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在欧洲癌症与营养前瞻性调查中,教育程度较高的女性中浸润性乳腺癌和原位乳腺癌的发病率较高,这与风险因素的作用有关。

The contribution of risk factors to the higher incidence of invasive and in situ breast cancers in women with higher levels of education in the European prospective investigation into cancer and nutrition.

机构信息

National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.

出版信息

Am J Epidemiol. 2011 Jan 1;173(1):26-37. doi: 10.1093/aje/kwq319. Epub 2010 Nov 17.

DOI:10.1093/aje/kwq319
PMID:21084553
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3320860/
Abstract

The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.

摘要

作者研究了已知风险因素在乳腺癌发病率的教育差异中的作用。分析基于欧洲癌症与营养前瞻性调查,包括 242095 名女性,433 例原位乳腺癌病例和 4469 例浸润性乳腺癌病例。分析中考虑了生育史(首次足月妊娠年龄和产次)、内源性和外源性激素暴露、身高和健康行为。使用 Cox 回归模型估计了教育的相对不平等指数(RII)。发现受教育程度较高的女性浸润性乳腺癌风险较高(RII = 1.22,95%置信区间(CI):1.09,1.37)。未观察到未育女性的这种关联(RII = 1.13,95%CI:0.84,1.52)。调整生育史后,乳腺癌发病率的不平等程度大大降低(RII = 1.11,95%CI:0.98,1.25),其中大部分关联归因于首次足月妊娠年龄。其他每个危险因素都解释了乳腺癌发病率不平等的一小部分额外部分。身高解释了大部分剩余的发病率差异。在调整了所有已知的危险因素后,作者发现教育水平与浸润性乳腺癌风险之间没有关联。原位乳腺癌的发病率不平等更为明显,并且在调整了所有已知的危险因素后,这些不平等仍然存在(RII = 1.61,95%CI:1.07,2.41),尤其是在未育女性中。

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