Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Slone Epidemiology Center at Boston University, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):71-79. doi: 10.1158/1055-9965.EPI-20-0556. Epub 2020 Oct 23.
Evidence suggests etiologic heterogeneity among breast cancer subtypes. Previous studies with six-marker IHC classification of intrinsic subtypes included small numbers of black women.
Using centralized laboratory results for estrogen receptor (ER), progesterone receptor, HER2, proliferation marker, Ki-67, EGFR, and cytokeratin (CK)5/6, we estimated case-only and case-control ORs for established breast cancer risk factors among cases ( = 2,354) and controls ( = 2,932) in the African American Breast Cancer Epidemiology and Risk (AMBER) consortium. ORs were estimated by ER status and intrinsic subtype using adjusted logistic regression.
Case-only analyses by ER status showed etiologic heterogeneity by age at menarche, parity (vs. nulliparity), and age at first birth. In case-control analyses for intrinsic subtype, increased body mass index and waist-to-hip ratio (WHR) were associated with increased risk of luminal A subtype, whereas older age at menarche and parity, regardless of breastfeeding, were associated with reduced risk. For basal-like cancers, parity without breastfeeding and increasing WHR were associated with increased risk, whereas breastfeeding and age ≥25 years at first birth were associated with reduced risk among parous women. Basal-like and ER/HER2 subtypes had earlier age-at-incidence distribution relative to luminal subtypes.
Breast cancer subtypes showed distinct etiologic profiles in the AMBER consortium, a study of more than 5,000 black women with centrally assessed tumor biospecimens.
Among black women, high WHR and parity without breastfeeding are emerging as important intervention points to reduce the incidence of basal-like breast cancer.
有证据表明乳腺癌亚型存在病因异质性。之前使用六标志物免疫组织化学分类内在亚型的研究纳入的少数黑种人女性。
使用集中化实验室结果进行雌激素受体（ER）、孕激素受体（PR）、HER2、增殖标志物、Ki-67、EGFR 和细胞角蛋白（CK）5/6，我们估计了非洲裔美国乳腺癌流行病学和风险（AMBER）联盟病例（=2354）和对照（=2932）中已确定的乳腺癌危险因素的病例对照比值比（OR）。通过 ER 状态和内在亚型使用调整后的逻辑回归来估计 OR。
仅通过 ER 状态进行的病例对照分析显示，发病年龄、产次（与 nulliparity 相比）和初潮年龄的差异会导致病因异质性。在内在亚型的病例对照分析中，体重指数和腰臀比（WHR）的增加与 luminal A 亚型的风险增加相关，而初潮年龄和产次的增加（无论是否母乳喂养）与风险降低相关。对于基底样癌症，未母乳喂养的产次和 WHR 的增加与风险增加相关，而母乳喂养和初产年龄≥25 岁与产次多的妇女的风险降低相关。基底样和 ER/HER2 亚型与 luminal 亚型相比，发病年龄分布更早。
在 AMBER 联盟中，超过 5000 名黑人女性的肿瘤生物标志物样本经过集中评估，乳腺癌亚型表现出不同的病因特征。
在黑人女性中，高 WHR 和未母乳喂养的产次增加成为减少基底样乳腺癌发病率的重要干预点。
