中国女性乳腺癌发病相关危险因素:病例对照研究Risk Factors of Breast Cancer in China:A Case-Control Study
徐雅莉;孙强;单广良;张瑾;廖海波;李世拥;姜军;邵志敏;蒋宏传;沈念春;石岳;尉承泽;张保宁;陈妍华;段学宁;李波;
XU Ya-li1,SUN Qiang1,SHAN Guang-liang2,Zhang Jin3,Liao Hai-bo4,Li Shi-yong5,JIANG Jun6,Shao Zhi-min7,JIANG Hong-chuan8,SHEN Nian-chun9,SHI Yue10,YU Cheng-ze11,ZHANG Bao-ning12,CHEN Yan-hua13,DUAN Xue-ning14,LI Bo15 1Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2Epidemiology and Statistics,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences & Peking Union Medical Colle
摘要(Abstract):
目的筛查中国女性乳腺癌发病相关危险因素,为个体化评估中国女性乳腺癌发病危险性提供依据。方法在全国8个省市14家研究中心开展1∶m配对病例对照研究,采用调查问卷通过面对面交流收集乳腺癌发病相关危险因素信息。乳腺癌患者及其配对健康对照女性年龄、生活环境相匹配。应用1∶m条件Logistic回归分析乳腺癌相关危险因素在病例组和对照组间的分布特点,明确其与乳腺癌发病危险性的相关性。结果共纳入416例乳腺癌患者及1156例健康对照女性。中国女性乳腺癌发病相关危险因素包括体重指数(body mass index,BMI)≥24(OR=4.07,95%CI:2.98~5.55),乳腺良性病变活检史(OR=1.68,95%CI:1.19~2.38),初潮年龄≥14岁(OR=1.41,95%CI:1.07~1.87),生存压力大(1~4级,OR=2.15,95%CI:1.26~3.66;5~9级,OR=3.48,95%CI:2.03~5.95),绝经(OR=2.22,95%CI:1.50~3.28)(P<0.05),乳腺癌家族史(OR=1.72,95%CI:1.15~2.58),肿瘤家族史(乳腺癌除外)(OR=1.55,95%CI:1.22~1.98)。口服避孕药(OR=1.59,95%CI:0.83~3.05)亦增加乳腺癌发病危险性,但差异未达到显著统计学意义(P>0.05)。结论中国女性乳腺癌发病相关危险因素包括BMI≥24、乳腺良性病变活检史、初潮年龄≥14岁、生存压力大、绝经、乳腺癌家族史及其他肿瘤家族史。本研究为个体化评估中国女性罹患乳腺癌危险性及广泛开展乳腺癌防治工作提供了依据。
Objective To screen the risk factors associated with breast cancer among Chinese women,with an attempt to provide evidence for the evaluation of breast cancer risks among Chinese women on an individual level.Methods A case-control study on 416 breast cancer patients and 1156 age-and region-matched controls was conducted in 14 hospitals in 8 provinces/municipalities of China.Conditional logistic regression was applied to analyze the association between risk factors and breast cancer.Results The risk factors of breast cancer among Chinese women included higher body mass index(BMI≥24)(OR=4.07,95%CI:2.98-5.55),history of benign breast disease biopsy(OR=1.68,95%CI:1.19-2.38),age of menarche≥14 years(OR=1.41,95%CI:1.07-1.87),psychological depression(for grade 1-4,OR=2.15,95% CI:1.26-3.66;for grade 5-9,OR=3.48,95% CI:2.03-5.95),menostasia(OR=2.22,95% CI:1.50-3.28),family history of breast cancer(OR=1.72,95%CI:1.15-2.58),and family history of cancer other than breast cancer(OR=1.55,95%CI:1.22~1.98)(all P<0.05 when compared between the 416 breast cancer patients and 1156 controls).Although use of oral contraceptives(OC)(OR=1.59,95% CI:0.83-3.05)was associated with an increased risk of breast cancer,the difference was not statistically significant(P>0.05).Conclusions Many risk factors including BMI≥24,history of benign breast disease biopsy,age of menarche≥14 years,psychological depression,menostasia,family history of breast cancer,and family history of cancer other than breast cancer may contribute to breast cancer among Chinese women.This research provides a basis for the individualized evaluation of risks of breast cancer and the population-based interventions in China.
