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Lee M, Kotake R, Yamauchi H. Physical Activity and Mammographic Density in Japanese Women. Cancer Epidemiol Biomarkers Prev 2024; 33:365-370. [PMID: 38147061 PMCID: PMC10905669 DOI: 10.1158/1055-9965.epi-23-0777] [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: 07/06/2023] [Revised: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Dense breast is one of the strong risk factors for breast cancer among women. While it has been established that physical activity is associated with decreased risk for breast cancer, results have been inconsistent in terms of mammographic density. Thus, we examined physical activity in relation to mammographic density among Japanese women in Tokyo. METHODS We used 123,026 records from 33,698 Japanese women without a history of breast cancer who got mammograms at St. Luke's International Hospital in Tokyo, Japan from 2004 to 2019. Mammographic density was classified according to the Breast Imaging Reporting and Data System (BI-RADS), and women self-reported their physical activity level over the past year. ORs were estimated using logistic generalized estimating equations after adjusting for age, body mass index, menopausal status, parity, family history of breast or ovarian cancer, hormone therapy use, smoking status, alcohol consumption, and year. RESULTS We observed inverse associations of physical activity with dense breasts. Adjusted ORs were 0.96 (95% confidence interval: 0.91-1.00) for women with physical exercise for 1-2 days per week, 0.94 (0.88-0.99) for those with physical exercise for 3-5 days per week, and 0.91 (0.84-0.99) for those with daily physical exercise when compared with those reported seldom physical exercise. CONCLUSIONS Higher levels of physical activity may be associated with decreased mammographic density levels in Japanese women. IMPACT Increasing physical activity may serve as a reasonable intervention to reduce mammographic density, and thereby, to mitigate the risk of breast cancer in Asian women.
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Affiliation(s)
- Mihye Lee
- St. Luke's School of Public Health, Tokyo, Japan
| | - Rina Kotake
- St. Luke's School of Public Health, Tokyo, Japan
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Sleep quality traits correlate with inflammatory markers in the breast tissue of women. Cytokine 2022; 160:156028. [PMID: 36099755 DOI: 10.1016/j.cyto.2022.156028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several mechanisms have been posited to play a role in the sleep and breast cancer association, including alterations in immune function, but evidence remains inconclusive. A closer look at how sleep quality traits affect the breast microenvironment may provide clues for molecular mechanisms underlying the link between sleep and breast cancer. We examined the association between sleep quality traits (sleep duration, sleep aids, and insomnia) and tissue-based protein levels and gene expression of several inflammatory markers associated with breast cancer. METHODS Breast tissues (normal n = 165 and adipose n = 74) were surgically obtained from women diagnosed with breast cancer. Protein levels by immunohistochemistry were determined using the quickscore method for 11 inflammatory markers in the normal epithelial breast tissue (interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), cyclooxygenase-2 (COX-2), leptin, serum amyloid A1 (SAA1), lactoferrin, transforming growth factor-beta (TGF-β), and signal transducer and activator of transcription 3 markers (STAT3). Relative quantification of 4 genes (COX-2, IL-6, TNF-α and LEP) in the adipose breast tissue was carried out using qPCR. Patient characteristics and sleep traits (average sleep duration per night, taking sleeping aids in the past year, and the average number of insomnia episodes per month) were determined by telephone interview. Associations were tested using Spearman's rank correlation (rs) coefficients adjusted (ars) for age at surgery, menopausal status and PCR batch when applicable. Sleep duration categories (<7, 7-9, >9 h) and root- or log-transformed biomarker levels were examined with adjusted linear mixed models. RESULTS TGF-β and CRP levels in normal epithelial breast tissue were positively correlated with sleep aids (ars = 0.28, p = 0.013), and insomnia (ars = 0.23, p = 0.044) in postmenopausal women, respectively. IL-6 in the adipose breast tissue was inversely correlated with sleep aids (ars = -0.26, p = 0.029) in all women. None of the sleep traits significantly correlated with inflammatory markers in premenopausal women. Several markers tended to correlate at 0.05 ≥ p ≤ 0.10. Adjusted mean levels of inflammatory markers were significantly different across sleep duration categories (<7, 7-9, >9 h). Higher mean levels of IL-6, CRP, IL-10, and IL-6 and COX-2 expression were noted in the breast tissues of women sleeping < 7, and particularly, >9 h per night (p < 0.05). CONCLUSION Our findings indicate that sleep duration, sleep aids, and insomnia may differently affect women's breast tissues depending on menopausal status. From a public health perspective, these results warrant further validation in larger studies. Since sleep is a modifiable factor, it may be an interesting approach for breast cancer prevention.
