From the Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI.
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC.
Epidemiology. 2022 Sep 1;33(5):729-738. doi: 10.1097/EDE.0000000000001507. Epub 2022 May 16.
Psychosocial trauma has been hypothesized to influence breast cancer risk, but little is known about how co-occurring traumas-particularly during early life-may impact incidence. We examine the relationship between multiple measures of early-life trauma and incident breast cancer.
The Sister Study is a prospective cohort study of US women (n = 50,884; enrollment 2003-2009; ages 35-74). Of 45,961 eligible participants, 3,070 developed invasive breast cancer or ductal carcinoma in situ through 2017. We assessed trauma before age 18 using previously studied measures (cumulative score, individual trauma type, and substantive domain) and a six-class latent variable to evaluate co-occurring traumas. We accounted for missing data using multiple imputation and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazards models.
Approximately 49% of participants reported early-life trauma. Using the latent class variable approach, breast cancer hazard was higher among participants who had sexual trauma or household dysfunction (HR = 1.1; CI = 0.93, 1.3) or moderate (HR = 1.2; CI = 0.99, 1.4) but not high trauma (HR = 0.66; CI = 0.44, 0.99) compared to low trauma. Breast cancer HRs associated with sexual early-life trauma or household dysfunction were elevated for pre- and postmenopausal breast cancer and by estrogen receptor status. We found no effect modification by race-ethnicity. Estimated effects were attenuated with report of constant childhood social support.
Breast cancer incidence varied by latent patterns of co-occurring early-life trauma. Models capturing childhood social support and trauma patterning, rather than cumulative or discrete indicators, may be more meaningful in breast cancer risk assessment.
心理社会创伤已被假设会影响乳腺癌风险，但对于同时发生的多种创伤，尤其是在生命早期发生的创伤，如何影响发病率知之甚少。我们研究了多种生命早期创伤指标与乳腺癌发病之间的关系。
姐妹研究是一项针对美国女性的前瞻性队列研究（n=50884；招募时间为 2003-2009 年；年龄 35-74 岁）。在 45961 名符合条件的参与者中，有 3070 人在 2017 年之前被诊断为浸润性乳腺癌或导管原位癌。我们使用先前研究的测量方法（累积评分、个体创伤类型和实质性领域）以及六类潜在变量来评估 18 岁之前的创伤，并使用多项缺失数据插补来评估共同发生的创伤。我们使用 Cox 比例风险模型估计风险比（HR）和 95%置信区间（CI）。
大约 49%的参与者报告了生命早期创伤。使用潜在类别变量方法，与低创伤组相比，经历过性创伤或家庭功能障碍（HR=1.1；CI=0.93，1.3）或中度（HR=1.2；CI=0.99，1.4）但非高度创伤（HR=0.66；CI=0.44，0.99）的参与者发生乳腺癌的风险更高。与性早期生命创伤或家庭功能障碍相关的乳腺癌 HR 在前绝经和绝经后乳腺癌以及雌激素受体状态中均升高。我们没有发现种族-民族的作用修饰。在报告持续的儿童社会支持时，估计的影响减弱了。
乳腺癌的发病率因同时发生的早期生命创伤的潜在模式而异。捕捉儿童社会支持和创伤模式的模型，而不是累积或离散的指标，在乳腺癌风险评估中可能更有意义。
