Rosner Bernard, Eliassen A Heather, Toriola Adetunji T, Chen Wendy Y, Hankinson Susan E, Willett Walter C, Berkey Catherine S, Colditz Graham A
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115.
Siteman Cancer Center and Washington University School of Medicine, Saint Louis, MO, 63110.
Int J Cancer. 2017 May 1;140(9):2003-2014. doi: 10.1002/ijc.30627.
Obesity is a well-established cause of postmenopausal breast cancer. However, early life adiposity is inversely associated with breast cancer incidence. To understand these conflicting relations, we use validated measures to assess adiposity in childhood and late adolescence, as well as weight change, in relation to total invasive breast cancer incidence and receptor subtypes. We conducted a prospective observational study among 74,177 women from the Nurses' Health Study from 1980-2012, with updated risk factors every 2 years during which 4,965 incident invasive breast cancers occurred. Overall, weight at age 18 was inversely associated with both premenopausal (HR per 30 kg = 0.52, 95% CI = 0.39-0.71) and postmenopausal (HR per 30 kg = 0.81, 95% CI = 0.72-0.92) breast cancer which was largely explained by adiposity at age 10. Long-term weight gain from age 18 both during premenopause and postmenopause were positively associated with postmenopausal breast cancer risk. However, premenopausal weight gain was not related to premenopausal breast cancer risk. Furthermore, weight gain since age 18 was positively associated with ER+/PR+ postmenopausal breast cancer (HR per 30 kg = 1.50, 95% CI = 1.36-1.65) but not ER+/PR- (HR per 30 kg = 0.96, 95% CI = 0.78-1.19) or ER-/PR- (HR per 30 kg = 1.16, 95% CI = 0.95-1.42) postmenopausal breast cancer. Overall, 17% of ER+/PR+ postmenopausal breast cancer and 14% of total postmenopausal breast cancer are attributable to weight gain of > 5 kg since age 18.
肥胖是绝经后乳腺癌的一个公认病因。然而，儿童期肥胖与乳腺癌发病率呈负相关。为了解这些相互矛盾的关系，我们使用经过验证的方法来评估儿童期和青春期后期的肥胖情况以及体重变化，并将其与浸润性乳腺癌的总发病率和受体亚型相关联。我们对来自护士健康研究的74177名女性进行了一项前瞻性观察研究，研究时间为1980年至2012年，每两年更新一次风险因素，在此期间发生了4965例浸润性乳腺癌。总体而言，18岁时的体重与绝经前（每增加30kg的风险比=0.52，95%置信区间=0.39-0.71）和绝经后（每增加30kg的风险比=0.81，95%置信区间=0.72-0.92）乳腺癌均呈负相关，这在很大程度上可由10岁时的肥胖情况来解释。绝经前和绝经后从18岁开始的长期体重增加与绝经后乳腺癌风险呈正相关。然而，绝经前体重增加与绝经前乳腺癌风险无关。此外，18岁以后的体重增加与ER+/PR+绝经后乳腺癌呈正相关（每增加30kg的风险比=1.50，95%置信区间=1.36-1.65），但与ER+/PR-（每增加30kg的风险比=0.96，95%置信区间=0.78-1.19）或ER-/PR-（每增加30kg的风险比=1.16，95%置信区间=0.95-1.42）绝经后乳腺癌无关。总体而言，17%的ER+/PR+绝经后乳腺癌和14%的绝经后乳腺癌总病例可归因于18岁以后体重增加超过5kg。