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Clemenceau A, Chang SL, Hanna M, Durocher F, Diorio C. Association between vitamin D and calcium intakes, breast microcalcifications, breast tissue age-related lobular involution and breast density. Menopause 2022; 29:1404-1415. [PMID: 36219808 DOI: 10.1097/gme.0000000000002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To demystify the potential role of vitamin D and calcium intakes in breast carcinogenesis, we explored the association between these two nutrients and three biomarkers of breast cancer risk: the presence of microcalcifications, age-related lobular involution and breast density. METHODS A total of 82 premenopausal and 79 postmenopausal women diagnosed with breast cancer completed a food frequency questionnaire to assess their total vitamin D and calcium intakes. Presence of microcalcifications was determined by reviewing pathology reports. Age-related lobular involution was assessed in nontumoral breast tissue on hematoxylin-eosin-stained slides and percent breast density was assessed by a computer-assisted method. Multivariate generalized linear models were used to evaluate associations between quartiles of vitamin D and calcium intakes and the biomarkers of breast cancer risk. RESULTS Increasing quartiles of vitamin D intake were inversely associated with the presence of microcalcifications (fourth quartile [Q4] prevalence ratio [PR] = 0.55; Ptrend = 0.021) and breast density (Q4-Q1 = -7.7%; Ptrend = 0.023) in postmenopausal women, and positively associated with age-related lobular involution in women with microcalcifications (Q4 PR = 1.62; Ptrend = 0.036). Increasing quartiles of calcium intake were inversely associated with microcalcifications among all (Q4 PR = 0.44), premenopausal (Q4 PR = 0.37) and postmenopausal women (Q4 PR = 0.38; Ptrend < 0.014 for all). It was also inversely associated with breast density in women without microcalcification (Q4-Q1 = -8.3%; Ptrend = 0.047), but positively associated with breast density in women with microcalcifications (Q4-Q1 = 10.0%; Ptrend = 0.032). CONCLUSIONS Results suggest that the association between vitamin D and calcium intakes and breast cancer risk factors could be influenced by the presence of microcalcifications.
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Chang SL, Tchernof A, Durocher F, Diorio C. Associations of Biomarkers of Inflammation and Breast Cancer in the Breast Adipose Tissue of Women with Combined Measures of Adiposity. J Obes 2021; 2021:3620147. [PMID: 34426770 PMCID: PMC8380177 DOI: 10.1155/2021/3620147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mechanisms underlying the obesity-breast cancer link involve inflammation but need to be elucidated. Determining obesity by combining body mass index (BMI) with the waist circumference (WC) may clarify the role of inflammatory and hormonally related markers in breast cancer. We examined the effect of combining adiposity indices (BMI/WC) with the gene expression of several biomarkers involved in breast cancer. METHODS Expression of cytochrome P450 family 19 subfamily A member 1 (CYP19A1), estrogen receptor-alpha (ER-α), allograft inflammatory factor 1 (AIF1), cyclooxygenase-2 (COX2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and leptin (LEP) in 141 adipose breast tissues was quantified using qPCR method. BMI and WC were measured by a trained nurse and categorized using the median split, BMILOWCLO, BMILOWCHI, BMIHIWCLO, and BMIHIWCHI. RESULTS Gene expression of IL-6 (3-fold), TNF-α (2-fold), and LEP (2-fold) was higher in the breast adipose tissue of women with high WC regardless of BMI, that is, BMILOWCHI and BMIHIWCHI women (all P < 0.01). Compared to BMILOWCLO women, gene expression of CYP19A1, COX2, and AIF1 was increased by two-fold in breast adipose tissue of BMIHIWCHI women (P < 0.10). ER-α was not different across adiposity categories. CONCLUSIONS The expression of some biomarkers, particularly those related to inflammation, is elevated in breast adipose tissue of women with a high WC independent of BMI. Obesity monitoring should also include women with normal or low BMI, but with central adiposity.
