Cui Yong, Deming-Halverson Sandra L, Shrubsole Martha J, Beeghly-Fadiel Alicia, Fair Alecia M, Sanderson Maureen, Shu Xiao-Ou, Kelley Mark C, Zheng Wei
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN.
Vanderbilt Institute of Clinical Translational Research, Vanderbilt University School of Medicine, Nashville, TN.
Clin Breast Cancer. 2014 Dec;14(6):417-25. doi: 10.1016/j.clbc.2014.04.003. Epub 2014 Jun 2.
Causes of racial disparities in breast cancer incidence and mortality between white and African American women remain unclear. This study evaluated associations of menstrual and reproductive factors with breast cancer risk by race and cancer subtypes.
Included in the study were 1866 breast cancer cases and 2306 controls recruited in the Nashville Breast Health Study, a population-based case-control study. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
African American women were more likely to have estrogen receptor-negative (ER(-)), progesterone receptor-negative (PR(-)), and triple-negative (ER(-)PR(-)HER2(-)) breast cancer than white women. Age at menarche (≥ 14 years) and multiparity (≥ 3 live births) were inversely associated with ER(+) tumors only, whereas late age at first live birth (> 30 years) and nulliparity were associated with elevated risk; such associations were predominantly seen in white women (OR = 0.70, 95% CI = 0.55-0.88; OR = 0.72, 95% CI = 0.56-0.92; OR = 1.42, 95% CI = 1.13-1.79; OR = 1.32, 95% CI = 1.06-1.63, respectively). Age at menopause between 47 and 51 years was associated with elevated risk of ER(-) tumors in both white and African American women. Among women who had natural menopause, positive association between ever-use of hormone replacement therapy and breast cancer risk was seen in white women only (OR = 1.39, 95% CI = 1.03-1.87).
This study suggests that certain hormone-related factors are differentially associated with risk of breast cancer subtypes, and these associations also differ by race.
白人和非裔美国女性在乳腺癌发病率和死亡率方面存在种族差异的原因尚不清楚。本研究按种族和癌症亚型评估了月经和生殖因素与乳腺癌风险的关联。
纳入纳什维尔乳腺健康研究中的1866例乳腺癌病例和2306例对照，该研究为基于人群的病例对照研究。采用多变量逻辑回归来估计比值比（OR）和95%置信区间（CI）。
与白人女性相比，非裔美国女性更易患雌激素受体阴性（ER（-））、孕激素受体阴性（PR（-））和三阴性（ER（-）PR（-）HER2（-））乳腺癌。初潮年龄（≥14岁）和多产（≥3次活产）仅与ER（+）肿瘤呈负相关，而首次活产年龄较大（>30岁）和未生育与风险升高相关；这些关联主要见于白人女性（OR分别为0.70，95%CI为0.55 - 0.88；OR为0.72，95%CI为0.56 - 0.92；OR为1.42，95%CI为1.13 - 1.79；OR为1.32，95%CI为1.06 - 1.63）。47至51岁的绝经年龄与白人和非裔美国女性ER（-）肿瘤风险升高相关。在自然绝经的女性中，仅在白人女性中发现曾经使用激素替代疗法与乳腺癌风险呈正相关（OR = 1.39，95%CI = 1.03 - 1.87）。
本研究表明，某些激素相关因素与乳腺癌亚型风险的关联存在差异，且这些关联也因种族而异。
