Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK.
School of Medicine, University of Leeds, Leeds, UK.
Cancer Causes Control. 2019 Nov;30(11):1183-1200. doi: 10.1007/s10552-019-01223-w. Epub 2019 Aug 30.
The purpose of the present study was to systematically review the complex associations between energy balance-related factors and breast cancer risk, for which previous evidence has suggested different associations in the life course of women and by hormone receptor (HR) status of the tumor.
Relevant publications on adulthood physical activity, sedentary behavior, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, and weight change and pre- and postmenopausal breast cancer risk were identified in PubMed up to 30 April 2017. Random-effects meta-analyses were conducted to summarize the relative risks across studies.
One hundred and twenty-six observational cohort studies comprising over 22,900 premenopausal and 103,000 postmenopausal breast cancer cases were meta-analyzed. Higher physical activity was inversely associated with both pre- and postmenopausal breast cancers, whereas increased sitting time was positively associated with postmenopausal breast cancer. Although higher early adult BMI (ages 18-30 years) was inversely associated with pre- and postmenopausal breast cancers, adult weight gain and greater body adiposity increased breast cancer risk in postmenopausal women, and the increased risk was evident for HR+ but not HR- breast cancers, and among never but not current users of postmenopausal hormones. The evidence was less consistent in premenopausal women. There were no associations with adult weight gain, inverse associations with adult BMI (study baseline) and hip circumference, and non-significant associations with waist circumference and waist-to-hip ratio that were reverted to positive associations on average in studies accounting for BMI. No significant associations were observed for HR-defined premenopausal breast cancers.
Better understanding on the impact of these factors on pre- and postmenopausal breast cancers and their subtypes along the life course is needed.
本研究旨在系统回顾与能量平衡相关因素和乳腺癌风险之间的复杂关联，此前的证据表明，这些因素在女性的生命历程中以及肿瘤的激素受体（HR）状态中存在不同的关联。
在截至 2017 年 4 月 30 日的 PubMed 中，检索有关成年期体力活动、久坐行为、体重指数（BMI）、腰围和臀围、腰臀比以及体重变化与绝经前和绝经后乳腺癌风险的相关文献。采用随机效应荟萃分析汇总研究间的相对风险。
对包括超过 22900 例绝经前和 103000 例绝经后乳腺癌病例的 126 项观察性队列研究进行了荟萃分析。较高的体力活动与绝经前和绝经后乳腺癌均呈负相关，而久坐时间的增加与绝经后乳腺癌呈正相关。虽然早期成年 BMI（18-30 岁）与绝经前和绝经后乳腺癌均呈负相关，但成年体重增加和体脂增加增加了绝经后女性的乳腺癌风险，并且这种风险在 HR+乳腺癌而非 HR-乳腺癌中更为明显，且在绝经后激素从未使用者或当前使用者中均可见。在绝经前女性中，证据不太一致。与成年体重增加没有关联，与成年 BMI（研究基线）和臀围呈负相关，与腰围和腰臀比无显著关联，而在考虑 BMI 的研究中，这些关联平均转为正相关。未观察到与 HR 定义的绝经前乳腺癌有显著关联。
需要更好地了解这些因素对绝经前和绝经后乳腺癌及其亚型在生命历程中的影响。