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Affiliation(s)
- Sue-Ling Chang
- CHU de Québec Research Center, Laval University, Quebec, QC, Canada
- Laval University Cancer Research Center, Quebec, QC, Canada
| | - André Tchernof
- CHU de Québec Research Center, Laval University, Quebec, QC, Canada
- School of Nutrition, Faculty of Agriculture and Food Sciences, Laval University, Quebec, QC, Canada
- Quebec Heart Lung Institute, Quebec, QC, Canada
| | - Francine Durocher
- CHU de Québec Research Center, Laval University, Quebec, QC, Canada
- Laval University Cancer Research Center, Quebec, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Caroline Diorio
- CHU de Québec Research Center, Laval University, Quebec, QC, Canada
- Laval University Cancer Research Center, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Deschênes-Fabia Center for Breast Diseases, Quebec, QC, Canada
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Breast Cancer and Microcalcifications: An Osteoimmunological Disorder? Int J Mol Sci 2020; 21:ijms21228613. [PMID: 33203195 PMCID: PMC7696282 DOI: 10.3390/ijms21228613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
The presence of microcalcifications in the breast microenvironment, combined with the growing evidences of the possible presence of osteoblast-like or osteoclast-like cells in the breast, suggest the existence of active processes of calcification in the breast tissue during a woman’s life. Furthermore, much evidence that osteoimmunological disorders, such as osteoarthritis, rheumatoid arthritis, or periodontitis influence the risk of developing breast cancer in women exists and vice versa. Antiresorptive drugs benefits on breast cancer incidence and progression have been reported in the past decades. More recently, biological agents targeting pro-inflammatory cytokines used against rheumatoid arthritis also demonstrated benefits against breast cancer cell lines proliferation, viability, and migratory abilities, both in vitro and in vivo in xenografted mice. Hence, it is tempting to hypothesize that breast carcinogenesis should be considered as a potential osteoimmunological disorder. In this review, we compare microenvironments and molecular characteristics in the most frequent osteoimmunological disorders with major events occurring in a woman’s breast during her lifetime. We also highlight what the use of bone anabolic drugs, antiresorptive, and biological agents targeting pro-inflammatory cytokines against breast cancer can teach us.
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Clemenceau A, Hanna M, Ennour-Idrissi K, Burguin A, Diorio C, Durocher F. Secreted Frizzled-Related Protein 1 as a Biomarker against Incomplete Age-Related Lobular Involution and Microcalcifications' Development. Cancers (Basel) 2020; 12:cancers12092693. [PMID: 32967276 PMCID: PMC7565692 DOI: 10.3390/cancers12092693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
As a downregulator of the Wnt signaling pathway, SFRP1 is involved in several components of the age-related lobular involution process such as inflammation, apoptosis, and adipogenesis. Because microcalcifications are associated with inflammation, we aimed to demystify the cross talk between SFRP1, inflammatory markers, and microcalcifications by assessing SFRP1 expression (immunohistochemistry) in a cohort of 162 women with different degrees of lobular involution. SFRP1 expression was inversely associated with the degree of lobular involution (OR = 0.84; p-value < 0.01). SFRP1 expression, age at mastectomy, and waist circumference taken together predicted the degree of lobular involution (AUC = 78.1). This predictive model was best in patients with microcalcifications (AUC = 81.1) and in parous women (AUC = 87.8). SFRP1 expression was correlated with leptin (rho = 0.32), TNF-α (rho = 0.21), and IL-6 (rho = 0.21) expression by epithelial cells (all p-values <0.001). SFRP1 expression was lower in nulliparous women with involuted breast tissue compared with parous women with involuted breast tissue (Δmean = -2.31; p-value < 0.01) and was higher in nulliparous women with microcalcifications compared with nulliparous women without microcalcifications (Δmean = 2.4; p-value < 0.05). In this study, we highlighted two SFRP1-based predictive models for incomplete lobular involution and the development of microcalcifications and identified two distinct inflammatory profiles associated with age-related lobular involution in parous and nulliparous women.
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Affiliation(s)
- Alisson Clemenceau
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (A.C.); (A.B.)
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
| | - Mirette Hanna
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Kaoutar Ennour-Idrissi
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Anna Burguin
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (A.C.); (A.B.)
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
| | - Caroline Diorio
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Francine Durocher
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (A.C.); (A.B.)
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada; (M.H.); (K.E.-I.); (C.D.)