关键词(KeyWords):
乳腺癌;危险因素;病例对照研究
breast cancer;risk factors;case-control study
基金项目(Foundation): “十一五”国家科技支撑计划项目(2006BAI02A09)
作者(Author):
徐雅莉;孙强;单广良;张瑾;廖海波;李世拥;姜军;邵志敏;蒋宏传;沈念春;石岳;尉承泽;张保宁;陈妍华;段学宁;李波;
XU Ya-li1,SUN Qiang1,SHAN Guang-liang2,Zhang Jin3,Liao Hai-bo4,Li Shi-yong5,JIANG Jun6,Shao Zhi-min7,JIANG Hong-chuan8,SHEN Nian-chun9,SHI Yue10,YU Cheng-ze11,ZHANG Bao-ning12,CHEN Yan-hua13,DUAN Xue-ning14,LI Bo15 1Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2Epidemiology and Statistics,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences & Peking Union Medical Colle
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DOI:
参考文献(References):
- [1]Hoskins KF,Zwaagstra A,Ranz M.Validation of a tool for identifying women at high risk for hereditary breast cancer in population-based screening[J].Cancer,2006,107:1769-1776.
- [2]Armstrong K,Eisen A,Weber WB.Assessing the risk of breast cancer[J].N Engl J Med,2000,342:564-571.
- [3]Domchek SM,Eisen A,Calzone K,et al.Application of breast cancer risk prediction models in clinical practice[J].J Clin Oncol,2003,21:593-601.
- [4]Freedman AN,Seminara D,Gail MH,et al.Cancer risk prediction models:a workshop on development,evaluation,and application[J].J Natl Cancer Inst,2005,97:715-723.
- [5]van Asperen CJ,Jonker MA,Jacobi CE,et al.Risk estima-tion for healthy women from breast cancer families:new in-sights and newstrategies[J].Cancer Epidemiol Biomark-ers Prev,2004,13:87-93.
- [6]Jacobi CE,de Bock GH,Siegerink B,etal.Differences and similarities in breast cancer risk assessment models in clini-cal practice:which model to choose[J].Breast Cancer Res Treat,2009,115:381-390.
- [7]Euhus DM.Understanding mathematical models for breast cancer risk assessment and counseling[J].Breast J,2001,7:224-232.
- [8]Petram C,Ames RC,Sandhya P.Oral contraceptive use and the risk of breast cancer[J].Mayo Clin Proc,2008,83:86-91.
- [9]Sweeney C,Baumgartner KB,Byers T,et al.Reproductive history in relation to breast cancer risk among Hispanic and non-Hispanic white women[J].Cancer Causes Control,2008,19:391-401.
- [10]Tjia J,Micco E,Armstrong K.Interest in breast cancer chemoprevention among older women[J].Breast Cancer Res Treat,2008,108:435-453.
- [11]Euhus DM,Bu D,Ashfaq R,etal.Atypia and DNAmethy-lation in nipple duct lavage in relation to predicted breast cancer risk[J].Cancer Epidemiol Biomarkers Prev,2007,16:1812-1821.
- [12]Cazzaniga M,Severi G,Casadio C,etal.Atypia and Ki-67expression from ductal lavage in women at different risk forbreast cancer[J].Cancer Epidemiol Biomarkers Prev,2006,15:1311-1315.
- [13]Brinton LA,Sherman ME,Carreon JD,et al.Recent trends in breast cancer among younger women in the United States[J].J Natl Cancer Inst,2008,100:1643-1648.
- [14]Vachon CM,van Gils CH,Sellers TA,etal.Mammographic density,breast cancer risk and risk prediction[J].Breast Cancer Res,2007,9:217-225.
- [15]Boyd NF,Guo H,Martin LJ,et al.Mammographic density and the risk and detection of breast cancer[J].N Engl J Med,2007,356:227-236.
