Carter C L, Jones D Y, Schatzkin A, Brinton L A
Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, MD 20892.
Public Health Rep. 1989 Jan-Feb;104(1):45-50.
Risk factors for breast cancer in a cohort of women who participated in the first National Health and Nutrition Examination Survey (NHANES) and its followup epidemiologic survey were examined. The analytic cohort consisted of 122 breast cancer cases and 7,304 noncases, with a median followup time of 10 years. We found no appreciable increase in risk among women who reported their onset of menarche as occurring before the age of 13 compared with those reporting onset at ages 13 and older. Breast cancer risk was progressively elevated with increasing age at first live birth (test for trend, P less than 0.007). The number of children born to a woman did not influence risk, but the data suggested an increased risk for nulliparous women. A family history of breast cancer in a first-degree relative was the strongest predictor of risk for this cohort of women, with relative risks of 2.2 and 2.4 associated with a mother or sister affected with breast cancer, compared with women having no family history. The age of natural menopause had little influence on breast cancer risk, and the data suggested a slight protective effect of early surgical menopause. Higher education (compared with less than a high school education) was associated with an increased risk in this cohort of women (relative risk (RR) = 2.1; 95 percent confidence interval (CI) = 0.9-5.1). These results (a) confirm the importance of some well-recognized risk factors for breast cancer in a cohort of women, followed prospectively for 10 years, and perhaps more importantly, (b) uniquely provide risk estimates on a probability sample of women in the United States.
对参加首次全国健康与营养检查调查（NHANES）及其后续流行病学调查的一组女性的乳腺癌风险因素进行了研究。分析队列包括122例乳腺癌病例和7304例非病例，中位随访时间为10年。我们发现，与报告月经初潮发生在13岁及以后的女性相比，报告月经初潮发生在13岁之前的女性风险没有明显增加。乳腺癌风险随着首次生育年龄的增加而逐渐升高（趋势检验，P<0.007）。女性生育的子女数量不影响风险，但数据表明未生育女性的风险增加。一级亲属中有乳腺癌家族史是该组女性风险的最强预测因素，与无家族史的女性相比，母亲或姐妹患乳腺癌的相对风险分别为2.2和2.4。自然绝经年龄对乳腺癌风险影响不大，数据表明早期手术绝经有轻微的保护作用。在该组女性中，高等教育（与高中以下教育相比）与风险增加相关（相对风险（RR）=2.1；95%置信区间（CI）=0.9-5.1）。这些结果（a）证实了在一组前瞻性随访10年的女性中一些公认的乳腺癌风险因素的重要性，也许更重要的是，（b）独特地提供了美国女性概率样本的风险估计。
