Trentham-Dietz Amy, Sprague Brian L, Hampton John M, Miglioretti Diana L, Nelson Heidi D, Titus Linda J, Egan Kathleen M, Remington Patrick L, Newcomb Polly A
Department of Population Health Sciences, University of Wisconsin Carbone Cancer Center, University of Wisconsin, 610 Walnut St., Madison, WI, 53726, USA,
Breast Cancer Res Treat. 2014 May;145(1):165-75. doi: 10.1007/s10549-014-2905-y. Epub 2014 Mar 20.
While several risk factors for breast cancer have been identified, studies have not consistently shown whether these factors operate more strongly at certain ages or for just pre- or postmenopausal women. We evaluated whether risk factors for breast cancer differ according to age or menopausal status. Data from five population-based case-control studies conducted during 1988-2008 were combined and analyzed. Cases (N = 23,959) and population controls (N = 28,304) completed telephone interviews. Logistic regression was used to estimate adjusted odds ratios and 95 % confidence intervals and tests for interaction by age and menopausal status. Odds ratios for first-degree family history of breast cancer were strongest for younger women-reaching twofold elevations-but were still statistically significantly elevated by 58-69 % among older women. Obesity was inversely associated with breast cancer among younger women and positively associated with risk for older women (interaction P < 0.0001). Recent alcohol intake was more strongly related to breast cancer risk among older women, although consumption of 3 or more drinks/day among younger women also was associated with elevated odd ratios (P < 0.0001). Associations with benign breast disease and most reproductive/menstrual factors did not vary by age. Repeating analysis stratifying by menopausal status produced similar results. With few exceptions, menstrual and lifestyle factors are associated with breast cancer risk regardless of age or menopausal status. Variation in the association of family history, obesity, and alcohol use with breast cancer risk by age and menopausal status may need to be considered when determining individual risk for breast cancer.
虽然已经确定了几种乳腺癌的风险因素，但研究并未始终表明这些因素在特定年龄或仅对绝经前或绝经后女性的作用更强。我们评估了乳腺癌风险因素是否因年龄或绝经状态而异。对1988年至2008年期间进行的五项基于人群的病例对照研究的数据进行了合并和分析。病例（N = 23,959）和人群对照（N = 28,304）完成了电话访谈。使用逻辑回归来估计调整后的优势比和95%置信区间，并检验年龄和绝经状态的交互作用。乳腺癌一级家族史的优势比在年轻女性中最强——达到两倍升高——但在老年女性中仍有统计学意义地升高了58%至69%。肥胖在年轻女性中与乳腺癌呈负相关，在老年女性中与风险呈正相关（交互作用P < 0.0001）。近期饮酒与老年女性的乳腺癌风险关系更强，尽管年轻女性每天饮用3杯或更多酒也与优势比升高有关（P < 0.0001）。与乳腺良性疾病和大多数生殖/月经因素的关联在不同年龄之间没有差异。按绝经状态分层进行重复分析产生了类似的结果。除了少数例外情况，月经和生活方式因素与乳腺癌风险相关，无论年龄或绝经状态如何。在确定个体乳腺癌风险时，可能需要考虑家族史、肥胖和饮酒与乳腺癌风险的关联因年龄和绝经状态的差异。
