model of independent variables. Results: Smoking and body mass index were differentially associated with likelihood of triple negative breast cancer compared to the Luminal A subtype (p= 0.013; p= 0.004): Women who ever smoked some time in their lives were 4.016 (OR= 0.249; CI 95%: 0.09- 0.71) times less likely to have triple negative breast cancer. Obese and overweight patients, respectively, were 4.489 (CI 95%: 1.32- 15.28) and 1.340 (CI 95%: 0.38- 4.69) times more likely to have triple negative breast cancer. Conclusions: Case-case analysis with the Luminal A subtype as the reference group indicated that smoking and body mass index are differentially associated with risk of triple negative breast cancer.
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19
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Unar-Munguía M, Torres-Mejía G, Colchero MA, González de Cosío T. Breastfeeding Mode and Risk of Breast Cancer: A Dose-Response Meta-Analysis. J Hum Lact 2017; 33:422-434. [PMID: 28196329 DOI: 10.1177/0890334416683676] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Breastfeeding reduces women's risk of breast cancer. Since exclusive breastfeeding has a stronger hormonal effect, it could theoretically result in a greater reduction in breast cancer risk than any breastfeeding mode. No meta-analysis has examined breast cancer risk by breastfeeding mode. Research aim: The authors conducted a meta-analysis for breast cancer risk in parous women who breastfed exclusively or in any mode versus parous women who formula fed their infants, and they estimated the summary dose-response association by the accumulated duration of any breastfeeding mode. METHODS A systematic review of studies published between 2005 and 2015 analyzing breastfeeding and breast cancer risk in women was conducted in PubMed and EBSCOhost. A meta-analysis ( n = 65 studies) with fixed effects (or random effects, if heterogeneity existed) was carried out stratified by breastfeeding mode and menopausal and parity status. A summary dose-response association was estimated using the generalized least-squares method. RESULTS The summary relative risk (SRR) for breast cancer in parous women who breastfed exclusively was 0.72, 95% confidence interval (CI) [0.58, 0.90], versus parous women who had never breastfed. For parous women who breastfed in any mode, the SRR was lower in both premenopausal women (0.86, 95% CI [0.80, 0.93]) and postmenopausal women (0.89, 95% CI [0.83, 0.95]). There was no heterogeneity or publication bias. There is weak evidence of a difference between exclusive and any breastfeeding mode ( p = .08). The summary dose-response curve was nonlinear ( p < .001). CONCLUSION Exclusive breastfeeding among parous women reduces the risk of breast cancer compared with parous women who do not breastfeed exclusively.
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Affiliation(s)
- Mishel Unar-Munguía
- 1 Center for Research on Health and Nutrition, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Gabriela Torres-Mejía
- 2 Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - M Arantxa Colchero
- 3 Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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20
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Ellingjord-Dale M, Vos L, Tretli S, Hofvind S, Dos-Santos-Silva I, Ursin G. Parity, hormones and breast cancer subtypes - results from a large nested case-control study in a national screening program. Breast Cancer Res 2017; 19:10. [PMID: 28114999 PMCID: PMC5259848 DOI: 10.1186/s13058-016-0798-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 12/29/2022] Open
Abstract
Background Breast cancer comprises several molecular subtypes with different prognoses and possibly different etiology. Reproductive and hormonal factors are associated with breast cancer overall, and with luminal subtypes, but the associations with other subtypes are unclear. We used data from a national screening program to conduct a large nested case-control study. Methods We conducted a nested case-control study on participants in the Norwegian Breast Cancer Screening Program in 2006 − 2014. There was information on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) for 4748 cases of breast cancer. Breast cancer subtypes were defined as luminal A-like (ER+ PR+ HER2-), luminal B-like (ER+ PR- HER2- or ER+ PR+/PR-HER2+), HER2-positive (ER- PR- HER2+) and triple-negative (ER- PR- HER2-). Conditional logistic regression was used to estimate odds ratios (ORs) of breast cancer associated with age at first birth, number of pregnancies, oral contraceptive use, intrauterine devices and menopausal hormone therapy. Analyses were adjusted for age, body mass index, education, age at menarche, number of pregnancies and menopausal status. Results Number of pregnancies was inversely associated with relative risk of luminal-like breast cancers (p-trend ≤0.02), and although not statistically significant, with HER2-positive (OR = 0.60, 95% CI 0.31–1.19) and triple-negative cancer (OR = 0.70, 95% CI 0.41–1.21). Women who had ≥4 pregnancies were at >40% lower risk of luminal-like and HER2-positive cancers than women who had never been pregnant. However, there was a larger discrepancy between tumor subtypes with menopausal hormone use. Women who used estrogen and progesterone therapy (EPT) had almost threefold increased risk of luminal A-like cancer (OR = 2.92, 95% CI 2.36–3.62) compared to never-users, but were not at elevated risk of HER2-positive (OR = 0.88, 95% CI 0.33–2.30) or triple-negative (OR = 0.92, 95% CI 0.43 − 1.98) subtypes. Conclusions Reproductive factors were to some extent associated with all subtypes; the strongest trends were with luminal-like subtypes. Hormone therapy use was strongly associated with risk of luminal-like breast cancer, and less so with risk of HER2-positive or triple-negative cancer. There are clearly some, but possibly limited, etiologic differences between subtypes, with the greatest contrast between luminal A-like and triple-negative subtypes. Trial registration Not applicable.
