绝经后浸润性乳腺癌及乳腺癌亚型的可改变和不可改变危险因素的人群归因风险。
Population attributable risk of invasive postmenopausal breast cancer and breast cancer subtypes for modifiable and non-modifiable risk factors.
机构信息
Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany.
出版信息
Cancer Epidemiol. 2011 Aug;35(4):345-52. doi: 10.1016/j.canep.2010.11.003. Epub 2010 Dec 14.
BACKGROUND
The population-level impact of modifiable postmenopausal breast cancer risk factors is incompletely understood, especially regarding potential heterogeneity by estrogen receptor (ER) and progesterone receptor (PR) status.
METHODS
Using data on 3074 cases and 6386 controls from a population-based case-control study of postmenopausal breast cancer conducted in Germany between 2002 and 2005, we calculated multivariable-adjusted odds ratios and population attributable risks (PARs) for modifiable and non-modifiable risk factors. We examined overall postmenopausal invasive breast cancer as well as tumor ER/PR subtypes. A bootstrap method provided estimates of 95% confidence intervals (95%CIs).
RESULTS
The summary PARs (95%CIs) for non-modifiable risk factors (age at menarche, age at menopause, parity, benign breast disease, and family history of breast cancer) were 37.2% (27.1-47.2%) regarding overall invasive tumors, 36.5% (23.3-47.6%) regarding ER+/PR+ tumors, 47.9% (26.4-64.4%) regarding ER+/PR- tumors, and 31.1% (4.0-51.9%) regarding ER-/PR- tumors. Of the modifiable risk factors (hormone therapy (HT) use, physical inactivity, BMI, alcohol consumption), HT use and physical inactivity had the highest impact with PARs of 19.4% (15.9-23.2%) and 12.8% (5.5-20.8%), respectively, regarding overall invasive tumors. For ER+/PR+ tumors, the corresponding PARs were 25.3% (20.9-29.7%) and 16.6% (7.0-26.0%). The summary PARs (95%CIs) for HT use and physical inactivity together were 29.8% (21.8-36.9%) and 37.9% (30.6-46.2%) regarding overall invasive and ER+/PR+ tumors, respectively.
CONCLUSIONS
The population-level impact of modifiable risk factors appears to be comparable to that of non-modifiable risk factors. Alterations in HT use and physical inactivity could potentially reduce postmenopausal invasive breast cancer incidence in Germany by nearly 30%, with the largest potential for reduction among ER+/PR+ tumors, the most frequently diagnosed subtype.
背景
可改变的绝经后乳腺癌风险因素对人群的影响尚不完全清楚，特别是关于雌激素受体（ER）和孕激素受体（PR）状态的潜在异质性。
方法
我们使用了 2002 年至 2005 年期间在德国进行的一项基于人群的绝经后乳腺癌病例对照研究中 3074 例病例和 6386 例对照的数据，计算了可改变和不可改变的风险因素的多变量调整比值比和人群归因风险（PAR）。我们检查了可改变和不可改变的风险因素对所有绝经后浸润性乳腺癌以及肿瘤 ER/PR 亚型的影响。自举法提供了 95%置信区间（95%CI）的估计值。
结果
不可改变风险因素（初潮年龄、绝经年龄、产次、良性乳腺疾病和乳腺癌家族史）的总体PAR（95%CI）为 37.2%（27.1-47.2%），ER+/PR+肿瘤为 36.5%（23.3-47.6%），ER+/PR-肿瘤为 47.9%（26.4-64.4%），ER-/PR-肿瘤为 31.1%（4.0-51.9%）。可改变的风险因素（激素治疗（HT）使用、身体活动不足、BMI、饮酒）中，HT 使用和身体活动不足的影响最大，其 PAR 分别为 19.4%（15.9-23.2%）和 12.8%（5.5-20.8%），与所有浸润性肿瘤有关。对于 ER+/PR+肿瘤，相应的 PAR 分别为 25.3%（20.9-29.7%）和 16.6%（7.0-26.0%）。HT 使用和身体活动不足的总 PAR 分别为 29.8%（21.8-36.9%）和 37.9%（30.6-46.2%），与所有浸润性和 ER+/PR+肿瘤有关。
结论
可改变风险因素对人群的影响似乎与不可改变风险因素相当。HT 使用和身体活动不足的改变可能会使德国绝经后浸润性乳腺癌的发病率降低近 30%，其中 ER+/PR+肿瘤的潜在降低幅度最大，这是最常见的诊断亚型。
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