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在一组韩国女性中,通过乳腺钼靶密度研究母乳喂养与乳腺癌风险之间的关联。

Associations between breastfeeding and breast cancer risk through mammographic breast density in a cohort of Korean women.

作者信息

Kim Soyeoun, Tran Thi Xuan Mai, Kim Mi Kyung, Chung Min Sung, Lee Eun Hye, Lee Woojoo, Park Boyoung

机构信息

Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.

Institute for Health and Society, Hanyang University, Seoul, Republic of Korea.

出版信息

Int J Epidemiol. 2024 Dec 16;54(1). doi: 10.1093/ije/dyae165.

Abstract

BACKGROUND

Mammographic breast density has been suggested to play a role as a mediator between the risk factors for breast cancer (BC) and BC risk. We investigated the extent to which never breastfeeding is a risk factor for BC and how this risk is further mediated by increased mammographic breast density.

METHODS

This retrospective cohort study included 4 136 723 women aged ≥40 years who underwent mammographic screening between 2009 and 2010 and were followed up until 31 December 2020. Breastfeeding information was obtained by using a self-administered questionnaire. Mammographic breast density was extracted from national BC screening results, which were assessed by trained radiologists and categorized into dense and fatty breasts. We estimated the hazard ratios (HRs) and the proportion of the associations between breastfeeding and BC risk mediated by breast density.

RESULTS

The HR of never breastfeeding on BC risk was 1.34 (95% CI, 1.32-1.37) when adjusted for only parity, body mass index and smoking status, which were selected as covariates through a directed acyclic graph and 1.21 (95% CI, 1.19-1.23) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in total, pre- and post-menopausal women was 35.48%, 17.86% and 24.0%, respectively (all P < 0.001). The HR of never breastfeeding on BC risk was 1.10 (95% CI, 1.08-1.12) when adjusted for nine known breast cancer risk factors and 1.09 (95% CI, 1.07-1.12) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in the total, pre- and post-menopausal women was 7.50%, 3.71% and 12.21%, respectively (all P < 0.001).

CONCLUSIONS

Our findings suggest that the association between never breastfeeding and BC risk may be mediated by breast density. However, the HR and proportion of medications varied according to the adjusted covariates, highlighting that variables for adjustment should be selected based on directed acyclic graphs.

摘要

背景

乳腺钼靶密度被认为在乳腺癌(BC)的危险因素与BC风险之间起中介作用。我们调查了从未母乳喂养作为BC危险因素的程度,以及这种风险如何通过乳腺钼靶密度增加进一步介导。

方法

这项回顾性队列研究纳入了4136723名年龄≥40岁的女性,她们在2009年至2010年期间接受了乳腺钼靶筛查,并随访至2020年12月31日。通过自行填写问卷获取母乳喂养信息。乳腺钼靶密度从国家BC筛查结果中提取,由训练有素的放射科医生进行评估,并分为致密型乳腺和脂肪型乳腺。我们估计了危险比(HRs)以及母乳喂养与由乳腺密度介导的BC风险之间关联的比例。

结果

仅调整经直接无环图选择作为协变量的产次、体重指数和吸烟状态时,从未母乳喂养对BC风险的HR为1.34(95%CI,1.32 - 1.37),额外调整乳腺密度时为1.21(95%CI,1.19 - 1.23)。在总体、绝经前和绝经后女性中,由乳腺密度介导的从未母乳喂养与BC风险之间关联的比例分别为35.48%、17.86%和24.0%(均P < 0.001)。调整九个已知的乳腺癌危险因素时,从未母乳喂养对BC风险的HR为1.10(95%CI,1.08 - 1.12),额外调整乳腺密度时为1.09(95%CI,1.07 - 1.12)。在总体、绝经前和绝经后女性中,由乳腺密度介导的从未母乳喂养与BC风险之间关联的比例分别为7.50%、3.71%和12.21%(均P < 0.001)。

结论

我们的研究结果表明,从未母乳喂养与BC风险之间的关联可能由乳腺密度介导。然而,HR和中介比例因调整的协变量而异,突出表明应基于直接无环图选择调整变量。

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