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Affiliation(s)
| | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | | | | | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway. .,University of Oslo, Oslo, Norway. .,University of Southern California, Los Angeles, CA, USA.
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Ma H, Ursin G, Xu X, Lee E, Togawa K, Duan L, Lu Y, Malone KE, Marchbanks PA, McDonald JA, Simon MS, Folger SG, Sullivan-Halley J, Deapen DM, Press MF, Bernstein L. Reproductive factors and the risk of triple-negative breast cancer in white women and African-American women: a pooled analysis. Breast Cancer Res 2017; 19:6. [PMID: 28086982 PMCID: PMC5237290 DOI: 10.1186/s13058-016-0799-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early age at menarche, nulliparity, late age at first completed pregnancy, and never having breastfed, are established breast cancer risk factors. However, among breast cancer subtypes, it remains unclear whether all of these are risk factors for triple-negative breast cancer (TNBC). METHODS We evaluated the associations of these reproductive factors with TNBC, in 2658 patients with breast cancer (including 554 with TNBC) and 2448 controls aged 20-64 years, who participated in one of the three population-based case-control studies: the Women's Contraceptive and Reproductive Experiences Study, the Women's Breast Carcinoma in situ Study, or the Women's Learning the Influence of Family and Environment Study. We used multivariable polychotomous unconditional logistic regression methods to conduct case-control comparisons among breast cancer subtypes defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 expression status. RESULTS TNBC risk decreased with increasing duration of breastfeeding (P trend = 0.006), but age at menarche, age at first completed pregnancy, and nulliparity were not associated with risk of TNBC. Parous women who breastfed for at least one year had a 31% lower risk of TNBC than parous women who had never breastfed (odds ratio, OR = 0.69; 95% confidence interval, CI = 0.50-0.96). The association between breastfeeding and risk of TNBC was modified by age and race. Parous African-American women aged 20-44 years who breastfed for 6 months or longer had an 82% lower risk of TNBC than their counterparts who had never breastfed (OR = 0.18, 95% CI = 0.07-0.46). CONCLUSIONS Our data indicate that breastfeeding decreases the risk of TNBC, especially for younger African-American women.
