遭受 1959-1961 年中国大饥荒的中国女性乳腺癌的发病率。
Incidence of breast cancer in Chinese women exposed to the 1959-1961 great Chinese famine.
机构信息
Center for Disease Control and Prevention of Minhang District, 965 Zhong Yi Road, Shanghai, 201101, China.
Department of Epidemiology, School of Public Health, Fudan University; Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), 138 Yi Xue Yuan Road, Shanghai, 200032, China.
出版信息
BMC Cancer. 2017 Dec 5;17(1):824. doi: 10.1186/s12885-017-3794-3.
BACKGROUND
The association of malnutrition in early life with breast cancer risk has been studied in Europe by investigating survivors of the Dutch Hunger Winter Famine, but not in China. We evaluated the effect of exposure to the 1959-1961 Great Leap Forward famine on subsequent breast cancer risk in Chinese women.
METHODS
A total of 59,060 women born in 1955~1966 were recruited from Minhang district, Shanghai, China, during the period 2008 to 2012. A baseline survey was conducted to collect demographic characteristics and known risk factors for breast cancer. Incident breast cancers were identified by conducting record linkage with the Shanghai Cancer Registry up to June 30, 2015, and confirmed through medical records. Cumulative probabilities of cancer incidence were evaluated after adjusting for age, educational level and other confounders. Cox regression models were applied to estimate the hazard ratios (HR) and 95% confidence intervals (CI) of breast cancer.
RESULTS
The overall crude incidence of in situ and invasive breast cancer were 19.2 and 115.0 per 100,000, respectively, in women conceived or born during the famine (1959-1962), slightly higher than those in women born before (1955-1958) (13.2 and 109.8/100,000) and after (1963-1966) (10.4 and 101.5/100,000). Particularly, at age group of 50-52 years when all participants contributed person-year of observations, the age-specific incidence of invasive breast cancer was higher in pre-natal exposed women (123.7/100,000, 95%CI: 94.5-161.9/100,000) than in post-natal exposed (109.6/100,000, 95%CI: 69.1-174.0/100,000) and unexposed women (82.7/100,000, 95%CI: 46.9-145.7/100,000). However, the incidence of cancer in situ was slightly lower in pre-natal exposed women at the age group. Adjusted cumulative probabilities of breast cancer incidence, both in-situ and invasive, were also observed to be higher in women exposed to the famine, however, the difference was not statistically significant.
CONCLUSION
Our results suggest a possible adverse, but limited, impact of exposure to the Great famine on the risk of breast cancer in Chinese women.
背景
欧洲通过调查荷兰饥饿冬季饥荒的幸存者研究了生命早期营养不良与乳腺癌风险之间的关系，但在中国尚未进行此类研究。我们评估了中国女性暴露于 1959-1961 年大跃进饥荒对随后乳腺癌风险的影响。
方法
2008 年至 2012 年期间，我们从中国上海闵行区招募了 59060 名出生于 1955 年至 1966 年的女性。基线调查收集了人口统计学特征和乳腺癌的已知危险因素。截至 2015 年 6 月 30 日，通过与上海癌症登记处进行记录链接确定乳腺癌的发病情况，并通过病历进行确认。在调整年龄、教育程度和其他混杂因素后，评估癌症发病率的累积概率。应用 Cox 回归模型估计乳腺癌的风险比（HR）和 95%置信区间（CI）。
结果
在饥荒期间（1959-1962 年）受孕或出生的女性中，原位和浸润性乳腺癌的总体粗发病率分别为 19.2 和 115.0/100000，略高于出生前（1955-1958 年）（13.2 和 109.8/100000）和出生后（1963-1966 年）（10.4 和 101.5/100000）的女性。特别是，在所有参与者贡献观察人年的 50-52 岁年龄组中，产前暴露女性的浸润性乳腺癌的年龄特异性发病率较高（123.7/100000，95%CI：94.5-161.9/100000）高于产后暴露（109.6/100000，95%CI：69.1-174.0/100000）和未暴露女性（82.7/100000，95%CI：46.9-145.7/100000）。然而，在该年龄组中，产前暴露女性的原位癌发病率略低。调整后的乳腺癌发病率（包括原位癌和浸润性癌）的累积概率也观察到在暴露于饥荒的女性中较高，但差异无统计学意义。
结论
我们的研究结果表明，中国女性暴露于大饥荒可能对乳腺癌风险产生不利但有限的影响。
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