Population attributable risks for breast cancer in Swedish women by morphological type

Granström, Charlotta; Sundquist, Jan; Hemminki, Kari

doi:10.1007/s10549-007-9814-2

Cited by 17 publications

(27 citation statements)

References 36 publications

(53 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…The overall relative risk in women whose age at menarche was 14 or more, compared to less than 12, was 0.95 (0.92 -0.99) for ductal cancer and 0.77 (0.71 -0.83) for lobular cancer. All eight previous studies (Ewertz and Duffy, 1988;Wohlfahrt et al, 1999;Li et al, 2003Li et al, , 2006Li et al, , 2007Garcia-Closas et al, 2006;Rosenberg et al, 2006;Granstrom et al, 2008) included in the meta-analysis of the effect of age at first birth showed a greater effect on lobular than ductal cancer; however, most of these studies had limited power and only one (Wohlfahrt et al, 1999) reported a significant difference in the RRs for lobular and ductal cancers according to age at first birth. Overall, the RR in women whose age at first birth was 30 or more, as opposed to less than 20, was 1.24 (1.20 -1.29) for ductal cancer and 1.66 (1.53 -1.80) for lobular cancer.…”

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confidence: 99%

“…For most of the reproductive factors considered, the relative risks for mixed ductal lobular cancer were intermediate between those found for ductal and lobular cancer. Several studies (LiVoisi et al, 1982;Rosen et al, 1982;Ewertz and Duffy, 1988;Stalsberg et al, 1989;Claus et al, 1993;Wohlfahrt et al, 1999;Li et al, 2003Li et al, , 2006Li et al, , 2007Li et al, , 2008Garcia-Closas et al, 2006;Rosenberg et al, 2006;Granstrom et al, 2008) have published findings on the relationship between reproductive factors and specific histological types of breast cancer and, although the majority found no significant differences in the effects of reproductive risk factors according to histological type, most lacked statistical power. Indeed only three studies (Stalsberg et al, 1989;Wohlfahrt et al, 1999;Li et al, 2008) have reported significant differences according to histological type for at least one aspect of reproductive history; two (Stalsberg et al, 1989;Wohlfahrt et al, 1999) found that increasing age at first birth was associated with a significantly greater relative risk of lobular cancer and/or tubular cancer than of ductal cancer, and one (Li et al, 2008) found a significantly greater effect of age at menarche on lobular compared with ductal breast cancer among postmenopausal women.…”

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confidence: 99%

“…Indeed only three studies (Stalsberg et al, 1989;Wohlfahrt et al, 1999;Li et al, 2008) have reported significant differences according to histological type for at least one aspect of reproductive history; two (Stalsberg et al, 1989;Wohlfahrt et al, 1999) found that increasing age at first birth was associated with a significantly greater relative risk of lobular cancer and/or tubular cancer than of ductal cancer, and one (Li et al, 2008) found a significantly greater effect of age at menarche on lobular compared with ductal breast cancer among postmenopausal women. A large record-linkage study in Sweden (Granstrom et al, 2008) also showed a greater effect of increasing age at first birth for lobular compared with other types, and a smaller effect of low parity on lobular compared with ductal and tubular subtypes; however, there was limited information on potential confounders and no formal tests of heterogeneity by histological subtype were given.Although few individual studies have had sufficient power to examine reliably the relationship between reproductive history and histology, a meta-analysis of published data on the effect of age at menarche and age at first birth on ductal and lobular cancer, together with the present results, provides strong evidence of material differences in their effects on these two tumour types (Figure 4).Only five studies have reported on the relationship between reproductive history and the risk of relatively rare subtypes of (Rosen et al, 1982;Stalsberg et al, 1989;Claus et al, 1993;Wohlfahrt et al, 1999;Li et al, 2006). For mucinous tumours (1% of all breast cancers in our cohort), two previous studies (Stalsberg et al, 1989;Wohlfahrt et al, 1999) found that the risk in parous compared with nulliparous women was significantly lower than for ductal cancers.…”

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Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