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Affiliation(s)
- Huiyan Ma
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Xinxin Xu
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Kayo Togawa
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Lei Duan
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
- School of Social Work, University of Southern California, Los Angeles, CA 90033 USA
| | - Yani Lu
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Kathleen E. Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Polly A. Marchbanks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Jill A. McDonald
- College of Health and Social Services, New Mexico State University, Las Cruces, NM 88003 USA
| | - Michael S. Simon
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI 48201 USA
| | - Suzanne G. Folger
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Jane Sullivan-Halley
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
| | - Dennis M. Deapen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Michael F. Press
- Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, 1500 East Duarte Rd. Duarte, City of Hope, CA 91010 USA
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Li H, Sun X, Miller E, Wang Q, Tao P, Liu L, Zhao Y, Wang M, Qi Y, Li J. BMI, reproductive factors, and breast cancer molecular subtypes: A case-control study and meta-analysis. J Epidemiol 2016; 27:143-151. [PMID: 28142040 PMCID: PMC5376312 DOI: 10.1016/j.je.2016.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/08/2016] [Indexed: 02/07/2023] Open
Abstract
Background The effects of body mass index (BMI) and reproductive factors may vary among breast cancer molecular subtypes, evidence of which is lacking in East Asia. Methods From 2002 to 2010, 1256 breast cancer patients and 1416 healthy women were recruited. Anthropometric and reproductive factors were collected from medical charts. Breast cancer subtype was defined by ER, PR, and HER2 status. Polytomous logistic regression was used to evaluate associations between risk factors and breast cancer subtypes, with subgroup analysis by menopausal status. A meta-analysis of relevant published studies in East Asia was also performed. Results In our case-control study, late menarche was negatively associated with luminal tumor risk (Ptrend = 0.03). Higher BMI was associated with risk of both luminal and triple-negative tumors (Ptrend<0.001). Late age at first live birth was associated with a 1.41- to 2.08-fold increased risk of all subtypes, while late menopause increased risk by 2.62–5.56 times. Heterogeneity of these associations was not detected for different menopausal statuses. The meta-analysis revealed a positive dose-response relationship between BMI and risk of both luminal and ER-PR- subtypes (Ptrend<0.05). Early menarche and nulliparity increased luminal tumor risk by 1.39 and 1.26 times, respectively. Non-breastfeeding also increased the risk of all subtypes. Conclusions For East Asian women, overweight, late menopause, and lack of breastfeeding appear to increase risk of both luminal and ER−PR− tumors. Early menarche and nulliparity mainly impacted luminal tumor risk. These associations were not impacted by menopausal status. For East Asian women, overweight increases risk of both luminal and ER-PR- tumors. For East Asian women, early menarche increases luminal tumor risk. For East Asian women, nulliparity increases luminal tumor risk.
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Affiliation(s)
- Hui Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Xuezheng Sun
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erline Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qiong Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China; Department of Health Service Management, Public Health School, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ping Tao
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Li Liu
- The Comprehensive Guidance Center of Women's Health, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Ying Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Mengjie Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Yana Qi
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China.
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Reproductive behaviors and risk of developing breast cancer according to tumor subtype: A systematic review and meta-analysis of epidemiological studies. Cancer Treat Rev 2016; 49:65-76. [PMID: 27529149 DOI: 10.1016/j.ctrv.2016.07.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breast cancer is composed of distinct subtypes defined mainly based on the expression of hormone receptors (HR) and HER2. For years, reproductive factors were shown to impact breast cancer risk but it is unclear whether this differs according to tumor subtype. In this meta-analysis we evaluated the association between parity, age at first birth, breastfeeding and the risk of developing breast cancer according to tumor subtype. METHODS PubMed and Embase were searched to identify epidemiological studies that evaluated the impact of parity and/or age at first birth and/or breastfeeding on breast cancer risk with available information on HR and HER2. Tumor subtypes were defined as: luminal (HR-positive, HER2-negative or HER2-positive), HER2 (HR-negative, HER2-positive) and triple-negative (HR-negative, HER2-negative). Summary risk estimates (pooled OR [pOR]) and 95% confidence intervals (CI) were calculated using random effects models. The MOOSE guidelines were applied. RESULTS This meta-analysis evaluated 15 studies, including 21,941 breast cancer patients and 864,177 controls. Parity was associated with a 25% reduced risk of developing luminal subtype (pOR 0.75; 95% CI, 0.70-0.81; p<0.0001). Advanced age at first birth was associated with an increased risk of developing luminal subtype (pOR 1.15; 95% CI, 1.00-1.32; p=0.05). Ever breastfeeding was associated with a reduced risk of developing both luminal (pOR 0.77; 95% CI, 0.66-0.88; p=0.003) and triple-negative (pOR 0.79, 95% CI, 0.66-0.94; p=0.01) subtypes. CONCLUSIONS The reproductive behaviors impact the risk of developing breast cancer but this varies according to subtype.
