Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
National Institute for Health Innovation, School of Public Health, University of Auckland, Level 4, Tamaki Campus, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand.
Eur J Epidemiol. 2019 Sep;34(9):863-870. doi: 10.1007/s10654-019-00528-z. Epub 2019 Jun 11.
There are known short-term benefits in breastfed infants versus bottle-fed infants in terms of lower risks of infection and obesity in infancy and childhood, but the long-term effect on the risk of adult cancers is unclear. In a cohort of 1 in 4 UK women born in 1935-1950 we report the incidence of adult cancers in relation to having been breastfed in infancy. In median year 2001 (interquartile range 2000-2003) 548,741 women without prior cancer reported whether they had been breastfed. There was 81% agreement between women's report of having been breastfed and information on breastfeeding recorded when they were 2 years old. Participants were followed by record-linkage to national cancer registration, hospital admission and death databases. Cox regression yielded adjusted relative risks (RRs) and 95% confidence intervals (CI) by having been breastfed or not for eight cancer sites with > 2000 incident cases and for related conditions, where appropriate. Of the eight cancers examined here one association was highly statistically significant: an increase in colorectal cancer incidence among women who had been breastfed versus not (RR 1.18, 95% CI 1.12-1.24, n = 8651). To investigate further the findings for colorectal cancer, we studied eight other gastro-intestinal conditions, and found increased risks in women who had been breastfed versus not for benign colorectal polyps (RR 1.09, 95% CI 1.05-1.13, n = 17,677) and for appendicitis (RR 1.19, 95% CI 1.07-1.31, n = 2108). The greater risks of adult colorectal cancer, colorectal polyps and appendicitis associated with having been breastfed in infancy suggest possible long-term effects of infant feeding practices on the gastrointestinal tract. Further studies are required to clarify this novel association.
在母乳喂养的婴儿和奶瓶喂养的婴儿中,短期来看前者在婴儿期和儿童期感染和肥胖的风险较低,但母乳喂养对成年癌症风险的长期影响尚不清楚。我们在一个由 1935-1950 年出生的英国女性中的 1/4 组成的队列中,报告了与婴儿期母乳喂养相关的成年癌症发病率。在 2001 年中值年份(2000-2003 年的四分位间距),548741 名无先前癌症的女性报告了她们是否进行过母乳喂养。女性对母乳喂养的报告与她们 2 岁时母乳喂养记录的信息之间有 81%的一致性。通过与国家癌症登记、住院和死亡数据库的记录链接,对参与者进行了随访。Cox 回归得出了有或没有母乳喂养的 8 个癌症部位和相关疾病的调整后的相对风险(RR)和 95%置信区间(CI),这些癌症部位的发病例数均超过 2000 例。在所检查的 8 种癌症中,有一个关联具有高度统计学意义:与未母乳喂养的女性相比,母乳喂养的女性结直肠癌发病率增加(RR 1.18,95%CI 1.12-1.24,n=8651)。为了进一步研究结直肠癌的发现,我们研究了另外 8 种胃肠道疾病,发现与未母乳喂养的女性相比,母乳喂养的女性患良性结直肠息肉(RR 1.09,95%CI 1.05-1.13,n=17677)和阑尾炎(RR 1.19,95%CI 1.07-1.31,n=2108)的风险增加。婴儿期母乳喂养与成年结直肠癌、结直肠息肉和阑尾炎风险增加之间的关联表明,婴儿喂养方式可能对胃肠道产生长期影响。需要进一步的研究来阐明这种新的关联。