Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
Eur J Epidemiol. 2021 Jan;36(1):37-55. doi: 10.1007/s10654-020-00688-3. Epub 2020 Oct 30.
Associations between anthropometric factors and breast cancer (BC) risk have varied inconsistently by estrogen and/or progesterone receptor (ER/PR) status. Associations between prediagnostic anthropometric factors and risk of premenopausal and postmenopausal BC overall and ER/PR status subtypes were investigated in a pooled analysis of 20 prospective cohorts, including 36,297 BC cases among 1,061,915 women, using multivariable Cox regression analyses, controlling for reproductive factors, diet and other risk factors. We estimated dose-response relationships and tested for nonlinear associations using restricted cubic splines. Height showed positive, linear associations for premenopausal and postmenopausal BC risk (6-7% RR increase per 5 cm increment), with stronger associations for receptor-positive subtypes. Body mass index (BMI) at cohort baseline was strongly inversely associated with premenopausal BC risk, and strongly positively-and nonlinearly-associated with postmenopausal BC (especially among women who never used hormone replacement therapy). This was primarily observed for receptor-positive subtypes. Early adult BMI (at 18-20 years) showed inverse, linear associations for premenopausal and postmenopausal BC risk (21% and 11% RR decrease per 5 kg/m, respectively) with stronger associations for receptor-negative subtypes. Adult weight gain since 18-20 years was positively associated with postmenopausal BC risk, stronger for receptor-positive subtypes, and among women who were leaner in early adulthood. Women heavier in early adulthood generally had reduced premenopausal BC risk, independent of later weight gain. Positive associations between height, baseline (adult) BMI, adult weight gain and postmenopausal BC risk were substantially stronger for hormone receptor-positive versus negative subtypes. Premenopausal BC risk was positively associated with height, but inversely with baseline BMI and weight gain (mostly in receptor-positive subtypes). Inverse associations with early adult BMI seemed stronger in receptor-negative subtypes of premenopausal and postmenopausal BC.
人体测量因素与乳腺癌（BC）风险之间的关系因雌激素和/或孕激素受体（ER/PR）状态而异。在对 20 项前瞻性队列的汇总分析中，研究了诊断前人体测量因素与绝经前和绝经后 BC 整体以及 ER/PR 状态亚型风险之间的关系，该分析包括 1061915 名女性中的 36297 例 BC 病例，使用多变量 Cox 回归分析，控制了生殖因素、饮食和其他危险因素。我们使用限制性立方样条估计了剂量-反应关系并测试了非线性关联。身高与绝经前和绝经后 BC 风险呈正线性关联（每增加 5 厘米身高增加 6-7%的 RR），与受体阳性亚型的关联更强。队列基线时的体重指数（BMI）与绝经前 BC 风险呈强烈负相关，与绝经后 BC 呈强烈正相关且非线性相关（尤其是从未使用激素替代疗法的女性）。这主要发生在受体阳性亚型中。成年早期 BMI（18-20 岁）与绝经前和绝经后 BC 风险呈负线性关联（分别减少 21%和 11%的 RR），与受体阴性亚型的关联更强。18-20 岁以来的成年体重增加与绝经后 BC 风险呈正相关，受体阳性亚型更强，并且在成年早期较瘦的女性中更强。成年早期较重的女性通常降低了绝经前 BC 的风险，而与后来的体重增加无关。身高、基线（成年）BMI、成年体重增加与绝经后 BC 风险之间的正相关关系对于激素受体阳性与阴性亚型来说要强得多。绝经前 BC 风险与身高呈正相关，但与基线 BMI 和体重增加呈负相关（主要在受体阳性亚型中）。与成年早期 BMI 的负相关关系在绝经前和绝经后 BC 的受体阴性亚型中似乎更强。