- Correspondence:
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Associations between markers of mammary adipose tissue dysfunction and breast cancer prognostic factors. Int J Obes (Lond) 2020; 45:195-205. [PMID: 32934318 DOI: 10.1038/s41366-020-00676-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity fosters worse clinical outcomes in both premenopausal and postmenopausal women with breast cancer. Emerging evidence suggests that an android body fat distribution in particular is deleterious for breast cancer prognosis. The extent of adipose tissue dysfunction, especially how it relates to breast cancer prognostic factors and anthropometric measurements, has not been fully investigated. OBJECTIVE Our objective was to examine if markers of adipose tissue dysfunction, such as hypertrophy and macrophage accumulation, are relevant for the pathophysiology of breast cancer and its associated prognostic factors in a well-characterised cohort of women with breast cancer who did not receive treatment before surgery. METHODS A consecutive series of 164 women with breast cancer provided breast adipose tissue sample. Multivariate generalised linear models were used to test associations of anthropometric indices and prognostic factors with markers of adipose tissue dysfunction. RESULTS We found associations of breast adipocyte size and macrophage infiltration (number of CD68+ cells/100 adipocytes) with adiposity, particularly a strong association between breast adipocyte size and central obesity, independent of total adiposity, age and menopausal status (βadj = 0.87; p = 0.0001). We also identified relationships of adipocyte hypertrophy and macrophage infiltration with prognostic factors, such as cancer stage and tumour grade (p < 0.05). RNA expression of pro-inflammatory cytokines (IL6, TNF) and leptin was also increased as a function of adipocyte size and CD86+/CD11c+ macrophage number/100 adipocytes (p < 0.05). CONCLUSIONS Our findings support the model of dysfunctional adipose tissue in obesity-associated breast cancer.
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Kothari C, Diorio C, Durocher F. The Importance of Breast Adipose Tissue in Breast Cancer. Int J Mol Sci 2020; 21:ijms21165760. [PMID: 32796696 PMCID: PMC7460846 DOI: 10.3390/ijms21165760] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
Adipose tissue is a complex endocrine organ, with a role in obesity and cancer. Adipose tissue is generally linked to excessive body fat, and it is well known that the female breast is rich in adipose tissue. Hence, one can wonder: what is the role of adipose tissue in the breast and why is it required? Adipose tissue as an organ consists of adipocytes, an extracellular matrix (ECM) and immune cells, with a significant role in the dynamics of breast changes throughout the life span of a female breast from puberty, pregnancy, lactation and involution. In this review, we will discuss the importance of breast adipose tissue in breast development and its involvement in breast changes happening during pregnancy, lactation and involution. We will focus on understanding the biology of breast adipose tissue, with an overview on its involvement in the various steps of breast cancer development and progression. The interaction between the breast adipose tissue surrounding cancer cells and vice-versa modifies the tumor microenvironment in favor of cancer. Understanding this mutual interaction and the role of breast adipose tissue in the tumor microenvironment could potentially raise the possibility of overcoming breast adipose tissue mediated resistance to therapies and finding novel candidates to target breast cancer.
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Affiliation(s)
- Charu Kothari
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC G1T 1C2, Canada;
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada;
| | - Caroline Diorio
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada;
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec, QC G1T 1C2, Canada
| | - Francine Durocher
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec, QC G1T 1C2, Canada;
- Cancer Research Centre, CHU de Quebec Research Centre, Quebec, QC G1V 4G2, Canada;
- Correspondence: ; Tel.: +1-(418)-525-4444 (ext. 48508)
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Association between expression of inflammatory markers in normal breast tissue and mammographic density among premenopausal and postmenopausal women. Menopause 2018; 24:524-535. [PMID: 28002200 DOI: 10.1097/gme.0000000000000794] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Inflammatory markers may be associated with breast cancer risk. We assessed the association between expression levels of proinflammatory (interleukin 6, tumor necrosis factor-α, C-reactive protein, cyclooxygenase 2, leptin, serum amyloid A1, interleukin 8, and signal transducer and activator of transcription 3) and anti-inflammatory markers (transforming growth factor-β, interleukin 10, and lactoferrin) in normal breast tissue with mammographic density, a strong breast cancer risk indicator, among 163 breast cancer patients. METHODS The expression of inflammatory markers was visually evaluated on immunohistochemistry stained slides. The percent mammographic density (PMD) was estimated by a computer-assisted method in the contralateral cancer-free breast. We used generalized linear models to estimate means of PMD by median expression levels of the inflammatory markers while adjusting for age and waist circumference. RESULTS Higher expression levels (above median) of the proinflammatory marker interleukin 6 were associated with higher PMD among all women (24.1% vs 18.5%, P = 0.007). Similarly, higher expression levels (above median) of the proinflammatory markers (interleukin 6, tumor necrosis factor-α, C-reactive protein, and interleukin 8) were associated with higher PMD among premenopausal women (absolute difference in the PMD of 8.8% [P = 0.006], 7.7% [P = 0.022], 6.7% [P = 0.037], and 16.5% [P = 0.032], respectively). Higher expression levels (above median) of the anti-inflammatory marker transforming growth factor-β were associated with lower PMD among all (18.8% vs 24.3%, P = 0.005) and postmenopausal women (14.5% vs 20.7%, P = 0.013). CONCLUSIONS Our results provide support for the hypothesized role of inflammatory markers in breast carcinogenesis through their effects on mammographic density. Inflammatory markers could be targeted in future breast cancer prevention interventions.
