Institute of Nutritional Sciences, Justus-Liebig-University Giessen, Giessen, Germany.
Breast Cancer Res Treat. 2013 Nov;142(1):133-41. doi: 10.1007/s10549-010-1255-7. Epub 2010 Nov 20.
Breast cancer is the leading cause of death among women worldwide. Studies in industrialised countries identified age at menarche, age at first full-term pregnancy, and lactation as determining factors in the aetiology of breast cancer. 115 female breast cancer patients (cases) and 230 age- and district-matched women clinically free from breast cancer (controls) were interviewed about their reproductive history and socioeconomic condition. Semi-structured interviews including anthropometric measurements were conducted by trained enumerators. The median age was 50 years (min/max 26 to 85 years). Estimated median BMI at age 20 was 21 kg/m(2) in both cases and controls. Median lifelong lactation of the mothers was 96 months (cases) and 108 months (controls). A high BMI at 20 years was associated with an increased breast cancer risk (OR 1.31 95% CI 1.11-1.55, P < 0.01). The odds ratio for lifelong lactation was slightly below one (OR 0.99 95% CI 0.98-1.00, P < 0.01). There was no significant association in risk for BMI at interview (median 25 kg/m(2) of cases and 26 kg/m(2) of controls), age at menarche (median 16 years), and age at first full-term pregnancy (median 20 years). The association of increased risk with higher BMI at age 20 years remained significant after stratification for menopause (premenopausal: OR 1.41 95% CI 1.10-1.81, P = 0.01; postmenopausal: OR 1.38 95% CI 1.06-1.80, P = 0.02). Late age at menarche and prolonged lifelong lactation were associated with a risk reduction among premenopausal women (ORmenarche 0.74 95% CI 0.56-1.00, P = 0.05; ORlactation 0.98 95% CI 0.97-0.99, P < 0.01). In conclusion, long-standing lactation and reproductive behaviour are associated with a lower breast cancer risk in the region. As current changes in lifestyle affect age at menarche, reproductive behaviour, and nutritional status, an increased incidence of breast cancer is to be expected. Preventive efforts should include advice on reproductive and breastfeeding behaviour.
乳腺癌是全球女性死亡的主要原因。在工业化国家的研究表明,初潮年龄、首次足月妊娠年龄和哺乳时间是乳腺癌病因的决定因素。对 115 名女性乳腺癌患者(病例)和 230 名年龄和地区匹配的无乳腺癌临床病史的女性(对照)进行了关于生育史和社会经济状况的访谈。由经过培训的调查员进行了半结构化访谈和人体测量。中位年龄为 50 岁(最小/最大 26-85 岁)。估计病例和对照在 20 岁时的中位 BMI 为 21kg/m2。母亲的中位终生哺乳时间为 96 个月(病例)和 108 个月(对照)。20 岁时 BMI 较高与乳腺癌风险增加相关(OR 1.31,95%CI 1.11-1.55,P < 0.01)。终生哺乳的比值比略低于 1(OR 0.99,95%CI 0.98-1.00,P < 0.01)。在 BMI (病例为 25kg/m2,对照为 26kg/m2)、初潮年龄(中位数 16 岁)和首次足月妊娠年龄(中位数 20 岁)方面,风险无显著相关性。在绝经分层后,20 岁时 BMI 较高与较高风险的相关性仍然显著(绝经前:OR 1.41,95%CI 1.10-1.81,P = 0.01;绝经后:OR 1.38,95%CI 1.06-1.80,P = 0.02)。初潮年龄晚和终生哺乳时间长与绝经前妇女的风险降低相关(OR 初潮 0.74,95%CI 0.56-1.00,P = 0.05;OR 哺乳 0.98,95%CI 0.97-0.99,P < 0.01)。总之,该地区长期哺乳和生殖行为与较低的乳腺癌风险相关。由于目前生活方式的改变影响初潮年龄、生殖行为和营养状况,预计乳腺癌的发病率将会增加。预防工作应包括有关生殖和母乳喂养行为的建议。