Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
Acta Oncol. 2013 Nov;52(8):1637-42. doi: 10.3109/0284186X.2012.754994. Epub 2013 Jan 15.
There are large geographic differences in breast cancer risk but whether survival differs between low- and high-risk groups is less well-established. As the survival of cancer depends on the level of healthcare and awareness of disease risks, subtle differences in cancer biology cannot be revealed in international comparisons. Instead, comparison of diverse immigrant groups in a country of uniformly accessible healthcare system should enable conclusions to be made about ethnic determinants of cancer risk and survival.
The Swedish Family-Cancer Database was used to calculate standardized incidence (SIRs) and hazard ratios (HRs) of death from female breast cancer in 12 505 and 137 547 patients diagnosed with breast cancer among immigrants and Swedes, respectively. The ratios were adjusted for age, period, region, parity, and age at first childbirth. Ordinal logistic regression analysis was used to estimate odds ratios (ORs) for the clinical TNM classes. The analyses were stratified by menopausal status and histology. Results. Turks, Southeast Asians, and Chileans had the lowest breast cancer risk (SIR = 0.44; 95% CI 0.37-0.51) and Iraqis the highest risk (1.19; 1.05-1.35), mainly due to premenopausal cancer (1.51; 1.27-1.78). The HRs for all breast cancers were between 0.98 (0.81-1.18) (low-risk Europeans) and 1.24 (0.94-1.63) (lowest-risk non-Europeans), but were not significant. No differences in survival of ductal carcinoma between immigrants and Swedes were found, while low-risk non-Europeans had a HR of 2.88 (1.37-6.08) for lobular carcinoma. Low-risk non-Europeans were diagnosed in a higher T-class (OR = 1.87; 1.21-2.87) than Swedes.
We did not find any evidence that ethnic differences in breast cancer risk substantially affect the survival. The observed poor survival of some low-risk immigrants in lobular carcinoma may be related to treatment. The tendency of low-risk immigrants to present with higher T-class compared to Swedes may depend on their lower participation in the mammography screening program.
乳腺癌风险在地理上存在较大差异，但低危和高危人群的生存率是否存在差异尚不清楚。由于癌症的生存取决于医疗水平和对疾病风险的认识，因此国际比较无法揭示癌症生物学中的细微差异。相反，在一个医疗保健系统普及的国家，比较不同移民群体应该能够得出癌症风险和生存的种族决定因素的结论。
使用瑞典家族癌症数据库，计算了移民和瑞典人中分别诊断出的 12505 例和 137547 例乳腺癌患者的标准化发病率（SIRs）和死亡风险比（HRs）。这些比值通过年龄、时期、地区、产次和首次生育年龄进行了调整。使用有序逻辑回归分析来估计临床 TNM 分期的比值比（ORs）。分析按绝经状态和组织学进行分层。结果：土耳其人、东南亚人和智利人患乳腺癌的风险最低（SIR=0.44；95%CI 0.37-0.51），而伊拉克人的风险最高（1.19；1.05-1.35），主要是因为绝经前癌症（1.51；1.27-1.78）。所有乳腺癌的 HRs 均在 0.98（0.81-1.18）（低危欧洲人）和 1.24（0.94-1.63）（最低危非欧洲人）之间，但无统计学意义。在导管癌的生存方面，移民与瑞典人之间没有差异，而低危非欧洲人患小叶癌的 HR 为 2.88（1.37-6.08）。低危非欧洲人被诊断为更高 T 期（OR=1.87；1.21-2.87）。
我们没有发现任何证据表明，乳腺癌风险的种族差异会显著影响生存率。一些低危移民在小叶癌中观察到的较差生存率可能与治疗有关。与瑞典人相比，低危移民倾向于呈现更高的 T 期，这可能取决于他们对乳房 X 线筛查计划的参与程度较低。