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Islami F, Liu Y, Jemal A, Zhou J, Weiderpass E, Colditz G, Boffetta P, Weiss M. Breastfeeding and breast cancer risk by receptor status--a systematic review and meta-analysis. Ann Oncol 2015; 26:2398-407. [PMID: 26504151 DOI: 10.1093/annonc/mdv379] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/06/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breastfeeding is inversely associated with overall risk of breast cancer. This association may differ in breast cancer subtypes defined by receptor status, as they may reflect different mechanisms of carcinogenesis. We conducted a systematic review and meta-analysis of case-control and prospective cohort studies to investigate the association between breastfeeding and breast cancer by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. DESIGN We searched the PubMed and Scopus databases and bibliographies of pertinent articles to identify relevant articles and used random-effects models to calculate summary odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS This meta-analysis represents 27 distinct studies (8 cohort and 19 case-control), with a total of 36 881 breast cancer cases. Among parous women, the risk estimates for the association between ever (versus never) breastfeeding and the breast cancers negative for both ER and PR were similar in three cohort and three case-control studies when results were adjusted for several factors, including the number of full-term pregnancies (combined OR 0.90; 95% CI 0.82-0.99), with little heterogeneity and no indication of publication bias. In a subset of three adjusted studies that included ER, PR, and HER2 status, ever breastfeeding showed a stronger inverse association with triple-negative breast cancer (OR 0.78; 95% CI 0.66-0.91) among parous women. Overall, cohort studies showed no significant association between breastfeeding and ER+/PR+ or ER+ and/or PR+ breast cancers, although one and two studies (out of four and seven studies, respectively) showed an inverse association. CONCLUSIONS This meta-analysis showed a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer. The association between breastfeeding and receptor-positive breast cancers needs more investigation.
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Affiliation(s)
- F Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Y Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA
| | - A Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta
| | - J Zhou
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - E Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø Cancer Registry of Norway, Oslo, Norway Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - G Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA Siteman Cancer Center, Washington University School of Medicine, St Louis
| | - P Boffetta
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - M Weiss
- Breastcancer.org/breasthealth.org, Lankenau Medical Center, Wynnewood, USA
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25
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Barnard ME, Boeke CE, Tamimi RM. Established breast cancer risk factors and risk of intrinsic tumor subtypes. Biochim Biophys Acta Rev Cancer 2015; 1856:73-85. [DOI: 10.1016/j.bbcan.2015.06.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/07/2015] [Accepted: 06/08/2015] [Indexed: 12/31/2022]
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Leon-Hernandez SR, Padilla EL, Algara AC, Rodriguez NC, Sanchez EF, Cruz JL, Mejia Barradas CM, Bandala C. Relation of alcohol/tobacco use with metastasis, hormonal (estrogen and progesterone) receptor status and c-erbB2 protein in mammary ductal carcinoma. Asian Pac J Cancer Prev 2015; 15:5709-14. [PMID: 25081690 DOI: 10.7314/apjcp.2014.15.14.5709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An association between alcohol/tobacco use and risk of metastasis in breast cancer has been clearly shown. MATERIALS AND METHODS The present study explored, in 48 samples of tissue from mammary ductal carcinoma (taken from Mexican women with an average age of 58.2±10.9 years), the association of risk of metastasis with the status of hormonal receptors and the c-erbB2 protein (by immunohistochemistry) as well as clinical, histopathological and sociodemographic factors. RESULTS Of 48 patients, 41.6% (20/48) presented with metastasis, 43.8% were positive for the estrogen receptor (RE+), 31.3% for the progesterone receptor (RP+) and 47.7% for c-erbB2 (c-erbB2+). The following combinations were found: RE+/RP+/c-erbB2+ 8.3%, RE+/RP+ 22.9%, RE+/RP- 20.8%, RE-/RP+ 8.3%, RE-/RP-/c-erbB2- 22.9% and RE-/RP- 47.8%. There were 12 patients who used alcohol/tobacco, of which 91.6% did not present metastasis and 81.9% were RE-/RP-. Compared to the RE-/RP-/c-erbB2+, the RE+/RP+/c-erbB2+ group had a 15-fold greater risk for metastasis (95%CI, 0.9-228.8, p=0.05). The carriers of the double negative hormonal receptors had a 4.7 fold greater probability of being (or having been) smokers or drinkers (95%CI, 1.0-20.4, p = 0.03). CONCLUSIONS There was a clear protective effect of using alcohol and/or tobacco, in the cases included in the present study of mammary ductal carcinoma, associated with double negative hormonal receptors. However, this association could be due to a protective factor not measured (Neyman bias) or to a bias inherent in the rate of hospitalization (Berkson fallacy). This question should be explored in a broad prospective longitudinal study.