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Hanna M, Dumas I, Orain M, Jacob S, Têtu B, Diorio C. Association between physical activity and the expression of mediators of inflammation in normal breast tissue among premenopausal and postmenopausal women. Cytokine 2017; 102:151-160. [PMID: 29102166 DOI: 10.1016/j.cyto.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/24/2017] [Accepted: 08/10/2017] [Indexed: 12/19/2022]
Abstract
Physical activity is associated with decreased breast cancer risk. The underlying biological mechanisms could include the reduction of the local inflammation in the breast tissue. We conducted a cross-sectional study to assess the association between the physical activity and the protein expression levels of eleven mediators of inflammation in normal breast tissue of 164 women having breast cancer. Information on total physical activity (household, occupational and recreational) performed during a one-year period was collected using a questionnaire. Normal breast tissue was obtained from mastectomy blocks distant from the tumor. The expression of the mediators of inflammation in normal breast tissue was visually evaluated by immunohistochemistry. Multivariate linear regression analyses were used to assess the prevalence ratios (PR) and 95% confidence intervals (CI) for higher protein expression levels of the mediators of inflammation in normal breast tissue across quartiles of physical activity. Higher total physical activity was associated with lower expression levels of the pro-inflammatory mediator TNF-α in normal breast epithelial tissue among all (PR=0.64, 95% CI=0.44-0.93 for the fourth quartile; Ptrend=0.013), premenopausal (PR=0.61, 95% CI=0.41-0.91 for the fourth quartile; Ptrend=0.014) and postmenopausal women (PR=0.45, 95% CI=0.21-0.96 for the fourth quartile; Ptrend=0.022). Conversely, higher total physical activity was associated with higher expression levels of the anti-inflammatory mediator IL-10 in normal breast epithelial tissue among all (PR=1.66, 95% CI=0.97-2.85 for the fourth quartile; Ptrend=0.071) and postmenopausal women (PR=4.69, 95% CI=1.26-17.43 for the fourth quartile; Ptrend=0.010). Our findings suggest a beneficial effect of physical activity on the local inflammatory profile in the breast tissue.
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Affiliation(s)
- Mirette Hanna
- Oncology Research Unit, CHU de Québec Research Center, Department of Social and Preventive Medicine, Cancer Research Center, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada
| | - Isabelle Dumas
- Oncology Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, QC G1S 4L8, Canada
| | - Michèle Orain
- Oncology Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, QC G1S 4L8, Canada
| | - Simon Jacob
- Oncology Research Unit, CHU de Québec Research Center, Service of Molecular Biology, Medical Chemistry and Pathology, Hôpital Saint-Sacrement, CHU de Québec, Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Department of Molecular Biology, Medical Chemistry and Pathology, Cancer Research Center, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada
| | - Bernard Têtu
- Oncology Research Unit, CHU de Québec Research Center, Service of Molecular Biology, Medical Chemistry and Pathology, Hôpital Saint-Sacrement, CHU de Québec, Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Department of Molecular Biology, Medical Chemistry and Pathology, Cancer Research Center, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada
| | - Caroline Diorio
- Oncology Research Unit, CHU de Québec Research Center, Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Department of Social and Preventive Medicine, Cancer Research Center, Université Laval,1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada.
