EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1250-1259. doi: 10.1158/1055-9965.EPI-20-1730. Epub 2021 Apr 13.
Breast cancer incidence is rising in Africa, but there are scare data regarding risk factors in this region. We assessed the relation between risk factors and the occurrence of breast cancer, overall and by tumor subtype in women from Mozambique.
The associations between education, number of births, height, weight, body mass index (BMI), and breast cancer risk among 138 cases (participants from the Moza-BC cohort) and 638 controls from the general population (from a World Health Organization stepwise approach to surveillance survey), recruited during 2014 to 2017, were investigated. Adjusted ORs (aOR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression.
Multiparity (≥6 vs. 0-1 live births) was a protective factor for the development of hormone receptor (HR)-positive (aOR = 0.22; 95% CI, 0.08-0.64) and HR-positive/HER2-negative tumors (aOR = 0.20; 95% CI, 0.06-0.68), whereas a higher educational level (≥8 vs. 0 schooling years) increased breast cancer risk across all subtypes (overall aOR = 1.98; 95% CI, 1.04-3.80). Higher weight and BMI were associated with a higher breast cancer risk among postmenopausal women (per 1-kg increase: aOR = 1.05; 95% CI, 1.02-1.08; per 1-kg/m increase: aOR = 1.11; 95% CI, 1.04-1.18, respectively), but were protective in premenopausal women (aOR = 0.98; 95% CI, 0.96-0.99; aOR = 0.95; 95% CI, 0.91-0.99, respectively), regardless of subtype. Higher height increased the risk of HR-negative tumors in postmenopause (per 10-cm increase: aOR = 2.81; 95% CI, 1.41-6.03).
These results demonstrate the etiological heterogeneity of breast cancer among native African women, namely regarding the differential effect of multiparity, education, and body parameters in breast cancer risk.
As the prevalence of obesity grows, these findings are important to inform public health policies on cancer prevention, by highlighting obesity as a modifiable risk factor for breast cancer among African women.
乳腺癌在非洲的发病率正在上升，但该地区关于风险因素的数据很少。我们评估了莫桑比克女性乳腺癌发病的危险因素，包括整体和肿瘤亚型。
在 2014 年至 2017 年期间，共招募了 138 例病例（莫扎-乳腺癌队列的参与者）和 638 例对照（来自世界卫生组织逐步监测调查的一般人群），采用多变量逻辑回归分析了教育程度、生育次数、身高、体重、体重指数（BMI）与乳腺癌风险之间的关系，并进行了调整。采用比值比（OR）和 95%置信区间（CI）来估计。
多胎产（≥6 次与 0-1 次活产）是激素受体（HR）阳性（调整 OR [aOR] = 0.22；95% CI，0.08-0.64）和 HR 阳性/HER2 阴性肿瘤（aOR = 0.20；95% CI，0.06-0.68）发展的保护因素，而较高的教育水平（≥8 年与 0 年学业）增加了所有亚型的乳腺癌风险（总体 aOR = 1.98；95% CI，1.04-3.80）。体重和 BMI 的增加与绝经后妇女的乳腺癌风险增加相关（每增加 1 公斤：aOR = 1.05；95% CI，1.02-1.08；每增加 1 公斤/平方米：aOR = 1.11；95% CI，1.04-1.18），但在绝经前妇女中是保护因素（aOR = 0.98；95% CI，0.96-0.99；aOR = 0.95；95% CI，0.91-0.99），与亚型无关。身高每增加 10 厘米，绝经后 HR 阴性肿瘤的风险增加（aOR = 2.81；95% CI，1.41-6.03）。
这些结果表明，非洲本地妇女的乳腺癌具有病因异质性，即多胎产、教育和身体参数对乳腺癌风险的影响不同。
随着肥胖的流行，这些发现对于制定癌症预防的公共卫生政策很重要，突出了肥胖是非洲妇女乳腺癌的一个可改变的危险因素。