- [16]BarlowWE,White E,Ballard-Barbash R,etal.Prospective breast cancer risk prediction model for women undergoing screening mammography[J].J Natl Cancer Inst,2006,98:1204-1214.
- [17]Rockhill B,Spiegelman D,Byrne C,et al.Model of breast cancer risk prediction and implications for chemoprevention[J].J Natl Cancer Inst,2001,93:358-366.
- [18]Palomares MR,Machia JR,Lehman CD,et al.Mammo-graphic density correlation with gail model breast cancer risk estimates and component risk factors[J].Cancer Epidemi-ol Biomarkers Prev,2006,15:1324-1330.
- [19]Anderson WF,Matsuno RK,Sherman ME,etal.Estimating age-specific breast cancer risks:a descriptive tool to identify age interactions[J].Cancer Causes Control,2007,18:439-447.
- [20]Santen RJ,Boyd NF,Chlebowski RT,et al.Breast cancer prevention collaborative group.critical assessment of new risk factors for breast cancer:considerations for development of an improved risk prediction model[J].Endocr Relat Cancer,2007,14:169-187.
- [21]Chen J,Pee D,Ayyagari R,et al.Projecting absolute inva-sive breast cancer risk in white women with a model that in-cluded mammographic density[J].J Natl Cancer Inst,2006,98:1215-1226.
- [22]Kelemen LE,Pankratz VS,Sellers TA,et al.Age-specific trends in mammographic density the minnesota breast cancer family study[J].Am J Epidemiol,2008,167:1027-1036.
- [23]Huo D,Adebamowo CA,Ogundiran TO,et al.Parity and breastfeeding are protective against breast cancer in Nigerian women[J].British J Cancer,2008,98:992-996.
- [24]Suzuki S,Kojima M,Tokudome S,et al.Japan Collabora-tive Cohort Study Group.Effect of physical activity on breast cancer risk:findings of the Japan Collaborative Cohort Study[J].Cancer Epidemiol Biomarkers Prev,2008,17:3396-3401.
- [25]Pirie K,Beral V,Peto R,et al.Million women study col-laborators,passive smoking and breast cancer in never smokers:prospective study and meta-analysis[J].Int J Epidemiol,2008,37:1069-1079.
- [26]Cui X,Dai Q,Tseng M,et al.Dietary patterns and breast cancer risk in the Shanghai breastCancer Study[J].Canc-er Epidemiol Biomarkers Prev,2007,16:1443-1448.
- [27]Mahoney MC,Bevers T,Linos E,et al.Opportunities and strategies for breast cancer prevention through risk reduction[J].CA Cancer J Clin,2008,58:347-371.
- [28]Wellisch DK,Lindberg NM.A psychological profile of de-pressed and nondepressed women at high risk for breast cancer[J].Psychosomatics,2001,42:330-336.
- [29]MouwT,Koster A,Wright ME,et al.Education and risk of cancer in a large cohort of men and women in the United States[J].PLoS One,2008,3:e3639.
- [30]Bremnes Y,Ursin G,Bjurstam N,et al.Different measures of smoking exposure and mammographic density in postm-enopausal Norwegian women:a cross-sectional study[J].Breast Cancer Res,2007,9:R73.
- [31]Cardis E,Hall J,Tavtigian SV.Identification of women with an increased risk of developing radiation-induced breast cancer[J].Breast Cancer Research,2007,9:106.
- [32]Sant M,Francisci S,Capocaccia R,et al.Time trends of breast cancer survival in Europe in relation to incidence and mortality[J].Int J Cancer,2006,119:2417-2422.
- [33]Karliner LS,Napoles-Springer A,Kerlikowske K,et al.Missed opportunities:family history and behavioral risk fac-tors in breast cancer risk assessment among a multiethnic group of women[J].J Gen Intern Med,2007,22:308-314.
- [34]Gail MH,Costantino JP.Validating and improving models for projecting the absolute risk of breast cancer[J].J Natl Cancer Inst,2001,93:334-335.