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Hanna M, Dumas I, Orain M, Jacob S, Têtu B, Sanschagrin F, Bureau A, Poirier B, Diorio C. Association between local inflammation and breast tissue age-related lobular involution among premenopausal and postmenopausal breast cancer patients. PLoS One 2017; 12:e0183579. [PMID: 28846716 PMCID: PMC5573208 DOI: 10.1371/journal.pone.0183579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/07/2017] [Indexed: 12/28/2022] Open
Abstract
Increased levels of pro-inflammatory markers and decreased levels of anti-inflammatory markers in the breast tissue can result in local inflammation. We aimed to investigate whether local inflammation in the breast tissue is associated with age-related lobular involution, a process inversely related to breast cancer risk. Levels of eleven pro- and anti-inflammatory markers were assessed by immunohistochemistry in normal breast tissue obtained from 164 pre- and postmenopausal breast cancer patients. Involution status of the breast (degree of lobular involution and the predominant lobule type) was microscopically assessed in normal breast tissue on hematoxylin-eosin stained mastectomy slides. Multivariate generalized linear models were used to assess the associations. In age-adjusted analyses, higher levels of pro-inflammatory markers IL-6, TNF-α, CRP, COX-2, leptin, SAA1 and IL-8; and anti-inflammatory marker IL-10, were inversely associated with the prevalence of complete lobular involution (all P≤0.04). Higher levels of the pro-inflammatory marker COX-2 were also associated with lower prevalence of predominant type 1/no type 3 lobules in the breast, an indicator of complete involution, in age-adjusted analysis (P = 0.017). Higher tissue levels of inflammatory markers, mainly the pro-inflammatory ones, are associated with less involuted breasts and may consequently be associated with an increased risk of developing breast cancer.
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Affiliation(s)
- Mirette Hanna
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Cancer Research Center, Université Laval, Québec, Québec, Canada
| | - Isabelle Dumas
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
| | - Michèle Orain
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
| | - Simon Jacob
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Department of Molecular Biology, Medical Chemistry and Pathology, Cancer Research Center, Université Laval, Québec, Québec, Canada
- Service of Molecular Biology, Medical Chemistry and Pathology, Hôpital Saint-Sacrement, CHU de Québec, Université Laval, Québec, Québec, Canada
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Québec, Canada
| | - Bernard Têtu
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Department of Molecular Biology, Medical Chemistry and Pathology, Cancer Research Center, Université Laval, Québec, Québec, Canada
- Service of Molecular Biology, Medical Chemistry and Pathology, Hôpital Saint-Sacrement, CHU de Québec, Université Laval, Québec, Québec, Canada
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Québec, Canada
| | - François Sanschagrin
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Québec, Canada
| | - Alexandre Bureau
- Department of Social and Preventive Medicine, Cancer Research Center, Université Laval, Québec, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Université Laval, Québec, Québec, Canada
| | - Brigitte Poirier
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Québec, Canada
- Department of Surgery, Cancer Research Center, Université Laval, Québec, Québec, Canada
| | - Caroline Diorio
- Oncology Research Unit, CHU de Québec Research Center, Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Cancer Research Center, Université Laval, Québec, Québec, Canada
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Québec, Canada
- * E-mail:
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12
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Larouche D, Hanna M, Chang SL, Jacob S, Têtu B, Diorio C. Evaluation of Antioxidant Intakes in Relation to Inflammatory Markers Expression Within the Normal Breast Tissue of Breast Cancer Patients. Integr Cancer Ther 2016; 16:485-495. [PMID: 27903840 PMCID: PMC5739140 DOI: 10.1177/1534735416676584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic inflammation may be a causative factor in breast cancer. One possible underlying mechanism is the generation of oxidative stress, which may favor tumorigenic processes. Antioxidant consumption may, therefore, help reduce tissue inflammation levels. However, few studies have explored this relation in breast tissue. We aimed to evaluate correlations between antioxidant (vitamin A/retinol, vitamin C, vitamin E, β-carotene, α-carotene, lycopene, lutein/zeaxanthin, β-cryptoxanthin, selenium, and zinc) intakes and protein expression levels of interleukin (IL)-6, tumor necrosis factor-α, C-reactive protein, cyclooxygenase-2, leptin, serum amyloid A1, signal transducer and activator of transcription 3, IL-8, IL-10, lactoferrin, and transforming growth factor-β measured in the normal breast tissue of 160 women diagnosed with breast cancer. Antioxidant intakes were collected using a self-administered food frequency questionnaire. Inflammation marker expression was assessed by immunohistochemistry. Correlations between antioxidant intakes and inflammatory marker expression were evaluated using Spearman's partial correlation coefficients ( r) for all women and for premenopausal and postmenopausal women separately. After Bonferroni correction, negative correlations were observed between dietary β-tocopherol and IL-10 expression in all women combined ( r = -0.26, P = .003) and among postmenopausal women ( r = -0.39, P = .003). For all women, a negative correlation was found between total zinc intakes and IL-10 ( r = -0.26, P = .002). Among postmenopausal women, dietary selenium intake was negatively correlated with the expression of lactoferrin ( r = -0.39, P = .003). No associations were observed in premenopausal women. Our findings suggest that consumption of specific antioxidants, including β-tocopherol, zinc, and selenium, may act on the breast tissue through mechanisms affecting the expression of some inflammation markers, particularly among postmenopausal women.