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de Almeida GS, Almeida LAL, Araujo GMR, Weller M. Reproductive Risk Factors Differ Among Breast Cancer Patients and Controls in a Public Hospital of Paraiba, Northeast Brazil. Asian Pac J Cancer Prev 2015; 16:2959-65. [DOI: 10.7314/apjcp.2015.16.7.2959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Healey MA, Hu R, Beck AH, Collins LC, Schnitt SJ, Tamimi RM, Hazra A. Association of H3K9me3 and H3K27me3 repressive histone marks with breast cancer subtypes in the Nurses' Health Study. Breast Cancer Res Treat 2014; 147:639-51. [PMID: 25224916 DOI: 10.1007/s10549-014-3089-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/29/2014] [Indexed: 02/07/2023]
Abstract
Repressive histone tail modifications have been associated with molecular breast cancer subtypes. We investigated whether histone 3 lysine 9 trimethylation (H3K9me3) and histone 3 lysine 27 trimethylation (H3K27me3) were associated with tumor features and subtypes while adjusting for prospectively collected reproductive and lifestyle breast cancer risk factors. We have tissue microarray data with immunohistochemical marker information on 804 incident cases of invasive breast cancer diagnosed from 1976-2000 in the Nurses' Health Study. Tissue microarray sections were stained for global H3K9me3 and H3K27me3, and scored into four categories. Multivariate odds ratios (OR) and 95 % confidence intervals (CI) were calculated using logistic regression models for tumor features and subtypes, adjusting for breast cancer risk factors. While there were no significant associations between H3K9me3 and tumor features, H3K27me3 was significantly associated with lower grade tumors compared to high grade tumors in the multivariate model (OR = 1.95, 95 % CI 1.35-2.81, p = 0.0004). H3K27me3 was suggestively associated with estrogen receptor-positive (ER+) tumors (OR = 1.47, 95 % CI 0.97-2.23, p = 0.07). In subtype analyses, H3K27me3 was positively associated with the luminal A subtype compared to all other subtypes (OR = 1.42, 95 % CI 1.14-1.77, p = 0.002), and was inversely associated with HER2-type (OR = 0.58, 95 % CI 0.37-0.91, p = 0.02) and basal-like breast cancer (OR = 0.52, 95 % CI 0.36-0.76, p = 0.0006). In the largest immunohistochemical examination of H3K9me3 and H3K27me3 in breast cancer, we found that H3K27me3 positivity, but not H3K9me3, was associated with lower grade tumors and the luminal A subtype after adjusting for reproductive and lifestyle breast cancer risk factors.
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Affiliation(s)
- Megan A Healey
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Reproductive risk factors and breast cancer subtypes: a review of the literature. Breast Cancer Res Treat 2014; 144:1-10. [PMID: 24477977 DOI: 10.1007/s10549-014-2852-7] [Citation(s) in RCA: 254] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 12/31/2022]
Abstract
Aside from age, sex, and family history, risk of developing breast cancer is largely linked to reproductive factors, which characterize exposure to sex hormones. Given that, molecular testing at the tumor level is currently possible, clinical characterization of tumor subtypes is routinely conducted to guide treatment decisions. However, despite the vast amount of published data from observational studies on reproductive factor associations and breast cancer risk, relatively fewer reports have been published on associations specific to breast tumor subtypes. We conducted a review of the literature and summarized the results of associations between reproductive factors and risk or odds of three distinct tumor subtypes: estrogen receptor/progesterone receptor positive (hormone receptor positive, HR+ tumors), tumors overexpressing the human epidermal receptor 2 protein (HER2+), and triple negative breast cancer (TNBC), which lacks the three markers. Results show that the most consistent evidence for associations with reproductive risk factors exists for HR+ breast cancers, with nulliparity, current use of menopausal hormone therapy, and prolonged interval between menarche and age at first birth being the strongest risk factors; increased age at first birth and decreased age at menarche were fairly consistently associated with HR+ cancers; and though less consistent, older age at menopause was also positively associated, while lactation was inversely associated with HR+ tumors. Fewer consistent associations have been reported for TNBC. The single protective factor most consistently associated with TNBC was longer duration of breastfeeding. Increased parity, younger age at first birth, older age at menarche, and oral contraceptive use were less consistently shown to be associated with TNBC. No remarkable associations for HER2+ breast cancers were evident, although this was based on relatively scarce data. Findings suggest heterogeneity in reproductive risk factors for the distinct subtypes of breast tumors, which may have implications for recommended prevention strategies.
