Hiatt Robert A, Engmann Natalie J, Balke Kaya, Rehkopf David H
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
Cancer Epidemiol Biomarkers Prev. 2020 Sep;29(9):1720-1730. doi: 10.1158/1055-9965.EPI-20-0016. Epub 2020 Jul 8.
The etiology of breast cancer is a complex system of interacting factors from multiple domains. New knowledge about breast cancer etiology continues to be produced by the research community, and the communication of this knowledge to other researchers, practitioners, decision makers, and the public is a challenge.
We updated the previously published Paradigm model (PMID: 25017248) to create a framework that describes breast cancer etiology in four overlapping domains of biologic, behavioral, environmental, and social determinants. This new Paradigm II conceptual model was part of a larger modeling effort that included input from multiple experts in fields from genetics to sociology, taking a team and transdisciplinary approach to the common problem of describing breast cancer etiology for the population of California women in 2010. Recent literature was reviewed with an emphasis on systematic reviews when available and larger epidemiologic studies when they were not. Environmental chemicals with strong animal data on etiology were also included.
The resulting model illustrates factors with their strength of association and the quality of the available data. The published evidence supporting each relationship is made available herein, and also in an online dynamic model that allows for manipulation of individual factors leading to breast cancer (https://cbcrp.org/causes/).
The Paradigm II model illustrates known etiologic factors in breast cancer, as well as gaps in knowledge and areas where better quality data are needed.
The Paradigm II model can be a stimulus for further research and for better understanding of breast cancer etiology.
乳腺癌的病因是一个由多个领域相互作用的因素构成的复杂系统。研究界不断产生关于乳腺癌病因的新知识，而将这些知识传达给其他研究人员、从业者、决策者和公众是一项挑战。
我们更新了之前发表的范式模型（PMID：25017248），以创建一个在生物学、行为、环境和社会决定因素四个重叠领域描述乳腺癌病因的框架。这个新的范式II概念模型是一项更大建模工作的一部分，该工作包括从遗传学到社会学等多个领域的专家提供的意见，采用团队和跨学科方法来解决为2010年加利福尼亚州女性群体描述乳腺癌病因这个共同问题。我们对近期文献进行了综述，如有系统性综述则重点参考，若无则参考规模较大的流行病学研究。还纳入了在病因方面有强有力动物数据的环境化学物质。
所得模型展示了各因素及其关联强度和现有数据的质量。支持每种关系的已发表证据在此处以及一个在线动态模型中提供，该模型允许对导致乳腺癌的个体因素进行操作（https://cbcrp.org/causes/）。
范式II模型展示了乳腺癌已知的病因因素，以及知识空白和需要更高质量数据的领域。
范式II模型可刺激进一步研究并增进对乳腺癌病因的理解。