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Affiliation(s)
- Danielle Larouche
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada.,3 Faculté de médecine de l'Université Laval, Quebec, QC, Canada
| | - Mirette Hanna
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada.,3 Faculté de médecine de l'Université Laval, Quebec, QC, Canada
| | - Sue-Ling Chang
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada
| | - Simon Jacob
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada.,3 Faculté de médecine de l'Université Laval, Quebec, QC, Canada.,4 Service de pathologie, Hôpital du Saint-Sacrement, Quebec, QC, Canada.,5 Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec, QC, Canada
| | - Bernard Têtu
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada.,3 Faculté de médecine de l'Université Laval, Quebec, QC, Canada.,4 Service de pathologie, Hôpital du Saint-Sacrement, Quebec, QC, Canada.,5 Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec, QC, Canada
| | - Caroline Diorio
- 1 Axe Oncologie, Centre de recherche du CHU de Québec-Université Laval, Quebec, QC, Canada.,2 Centre de recherche sur le cancer de l'Université Laval, Quebec, QC, Canada.,3 Faculté de médecine de l'Université Laval, Quebec, QC, Canada.,5 Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec, QC, Canada
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13
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Ennour-Idrissi K, Têtu B, Maunsell E, Poirier B, Montoni A, Rochette PJ, Diorio C. Association of Telomere Length with Breast Cancer Prognostic Factors. PLoS One 2016; 11:e0161903. [PMID: 27571273 PMCID: PMC5003390 DOI: 10.1371/journal.pone.0161903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Telomere length, a marker of cell aging, seems to be affected by the same factors thought to be associated with breast cancer prognosis. Objective To examine associations of peripheral blood cell-measured telomere length with traditional and potential prognostic factors in breast cancer patients. Methods We conducted a cross-sectional analysis of data collected before surgery from 162 breast cancer patients recruited consecutively between 01/2011 and 05/2012, at a breast cancer reference center. Data on the main lifestyle factors (smoking, alcohol consumption, physical activity) were collected using standardized questionnaires. Anthropometric factors were measured. Tumor biological characteristics were extracted from pathology reports. Telomere length was measured using a highly reproducible quantitative PCR method in peripheral white blood cells. Spearman partial rank-order correlations and multivariate general linear models were used to evaluate relationships between telomere length and prognostic factors. Results Telomere length was positively associated with total physical activity (rs = 0.17, P = 0.033; Ptrend= 0.069), occupational physical activity (rs = 0.15, P = 0.054; Ptrend= 0.054) and transportation-related physical activity (rs = 0.19, P = 0.019; P = 0.005). Among post-menopausal women, telomere length remained positively associated with total physical activity (rs = 0.27, P = 0.016; Ptrend= 0.054) and occupational physical activity (rs = 0.26, P = 0.021; Ptrend= 0.056) and was only associated with transportation-related physical activity among pre-menopausal women (rs = 0.27, P = 0.015; P = 0.004). No association was observed between telomere length and recreational or household activities, other lifestyle factors or traditional prognostic factors. Conclusions Telomeres are longer in more active breast cancer patients. Since white blood cells are involved in anticancer immune responses, these findings suggest that even regular low-intensity physical activity, such as that related to transportation or occupation, could be recommended to breast cancer patients.
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Affiliation(s)
- Kaoutar Ennour-Idrissi
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada
| | - Bernard Têtu
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
| | - Elizabeth Maunsell
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
| | - Brigitte Poirier
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada.,Department de chirurgie, Faculté de médecine, Université Laval, Quebec city (QC), Canada
| | - Alicia Montoni
- Axe Médecine Régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada
| | - Patrick J Rochette
- Axe Médecine Régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada
| | - Caroline Diorio
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec city (QC), Canada.,Centre de Recherche sur le Cancer, Université Laval, Quebec city (QC), Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec city (QC), Canada.,Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Quebec city (QC), Canada
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14
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Chen Y, Wen YY, Li ZR, Luo DL, Zhang XH. The molecular mechanisms between metabolic syndrome and breast cancer. Biochem Biophys Res Commun 2016; 471:391-5. [PMID: 26891869 DOI: 10.1016/j.bbrc.2016.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome, which is extremely common in developed and some developing countries, is a clustering of at least three of five of the following medical conditions: abdominal obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density lipoprotein levels. It has been proved that there is a strong association between metabolic syndrome and breast cancer. Metabolic syndrome could increase the risk of breast cancer and influence the prognosis of the breast cancer patients. Some characteristic of metabolic syndrome such as obesity and lack of physical exercise are all risk factors for developing breast cancer. The metabolic syndrome mainly include obesity, type 2 diabetes, hypercholesterolemia and nonalcoholic fatty liver disease, and each of them impacts the risk of breast cancer and the prognosis of the breast cancer patients in different ways. In this Review, we focus on recently uncovered aspects of the immunological and molecular mechanisms that are responsible for the development of this highly prevalent and serious disease. These studies bring new insight into the complex associations between metabolic syndrome and breast cancer and have led to the development of novel therapeutic strategies that might enable a personalized approach in the management of this disease.
