Kampert J B, Whittemore A S, Paffenbarger R S
Department of Family, Community, and Preventive Medicine, Stanford University School of Medicine, CA 94305.
Am J Epidemiol. 1988 Nov;128(5):962-79. doi: 10.1093/oxfordjournals.aje.a115070.
Pike et al. (Nature 1983;303:767-70) and Moolgavkar et al. (JNCI 1980;65:59-69) proposed quantitative theories for the effect on age-specific breast cancer risk of ages at menarche, first childbirth, and menopause. Here the incidence rate functions predicted by these theories are fit to data for 1,884 women of all ages with breast cancer and 3,432 matched controls admitted to San Francisco Bay area hospitals in 1970-1977. A third function describing age-specific breast cancer risk based on the timing of childbearing and menstrual events is presented, and its fit to the data is compared with that of the functions of Pike et al. and Moolgavkar et al. None of the three fully accounted for the protective effects of early age at first childbirth in premenopausal women or of early age at menopause in parous postmenopausal women. To account for the effects of total parity and body mass (Quetelet) index on risk of breast cancer occurrence, the authors developed a fourth incidence rate function by extending the third. Goodness of fit to the data of the fourth function is demonstrated. Age-specific relative risks of breast cancer according to childbearing, menstrual events, and body size are estimated from the fourth function. The main qualitative findings are that 1) the protective effects of late menarche and of early first full-term pregnancy are greater in premenopausal than in postmenopausal women; 2) first full-term pregnancy initially boosts the level of risk, but incidence rates increase with age more slowly thereafter; 3) among the parous, multiparity is protective both in premenopausal and postmenopausal women, regardless of age at first full-term pregnancy; 4) both nulliparous and lean women are more protected by early menopause than are parous and overweight women; 5) increased body mass index is protective before, but detrimental after, menopause; and 6) postmenopausal incidence rates increase with age more rapidly among overweight than among lean women.
派克等人（《自然》，1983年；303:767 - 70）以及穆尔加夫卡尔等人（《美国国家癌症研究所杂志》，1980年；65:59 - 69）提出了关于初潮年龄、首次生育年龄和绝经年龄对特定年龄乳腺癌风险影响的定量理论。在此，将这些理论所预测的发病率函数与1970 - 1977年入住旧金山湾区医院的1884名各年龄段乳腺癌女性及3432名匹配对照的数据进行拟合。提出了第三个基于生育和月经事件时间描述特定年龄乳腺癌风险的函数，并将其与派克等人及穆尔加夫卡尔等人的函数对数据的拟合情况进行比较。这三个函数均未完全解释初潮早对绝经前女性的保护作用，或首次生育早对已生育绝经后女性的保护作用。为解释总产次和体重（奎特利）指数对乳腺癌发生风险的影响，作者通过扩展第三个函数开发了第四个发病率函数。证明了第四个函数对数据的拟合优度。根据第四个函数估算了按生育、月经事件和体型划分的特定年龄乳腺癌相对风险。主要定性结果为：1）初潮晚和首次足月妊娠早的保护作用在绝经前女性中比在绝经后女性中更大；2）首次足月妊娠最初会提高风险水平，但此后发病率随年龄增长的速度会更慢；3）在已生育女性中，多产对绝经前和绝经后女性均有保护作用，与首次足月妊娠年龄无关；4）未生育和瘦的女性比已生育和超重的女性更受绝经早的保护；5）体重指数增加在绝经前有保护作用，但在绝经后有不利影响；6）超重女性绝经后发病率随年龄增长的速度比瘦女性更快。