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González-Jiménez E, García PA, Aguilar MJ, Padilla CA, Álvarez J. Breastfeeding and the prevention of breast cancer: a retrospective review of clinical histories. J Clin Nurs 2013; 23:2397-403. [DOI: 10.1111/jocn.12368] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Emilio González-Jiménez
- Departamento de Enfermería; Facultad de Enfermería (Campus de Melilla); Universidad de Granada; Melilla Spain
| | - Pedro A García
- Departamento de Estadística e I.O.; Facultad de Ciencias del Trabajo; Universidad de Granada; Granada Spain
| | - María José Aguilar
- Departamento de Enfermería; Facultad de Ciencias de la Salud; Universidad de Granada; Granada Spain
| | - Carlos A Padilla
- Junta de Andalucía; Grupo de Investigación CTS-367; Granada Spain
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McNamara KM, Yoda T, Takagi K, Miki Y, Suzuki T, Sasano H. Androgen receptor in triple negative breast cancer. J Steroid Biochem Mol Biol 2013; 133:66-76. [PMID: 22982153 DOI: 10.1016/j.jsbmb.2012.08.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/27/2012] [Accepted: 08/17/2012] [Indexed: 01/22/2023]
Abstract
The clinical management of triple negative breast cancer (TNBC) is challenging due to the relatively aggressive biological behaviour and paucity of specific targeted therapy. A subset of TNBC patients has been reported to express androgen receptor (AR) in carcinoma cells and the manipulation of androgen signalling or AR targeted therapies have been proposed. However, the biological significance of AR in TNBC has remained relatively unknown. Therefore, this review aims to summarise the reported studies assessing the rates of AR positivity in TNBC patients and androgenic effects in TNBC cell lines. The rates of AR positivity among TNBC cases varied depending on the study population (0-53% of all TNBC patients). This difference among the reported studies may be largely due to the methodological differences of analysing AR. While the majority of cell line studies suggest that androgen increase proliferation and preliminary clinical studies suggest that AR antagonists improve the prognosis of AR positive TNBC patients, cell line transfection experiments and survival analyses of histological samples suggest that the presence of AR in tumour is either benign or predicts better survival. Therefore further translational investigations regarding the mechanisms of androgen action in TNBC are required to explain this discrepancy between clinical and basic studies.
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Affiliation(s)
- K M McNamara
- Department of Anatomical Pathology, Tohoku University School of Graduate Medicine, Japan.
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Sueta A, Ito H, Islam T, Hosono S, Watanabe M, Hirose K, Fujita T, Yatabe Y, Iwata H, Tajima K, Tanaka H, Iwase H, Matsuo K. Differential impact of body mass index and its change on the risk of breast cancer by molecular subtype: A case-control study in Japanese women. SPRINGERPLUS 2012; 1:39. [PMID: 23350064 PMCID: PMC3550694 DOI: 10.1186/2193-1801-1-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 01/05/2023]
Abstract
Body mass index (BMI) is an independent risk factor for luminal-type breast cancer in Western populations. However, it is unclear whether the impact of BMI differs according to breast cancer subtype in Japanese populations. We conducted a case–control study with 715 cases and 1430 age- and menopausal status-matched controls to evaluate the associations of BMI and its change (from age 20 years to the current age) with breast cancer risk. We applied conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Tumor subtypes were divided into four subtypes, namely the luminal, luminal/HER2, HER2-rich, and triple-negative subtypes. Current BMI and BMI change were positively associated with postmenopausal breast cancer risk. On stratified analysis by tumor subtype, we observed associations between current BMI and BMI change and postmenopausal breast cancer risk for the luminal subtype, with OR for each 1 kg/m2 increase in current BMI of 1.14 (95% CI: 1.07 - 1.20) and the corresponding OR of BMI change of 1.16 (1.09 - 1.23) (each Ptrend < 0.001). Additionally, we found the same tendency for the triple-negative subtype, with the OR for a 1 kg/m2 increase in current BMI of 1.21 (1.05 - 1.39) and that for BMI change of 1.18 (1.02 - 1.36) (Ptrend was 0.008 and 0.024, respectively). In premenopausal women, a suggestive inverse association was observed between BMI change and breast cancer risk for the luminal subtype only, with OR of BMI change of 0.93 (0.87 - 1.00, Ptrend = 0.054). No association was seen between BMI at age 20 years and risk of any tumor subtype. In conclusion, BMI and its change are associated with the risk of both luminal and triple-negative breast cancer among postmenopausal Japanese women. These findings suggest the etiological heterogeneity of breast cancer among tumor subtypes.
