Albrektsen Grethe, Heuch Ivar, Thoresen Steinar, Kvåle Gunnar
Department of Mathematics, University of Bergen, Bergen, Norway.
Int J Cancer. 2006 Sep 15;119(6):1468-74. doi: 10.1002/ijc.22003.
The long-term protective effect of a pregnancy on breast cancer risk is preceded by a short-term adverse effect, possibly reflecting a promoting effect of pregnancy hormones. In the present study, we explore whether a family history of breast cancer modifies time-related effects of pregnancies, with special emphasis on the transient increase in risk of breast cancer shortly after birth. Our study cohort comprises 1,067,289 Norwegian women aged 20-74 years. The mean follow-up time was 18 years. Incidence rate ratios were estimated by Poisson regression analyses of person-years at risk. Of the 7,377 women diagnosed with breast cancer during follow-up, a total of 828 (11%) had a mother or a sister with breast cancer diagnosis. Women with a family history of breast cancer had a 2-3-fold higher risk of breast cancer than did women without any affected family member, highest for those with a relative diagnosed before they were 50 years. Similar to women without a familial excess risk, increasing parity was associated with an overall protective effect among women with a familial predisposition, regardless of age at diagnosis of the relative. Whereas women with no familial excess risk experienced a transient increase in risk mainly after late age births, women with a family history of breast cancer experienced an adverse effect of pregnancies also at younger ages. The present results give further support to the hypothesis that the adverse effect of a term birth can be explained by a promoting effect of pregnancy hormones.
妊娠对乳腺癌风险的长期保护作用之前存在短期不良影响,这可能反映了妊娠激素的促进作用。在本研究中,我们探讨乳腺癌家族史是否会改变妊娠与时间相关的影响,特别关注出生后不久乳腺癌风险的短暂增加。我们的研究队列包括1,067,289名年龄在20 - 74岁之间的挪威女性。平均随访时间为18年。发病率比通过对风险人年的泊松回归分析进行估计。在随访期间被诊断为乳腺癌的7,377名女性中,共有828名(11%)的母亲或姐妹被诊断患有乳腺癌。有乳腺癌家族史的女性患乳腺癌的风险比没有任何受影响家庭成员的女性高2 - 3倍,对于那些亲属在50岁之前被诊断出的女性风险最高。与没有家族性额外风险的女性相似,生育次数增加在有家族易感性的女性中与总体保护作用相关,无论亲属诊断时的年龄如何。没有家族性额外风险的女性主要在晚育后风险短暂增加,而有乳腺癌家族史的女性在较年轻时也会经历妊娠的不良影响。目前的结果进一步支持了足月分娩的不良影响可由妊娠激素的促进作用来解释这一假设。