Center for Research in Epidemiology and Population Health, French Institute of Health and Medical Research, Villejuif Cedex, France.
Eur J Cancer Prev. 2013 Jan;22(1):29-37. doi: 10.1097/CEJ.0b013e328355ec04.
Although earlier studies have indicated an inverse association between corpulence during childhood and the risk for breast cancer in adulthood, no study had evaluated body shape at different ages or body shape evolution in relation to the risk for breast cancer defined by menopausal status and hormone receptor status. Hazard ratios (HR) were estimated using multivariate Cox models in 81,089 women from the French E3N cohort to evaluate the risk for breast cancer associated with body shape (Sørensen's scale) at ages 8, menarche, 20-25, and 35-40 years. Six lifetime body shape trajectories were also estimated according to Nagin's approach to group-based trajectory modeling, and were analyzed in relation to the risk for breast cancer. During follow-up, 3573 breast cancer cases were diagnosed. At age 8 and at menarche, an increasing size of the body was associated with a significantly negative risk for estrogen receptor (ER)+/progesterone receptor (PR)+ postmenopausal breast cancer [both had a P(trend)=0.001; HR=0.80 (0.67-0.94) and HR=0.74 (0.64-0.86), respectively], for the largest body shapes compared with the first body shape. No significant association with body shape was found at the other ages. In terms of body shape evolution throughout life, women with a large body shape at menarche, irrespective of their body shape before or after menarche, tended to have a decreased risk for ER+/PR+ postmenopausal breast cancer compared with women who were constantly lean. Adjustment for current BMI or age at menarche did not modify any associations. Our study found an inverse association between adiposity at menarche and the risk for ER+/PR+ postmenopausal breast cancer, independent of corpulence at other ages. This work should encourage longitudinal studies with hormonal information to examine the underlying biological mechanisms.
虽然早期的研究表明儿童期肥胖与成年后患乳腺癌的风险呈负相关，但没有研究评估过不同年龄的体型或与绝经状态和激素受体状态定义的乳腺癌风险相关的体型演变。使用来自法国 E3N 队列的 81089 名女性的多变量 Cox 模型估计了危险比 (HR)，以评估在 8 岁、初潮、20-25 岁和 35-40 岁时的体型 (Sørensen 量表) 与乳腺癌风险之间的关系。还根据 Nagin 的基于群组的轨迹建模方法估计了六个终生体型轨迹，并分析了它们与乳腺癌风险的关系。在随访期间，诊断出 3573 例乳腺癌病例。在 8 岁和初潮时，体型增大与雌激素受体 (ER)+/孕激素受体 (PR)+绝经后乳腺癌的风险呈显著负相关[两者的趋势 P 值均为 0.001；HR=0.80(0.67-0.94)和 HR=0.74(0.64-0.86)]，与最大体型相比，与第一体型相比。在其他年龄时，体型与体型无显著相关性。就一生的体型演变而言，初潮时体型较大的女性，无论初潮前后的体型如何，与持续消瘦的女性相比，绝经后 ER+/PR+乳腺癌的风险降低。调整当前 BMI 或初潮年龄并未改变任何关联。我们的研究发现，初潮时肥胖与绝经后 ER+/PR+乳腺癌的风险呈负相关，与其他年龄的肥胖无关。这项工作应该鼓励进行有激素信息的纵向研究，以检查潜在的生物学机制。