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Affiliation(s)
- Aiko Sueta
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681 Japan ; Department of Breast and Endocrine Surgery, Kumamoto University Graduate School of Medical Science, 1-1-1, Honjo, Kumamoto, 860-8556 Japan
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Kawai M, Kakugawa Y, Nishino Y, Hamanaka Y, Ohuchi N, Minami Y. Reproductive factors and breast cancer risk in relation to hormone receptor and menopausal status in Japanese women. Cancer Sci 2012; 103:1861-70. [PMID: 22762156 DOI: 10.1111/j.1349-7006.2012.02379.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 12/29/2022] Open
Abstract
The associations between menstrual and reproductive factors and breast cancer risk in relation to estrogen/progesterone receptor (ER/PgR) status have been unclear in Japanese women. This case-control study evaluated these associations, overall and separately, by menopausal status. A total of 1092 breast cancer cases and 3160 controls were selected from among female patients aged 30 years and over admitted to a single hospital in Miyagi Prefecture between 1997 and 2009. The receptor status distribution among the cases (missing: 8.4%) was 571 ER+/PgR+, 133 ER+/PgR-, 24 ER-/PgR+ and 271 ER-/PgR-. Menstrual and reproductive factors were assessed using a self-administered questionnaire. Polytomous logistic regression and tests for heterogeneity across ER+/PgR+ and ER-/PgR- were conducted. Later age at menarche was significantly associated with a decreased risk of both ER+/PgR+ and ER-/PgR- cancer among women overall (P(trend) = 0.0016 for ER+/PgR+; P(trend) = 0.015 for ER-/PgR-) and among postmenopausal women (P(trend) = 0.012 for ER+/PgR+; P(trend) = 0.0056 for ER-/PgR-). Nulliparity was associated with an increased risk of ER+/PgR+, but not ER-/PgR- cancer among women overall (P(heterogeneity) = 0.019) and among postmenopausal women (odds ratio for ER+/PgR+ = 2.56, 95% confidence interval = 1.61-4.07; P(heterogeneity) = 0.0095). A longer duration of breastfeeding tended to be associated with a decreased risk in all subtypes among women overall. Later age at menarche has a protective effect against both ER+/PgR+ and ER-/PgR- cancer. However, parity might impact differently on various subtypes of breast cancer. Further studies are needed to clarify the etiology of the rare ER+/PgR- and ER-/PgR+ cancer subtypes.
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Affiliation(s)
- Masaaki Kawai
- Division of Community Health, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kobayashi S, Sugiura H, Ando Y, Shiraki N, Yanagi T, Yamashita H, Toyama T. Reproductive history and breast cancer risk. Breast Cancer 2012; 19:302-8. [PMID: 22711317 PMCID: PMC3479376 DOI: 10.1007/s12282-012-0384-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/30/2012] [Indexed: 12/23/2022]
Abstract
The fact that reproductive factors have significant influence on the risk of breast cancer is well known. Early age of first full-term birth is highly protective against late-onset breast cancers, but each pregnancy, including the first one, increases the risk of early-onset breast cancer. Estradiol and progesterone induce receptor activator of NF-kappa B ligand (RANKL) in estrogen receptor (ER)- and progesterone receptor (PgR)-positive luminal cells. RANKL then acts in a paracrine fashion on the membranous RANK of ER/PgR-negative epithelial stem cells of the breast. This reaction cascade is triggered by chorionic gonadotropin during the first trimester of pregnancy and results in the morphological and functional development of breast tissue. On the other hand, the administration of non-steroidal anti-inflammatory drugs in the early steps of weaning protects against tumor growth through reduction of the acute inflammatory reaction of post lactation remodeling of breast tissue. This is experimental evidence that may explain the short-term tumor-promoting effect of pregnancy. The protective effect of prolonged breast feeding may also be explained, at least in a part, by a reduced inflammatory reaction due to gradual weaning. Delay of first birth together with low parity and short duration of breast feeding are increasing social trends in developed countries. Therefore, breast cancer risk as a result of reproductive factors will not decrease in these countries in the foreseeable future. In this review, the significance of reproductive history with regard to the risk of breast cancers will be discussed, focusing on the age of first full-term birth and post lactation involution of the breast.
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Affiliation(s)
- Shunzo Kobayashi
- Department of Breast and Endocrine Surgery, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan.
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