Claus E B, Stowe M, Carter D
Department of Epidemiology and Public Health, P.O. Box 208034, Yale University School of Medicine, 60 College St., New Haven, CT 06520-8034, USA.
J Natl Cancer Inst. 2001 Dec 5;93(23):1811-7. doi: 10.1093/jnci/93.23.1811.
Risk factors associated with invasive breast cancer are well documented, but those associated with breast carcinoma in situ are not well defined.
We conducted a population-based, case-control study among female residents of Connecticut to identify risk factors for breast carcinoma in situ. Case patients, diagnosed with ductal carcinoma in situ (DCIS) (n = 875) or lobular carcinoma in situ (LCIS) (n = 123), were matched by 5-year age groups with control subjects (n = 999). Case patients were diagnosed between September 15, 1994, through March 14, 1998, and all subjects were between the ages of 20 and 79 years. Information on risk factors and cancer-screening history was collected by telephone interviews. Conditional logistic regression was used to determine odds ratios (ORs) for the association of these factors with the risk of DCIS and LCIS.
Case patients with DCIS were more likely than control subjects to report a family history of breast cancer (OR = 1.48; 95% confidence interval [CI] = 1.19 to 1.85) or previous breast biopsy (OR = 3.56; 95% CI = 2.86 to 4.43). They also had fewer full-term pregnancies (OR = 0.86; 95% CI = 0.80 to 0.93) and were older at first full-term pregnancy (OR for being 20-29 years old relative to being <20 years old = 1.68; 95% CI = 1.17 to 2.43) and at menopause (OR for being > or =55 years old relative to being <45 years old = 1.71; 95% CI = 1.05 to 2.77). DCIS case patients were more likely than control subjects to have had a mammographic examination (OR = 2.46; 95% CI = 1.78 to 3.40) or an annual clinical breast examination (OR = 1.83; 95% CI = 1.48 to 2.26). DCIS patients and control subjects did not differ with respect to oral contraceptive use, hormone replacement therapy, alcohol consumption or smoking history, or breast self-examination. Associations for LCIS were similar.
The risk factors associated with DCIS and LCIS are similar to those associated with invasive breast cancer. Diagnosis of DCIS is associated with increased mammography screening.
与浸润性乳腺癌相关的危险因素已有充分记录，但与原位乳腺癌相关的危险因素尚不明确。
我们在康涅狄格州的女性居民中开展了一项基于人群的病例对照研究，以确定原位乳腺癌的危险因素。诊断为导管原位癌（DCIS）（n = 875）或小叶原位癌（LCIS）（n = 123）的病例患者，按5岁年龄组与对照受试者（n = 999）进行匹配。病例患者于1994年9月15日至1998年3月14日期间被诊断，所有受试者年龄在20至79岁之间。通过电话访谈收集危险因素和癌症筛查史的信息。采用条件逻辑回归确定这些因素与DCIS和LCIS风险关联的比值比（OR）。
DCIS病例患者比对照受试者更有可能报告有乳腺癌家族史（OR = 1.48；95%置信区间[CI] = 1.19至1.85）或既往乳腺活检史（OR = 3.56；95%CI = 2.86至4.43）。她们的足月妊娠次数也较少（OR = 0.86；95%CI = 0.80至0.93），首次足月妊娠时年龄较大（相对于<20岁，20 - 29岁的OR = 1.68；95%CI = 1.17至2.43），绝经时年龄也较大（相对于<45岁，≥55岁的OR = 1.71；95%CI = 1.05至2.77）。DCIS病例患者比对照受试者更有可能进行过乳腺钼靶检查（OR = 2.46；95%CI = 1.78至3.40）或年度临床乳腺检查（OR = 1.83；95%CI = 1.48至2.26）。DCIS患者和对照受试者在口服避孕药使用、激素替代疗法、饮酒或吸烟史或乳腺自我检查方面没有差异。LCIS的关联情况相似。
与DCIS和LCIS相关的危险因素与浸润性乳腺癌相关的危险因素相似。DCIS的诊断与乳腺钼靶筛查增加有关。
