Cook L S, White E, Schwartz S M, McKnight B, Daling J R, Weiss N S
Department of Epidemiology, University of Washington, Seattle, USA.
Cancer Causes Control. 1996 May;7(3):382-90. doi: 10.1007/BF00052945.
To evaluate predictors of contralateral breast cancer risk, we examined data from a nested case-control study of second primary cancers among a cohort of women in western Washington (United States) diagnosed with breast cancer during 1978 through 1990 and identified through a population-based cancer registry. Cases included all women in the cohort who subsequently developed contralateral breast cancer at least six months after the initial diagnosis, but prior to 1992 (n = 234). Controls were sampled randomly from the cohort, matched to cases on age, stage, and year of initial breast cancer diagnosis. Information on potential risk factors for second primary cancer was obtained through medical record abstractions and physician questionnaires. Women who were postmenopausal due to a bilateral oophorectomy (i.e., a surgical menopause) at initial breast cancer diagnosis had a reduction in contralateral breast cancer risk compared with premenopausal women (matched odds ratio [mOR] = 0.25, 95 percent confidence interval [CI] = 0.09-0.68), whereas no reduction in risk was noted among postmenopausal women who had had a natural menopause (mOR = 0.90, CI = 0.39-2.09). Among postmenopausal women, there was a suggestion of a lower risk associated with relatively high parity (2+). A family history of breast cancer was associated with an increased risk (mOR = 1.96, CI = 1.22-5.15) and varied little by menopausal status. Having an initial tumor with a lobular component (c.f. a ductal histology) was not related strongly to risk (mOR = 1.47, CI = 0.79-2.74). The results of the present and earlier studies argue that we have limited ability to predict the occurrence of a contralateral breast tumor. Better predictors will be required before diagnostic and preventive interventions can be targeted to subgroups of patients with unilateral breast cancer.
为了评估对侧乳腺癌风险的预测因素，我们研究了来自美国华盛顿州西部一组1978年至1990年期间被诊断为乳腺癌并通过基于人群的癌症登记系统识别出的女性队列中的第二原发性癌症的巢式病例对照研究数据。病例包括该队列中所有在初始诊断后至少6个月但在1992年之前发生对侧乳腺癌的女性（n = 234）。对照从该队列中随机抽取，在年龄、分期和初始乳腺癌诊断年份方面与病例匹配。通过病历摘要和医生问卷获得有关第二原发性癌症潜在风险因素的信息。在初始乳腺癌诊断时因双侧卵巢切除术（即手术绝经）而绝经的女性与绝经前女性相比，对侧乳腺癌风险降低（匹配比值比[mOR] = 0.25，95%置信区间[CI] = 0.09 - 0.68），而自然绝经的绝经后女性未观察到风险降低（mOR = 0.90，CI = 0.39 - 2.09）。在绝经后女性中，有迹象表明相对高胎次（2胎及以上）与较低风险相关。乳腺癌家族史与风险增加相关（mOR = 1.96，CI = 1.22 - 5.15），且在绝经状态方面差异不大。初始肿瘤具有小叶成分（与导管组织学相比）与风险无强烈关联（mOR = 1.47，CI = 0.79 - 2.74）。本研究及早期研究结果表明，我们预测对侧乳腺肿瘤发生的能力有限。在诊断和预防性干预能够针对单侧乳腺癌患者亚组之前，需要更好的预测因素。