et al. 2009

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Little is known about how reproductive factors affect the risk of breast cancers of different histology. In an analysis of prospective data on 1.2 million middle-aged UK women, we used proportional hazards models to estimate the relative risks of six histological types in relation to menarche, childbearing and menopause. During 8.7 million person-years of follow-up, 17 923 ductal, 3332 lobular, 1062 tubular, 944 mixed ductal lobular, 330 mucinous and 117 medullary cancers were diagnosed. The effect of both age at menarche and age at first birth was greatest for lobular tumours; relative risks per 5-year increase in age at menarche for ductal, lobular, and tubular cancers were 0.93 (0.87 -0.99), 0.65 (0.56 -0.76), and 0.75 (0.57 -0.98), respectively (P-value for heterogeneity ¼ 0.0001); and the relative risks per 5-year increase in age at first birth were 1.10 (1.07 -1.12), 1.23 (1.17 -1.29), and 1.13 (1.03 -1.23), respectively (Pvalue for heterogeneity ¼ 0.0006). Increasing parity reduced the risk of each tumour type, except medullary cancers, but the reduction in risk was greater for mucinous cancers than for any other subtype considered (Po0.05 for comparison with each other subtype in turn). The effect of menopause did not vary significantly by tumour histology. Meta-analysis of published results on the effects of age at menarche and age at first birth on ductal and lobular cancers were in keeping with our findings. Keywords: breast cancer histology; menarche; age at first birth; parity; menopause Despite the fact that reproductive factors are among the most established risk factors for breast cancer, little is known about whether their effects differ by tumour histology. Few studies of breast cancer in relation to reproductive factors have had sufficient power to estimate reliably the risk of specific subtypes according to detailed reproductive history. We report here on the relationship between age at menarche, parity, age at first birth and age at menopause, and the risk of six histological subtypes of breast cancer in a large prospective study of women in the UK, and present meta-analyses of published results. MATERIALS AND METHODSThe Million Women Study recruited 1.3 million middle-aged women in 1996 -2001, who completed a questionnaire about reproductive factors, sociodemographic factors and other personal characteristics. They were resurveyed about 3 years after recruitment to update information on menopausal status and other factors, with a 65% response rate. Full details of the study design and methods are described elsewhere (The Million Women Study Collaborative Group, 1999) and questionnaires can be viewed at http://www.millionwomenstudy.org. All participants were flagged on the National Health Service (NHS) Central Registers so that cancer registrations and deaths are routinely notified to the study investigators. These registers provide information on the date of each such event and the cancer site and morphology codes using the 10th revision of the International Classification of Diseases (IC...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

et al. 2009

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“…Later age of first childbearing and low total parity are commonly associated with higher levels of education and higher SES, due to postponement of childbearing until after the completion of education and the consequent increase of maternal age. There has been a uniform shift towards later first childbearing in most European countries [28][29][30].…”

Section: Increasing Riskmentioning

confidence: 99%

Breast Cancer and Socioeconomic Status in Austria

Kunze

Böhm²

2009

Breast Care

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With 28% of all cancers, breast cancer is the most common cancer in the Austrian female population (also worldwide), and incidence has shown a development similar to that in most of the Western European countries. Several studies reveal a higher incidence of breast cancer in women of higher socioeconomic status (SES) compared to women of lower SES. Later age of first childbearing, low total parity, significantly greater use of hormone replacement therapy, and a greater use of mammography screening by women of higher SES are possible explanations for these trends. Socioeconomic inequalities have a strong influence on the subjective perception of health, but also on objective indicators of the health situation. The health behavior of the Austrian population is, of course, determined by social factors. People with a higher socioeconomic status not only live longer than people with a lower SES, they also have a healthier lifestyle and they better assess their own health status. These inequalities can also be observed in significant differences in life expectancy between university graduates and low-educated people (6.2 years for men and 2.6 years for women).

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Late age at first full term birth is strongly associated with lobular breast cancer

Newcomb

Trentham‐Dietz

Hampton

et al. 2010

Cancer

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BACKGROUND: Late age at first full-term birth and nulliparity are known to increase breast cancer risk. The frequency of these risk factors has increased in recent decades. METHODS: The purpose of this population-based casecontrol study was to examine associations between parity, age at first birth (AFB), and specific histological subtypes of breast cancer. Women with breast cancer were identified from cancer registries in Wisconsin, Massachusetts, and New Hampshire. Control subjects were randomly selected from population lists. Interviews collected information on reproductive histories and other risk factors. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of ductal, lobular, and mixed ductal-lobular breast cancer diagnosis in association with AFB and nulliparity. RESULTS: AFB 30 years was associated with a 2.4-fold increase in risk of lobular breast cancer compared with AFB <20 years (OR, 2.4; 95% CI, 1.9-2.9). The association was less pronounced for ductal breast cancer (OR, 1.3; 95% CI, 1.2-1.4). Nulliparity was associated with increased risk for all breast cancer subtypes, compared with women with AFB <20 years, but the association was stronger for lobular (OR, 1.7; 95% CI, 1.3-2.2) than for ductal (OR, 1.2; 95% CI, 1.1-1.3) subtypes (P ¼ .004). The adverse effects of later AFB was stronger with obesity (P ¼ .03) in lobular, but not ductal, breast cancer. CONCLUSIONS: Stronger associations observed for late AFB and nulliparity suggest that these factors preferentially stimulate growth of lobular breast carcinomas. Recent temporal changes in reproductive patterns and rates of obesity may impact the histological presentation of breast cancer. Cancer 2011;117:1946-56.

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Population attributable risks for breast cancer in Swedish women by morphological type

Cited by 17 publications

References 36 publications

Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

Breast Cancer and Socioeconomic Status in Austria

Late age at first full term birth is strongly associated with lobular breast cancer

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