Granström Charlotta, Sundquist Jan, Hemminki Kari
Center for Family and Community Medicine, Karolinska Institute, Huddinge, Sweden.
Breast Cancer Res Treat. 2008 Oct;111(3):559-68. doi: 10.1007/s10549-007-9814-2. Epub 2007 Nov 8.
The purpose of this population-based cohort study is to describe the etiology of invasive and in situ breast cancer, using the Swedish Family-Cancer Database. A total of 1,028,455 women, aged 40-61 years, were followed from 1993 through 2004. Invasive and in situ breast cancer was identified in 27,243 and 3,496 women, respectively, with data on family history, reproductive variables, residential region and socioeconomic status. Relative risks (RRs) and population attributable fractions (PAFs) were estimated by Poisson regression. The overall PAF of invasive breast cancer was 5.3% for family history and 17.9% for reproductive factors. Morphology-specific PAFs were calculated for ductal (family history: 5.2%, reproductive factors: 16.6%), lobular (family history: 6.2%, reproductive factors: 19.9%) and comedo types (family history: 5.2%, reproductive factors: 25.9%). The corresponding PAFs of in situ tumors were higher due to family history and reproductive factors. Family history, late age at first birth and high socioeconomic status were associated with elevated risks in all morphologies, whereas low parity did not have an impact on the invasive and in situ lobular and comedo tumors. The risks for women with a family history were the highest, but these women accounted for the smallest proportion of the cases, thus resulting in the lowest PAFs.
这项基于人群的队列研究旨在利用瑞典家庭癌症数据库描述浸润性和原位乳腺癌的病因。共有1,028,455名年龄在40至61岁之间的女性从1993年至2004年被随访。分别在27,243名和3,496名女性中发现了浸润性和原位乳腺癌，并获取了她们的家族史、生殖变量、居住地区和社会经济地位等数据。通过泊松回归估计相对风险（RRs）和人群归因分数（PAFs）。浸润性乳腺癌的总体PAF中，家族史占5.3%，生殖因素占17.9%。计算了导管型（家族史：5.2%，生殖因素：16.6%）、小叶型（家族史：6.2%，生殖因素：19.9%）和粉刺型（家族史：5.2%，生殖因素：25.9%）的形态特异性PAFs。由于家族史和生殖因素，原位肿瘤的相应PAFs更高。家族史、初产年龄较大和社会经济地位较高与所有形态的风险升高相关，而低生育次数对浸润性和原位小叶型及粉刺型肿瘤没有影响。有家族史的女性风险最高，但这些女性在病例中所占比例最小，因此导致PAFs最低。