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Affiliation(s)
- Yi Chen
- Department of General Surgery (Breast, Thyroid and Vascular Suerery), Daping Hospital of the Third Military Medical University, Chongqing, 400042, China
| | - Ya-yuan Wen
- Department of General Surgery (Breast, Thyroid and Vascular Suerery), Daping Hospital of the Third Military Medical University, Chongqing, 400042, China
| | - Zhi-rong Li
- Department of General Surgery (Breast, Thyroid and Vascular Suerery), Daping Hospital of the Third Military Medical University, Chongqing, 400042, China
| | - Dong-lin Luo
- Department of General Surgery (Breast, Thyroid and Vascular Suerery), Daping Hospital of the Third Military Medical University, Chongqing, 400042, China
| | - Xiao-hua Zhang
- Department of General Surgery (Breast, Thyroid and Vascular Suerery), Daping Hospital of the Third Military Medical University, Chongqing, 400042, China.
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15
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Gierach GL, Patel DA, Pfeiffer RM, Figueroa JD, Linville L, Papathomas D, Johnson JM, Chicoine RE, Herschorn SD, Shepherd JA, Wang J, Malkov S, Vacek PM, Weaver DL, Fan B, Mahmoudzadeh AP, Palakal M, Xiang J, Oh H, Horne HN, Sprague BL, Hewitt SM, Brinton LA, Sherman ME. Relationship of Terminal Duct Lobular Unit Involution of the Breast with Area and Volume Mammographic Densities. Cancer Prev Res (Phila) 2015; 9:149-58. [PMID: 26645278 DOI: 10.1158/1940-6207.capr-15-0282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/17/2015] [Indexed: 01/05/2023]
Abstract
Elevated mammographic density (MD) is an established breast cancer risk factor. Reduced involution of terminal duct lobular units (TDLU), the histologic source of most breast cancers, has been associated with higher MD and breast cancer risk. We investigated relationships of TDLU involution with area and volumetric MD, measured throughout the breast and surrounding biopsy targets (perilesional). Three measures inversely related to TDLU involution (TDLU count/mm(2), median TDLU span, median acini count/TDLU) assessed in benign diagnostic biopsies from 348 women, ages 40-65, were related to MD area (quantified with thresholding software) and volume (assessed with a density phantom) by analysis of covariance, stratified by menopausal status and adjusted for confounders. Among premenopausal women, TDLU count was directly associated with percent perilesional MD (P trend = 0.03), but not with absolute dense area/volume. Greater TDLU span was associated with elevated percent dense area/volume (P trend<0.05) and absolute perilesional MD (P = 0.003). Acini count was directly associated with absolute perilesional MD (P = 0.02). Greater TDLU involution (all metrics) was associated with increased nondense area/volume (P trend ≤ 0.04). Among postmenopausal women, TDLU measures were not significantly associated with MD. Among premenopausal women, reduced TDLU involution was associated with higher area and volumetric MD, particularly in perilesional parenchyma. Data indicating that TDLU involution and MD are correlated markers of breast cancer risk suggest that associations of MD with breast cancer may partly reflect amounts of at-risk epithelium. If confirmed, these results could suggest a prevention paradigm based on enhancing TDLU involution and monitoring efficacy by assessing MD reduction.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Deesha A Patel
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonine D Figueroa
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laura Linville
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Papathomas
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason M Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - John A Shepherd
- University of California, San Francisco, San Francisco, California
| | - Jeff Wang
- University of California, San Francisco, San Francisco, California
| | - Serghei Malkov
- University of California, San Francisco, San Francisco, California
| | | | | | - Bo Fan
- University of California, San Francisco, San Francisco, California
| | | | - Maya Palakal
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jackie Xiang
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah Oh
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hisani N Horne
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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