老年女性裙子尺码与绝经后乳腺癌风险的关联：英国卵巢癌筛查协作试验（UKCTOCS）中的一项队列研究
Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
作者信息
Fourkala Evangelia-Ourania, Burnell Matthew, Cox Catherine, Ryan Andy, Salter Laura Currin, Gentry-Maharaj Aleksandra, Parmar Mahesh, Jacobs Ian, Menon Usha
机构信息
Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.
University College London Hospitals NHS Foundation Trust, London, UK.
出版信息
BMJ Open. 2014 Sep 24;4(9):e005400. doi: 10.1136/bmjopen-2014-005400.
OBJECTIVES
Several studies suggest that overall and central-obesity are associated with increased breast cancer (BC) risk in postmenopausal-women. However, there are no studies investigating changes of central obesity and BC. We report on the association of BC risk with self-reported skirt size (SS; waist-circumference proxy) changes between 20s and postmenopausal-age.
DESIGN
Prospective cohort-study.
SETTING
UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) involving the nine trial centres in England.
PARTICIPANTS
Postmenopausal-women aged >50 with no known history of BC prior to or on the day of completion of the study-entry questionnaire.
INTERVENTIONS
At recruitment and at study entry, women were asked to complete a questionnaire. Women were followed-up via 'flagging' at the NHS Information Centre in England and the Hospital Episode Statistics.
MAIN OUTCOME-MEASURE: Time to initial BC diagnosis.
RESULTS
Between 2 January 2005 and 1 July 2010, 92,834 UKCTOCS participants (median age 64.0) completed the study-entry questionnaire. During median follow-up of 3.19 years (25th-75th centile: 2.46-3.78), 1090 women developed BC. Model adjusted analysis for potential confounders showed body mass index (BMI) at recruitment to UKCTOCS (HR for a 5 unit change=1.076, 95% CI 1.012 to 1.136), current SS at study entry (HR=1.051; 95% CI 1.014 to 1.089) and change in SS per 10 years (CSS) (HR=1.330; 95% CI 1.121 to 1.579) were associated with increased BC risk but not SS at 25 (HR=1.006; 95% CI 0.958 to 1.056). CSS was the most predictive singe adiposity measure and further analysis including both CSS and BMI in the model revealed CSS remained significant (HR=1.266; 95% CI 1.041 to 1.538) but not BMI (HR=1.037; 95% CI 0.970 to 1.109).
CONCLUSIONS
CSS is associated with BC risk independent of BMI. A unit increase in UK SS (eg, 12-14) every 10-years between 25 and postmenopausal-age is associated with postmenopausal BC risk by 33%. Validation of these results could provide women with a simple and easy to understand message.
TRIAL REGISTRATION NUMBER
ISRCTN22488978.
目的
多项研究表明，总体肥胖和中心性肥胖与绝经后女性患乳腺癌（BC）风险增加有关。然而，尚无研究调查中心性肥胖与乳腺癌的变化情况。我们报告了乳腺癌风险与20多岁至绝经后年龄期间自我报告的裙子尺寸（SS；腰围替代指标）变化之间的关联。
设计
前瞻性队列研究。
地点
英国卵巢癌筛查协作试验（UKCTOCS），涉及英格兰的9个试验中心。
参与者
年龄大于50岁的绝经后女性，在完成研究入组问卷之前或当天无已知乳腺癌病史。
干预措施
在招募时和研究入组时，要求女性填写问卷。通过英格兰国民健康服务信息中心的“标记”和医院病历统计对女性进行随访。
主要观察指标
首次乳腺癌诊断时间。
结果
在2005年1月2日至2010年7月1日期间，92834名UKCTOCS参与者（中位年龄64.0岁）完成了研究入组问卷。在中位随访3.19年（第25-75百分位数：2.46-3.78年）期间，1090名女性患了乳腺癌。对潜在混杂因素进行模型调整分析显示，UKCTOCS招募时的体重指数（BMI）（每变化5个单位的风险比=1.076，95%可信区间1.012至1.136）、研究入组时的当前SS（风险比=1.051；95%可信区间1.014至1.089）以及每10年SS的变化（CSS）（风险比=1.330；95%可信区间1.121至1.579）与乳腺癌风险增加相关，但25岁时的SS无关（风险比=1.006；95%可信区间0.958至1.056）。CSS是最具预测性的单一肥胖指标，在模型中纳入CSS和BMI的进一步分析显示，CSS仍然显著（风险比=1.266；95%可信区间1.041至1.538），但BMI不显著（风险比=1.037；95%可信区间0.970至1.109）。
结论
CSS与乳腺癌风险相关，独立于BMI。25岁至绝经后年龄期间每10年英国SS增加一个单位（例如，从12到14）与绝经后乳腺癌风险增加33%相关。对这些结果的验证可为女性提供一个简单易懂的信息。
试验注册号
ISRCTN22488978。
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