- [35]Gail MH,Benichou J.Epidemiology and biostatistics pro-gram of the national cancer institute[J].J Natl Cancer Inst,1994,86:573-575.
- [36]Kilfoy BA,Zhang Y,Shu XO,et al.Family history of ma-lignancies and risk of breast cancer:prospective data from the Shanghai women s health study[J].Cancer Causes Control,2008,19:1139-1145.
- [37]Rosenberg L,Zhang Y,Coogan PF,et al.A case-control study of oral contraceptive use and incident breast cancer[J].Am J Epidemiol,2009,169:473-479.
- [38]Oerlemans ME,van den Akker M,Schuurman AG,et al.A meta-analysis on depression and subsequent cancer risk[J].Clin Pract Epidemol Ment Health,2007,3:329.
- [39]Wakai K,Kojima M,Nishio K,et al.For the JACC Study Group.Psychological attitudes and risk of breast cancer in Japan:a prospective study[J].Cancer Causes Control,2007,18:259-267.
- [40]Ozmen V,Ozcinar B,Karanlik H,et al.Breast cancer risk factors in Turkish women-a University hospital based nested case control study[J].World J Surg Oncol,2009,7:37.
- [41]Wu MH,Chou YC,Chou WY,et al.Relationships between critical period of estrogen exposure and circulating levels of insulin-like growth factor-I(IGF-I)in breast cancer:Evi-dence from a case-control study[J].Int J Cancer,2010,126:508-514.
- [42]Verkooijen HM,Rapiti E,Fioretta G,et al.Impact of a positive family history on diagnosis,management,and sur-vival of breastcancer:differenteffects across socio-economic groups[J].Cancer Causes Control,2009,20:1689-1696.
- [43]Folger SG,Marchbanks PA,McDonald JA,et al.Risk of breast cancer associated with short-term use of oral contra-ceptives[J].Cancer Causes Control,2007,18:189-198.
- [44]Bondy ML,Newman LA.Assessing breast cancer risk:evo-lution of the Gail model[J].J Natl Cancer Inst,2006,98:1172-1173.
- [45]Adams-Campbell LL,Makambi KH,Palmer JR,et al.Diag-nostic accuracy of the Gail model in the black women s health study[J].Breast J,2007,13:332-336.
- [46]Decarli A,Calza S,Masala G,et al.Gail model for predic-tion of absolute risk of invasive breast cancer:independent evaluation in the florence-European prospective investiga-tion into cancer and nutrition cohort[J].J Natl Cancer Inst,2006,98:1686-1693.
- [47]Claus EB,Risch N,Thompson WD.Genetic analysis of breast cancer in the cancer and steroid hormone study[J].Am J Hum Genet,1991,48:232-242.
- [48]Fisher B,Costantino JP,Wickerham DL,et al.Tamoxifen for prevention of breast cancer:report of the national surgi-cal adjuvant breast and bowel project P-1study[J].J Natl Cancer Inst,1998,90:1371-1388.
- [49]Jonker MA,Jacobi CE,Hoogendoorn WE,et al.Modeling familial clustered breast cancer using published data[J].Cancer Epidemiol Biomarkers Prev,2003,12:1479-1485.
- [50]Antoniou AC,Pharoah PP,Smith P,etal.The BOADICEA model of genetic susceptibility to breast and ovarian cancer[J].Br J Cancer,2004,91:1580-1590.
- 徐雅莉
- 孙强
- 单广良
- 张瑾
- 廖海波
- 李世拥
- 姜军
- 邵志敏
- 蒋宏传
- 沈念春
- 石岳
- 尉承泽
- 张保宁
- 陈妍华
- 段学宁
- 李波
XU Ya-li1- SUN Qiang1
- SHAN Guang-liang2
- Zhang Jin3
- Liao Hai-bo4
- Li Shi-yong5
- JIANG Jun6
- Shao Zhi-min7
- JIANG Hong-chuan8
- SHEN Nian-chun9
- SHI Yue10
- YU Cheng-ze11
- ZHANG Bao-ning12
- CHEN Yan-hua13
- DUAN Xue-ning14
- LI Bo15 1Department of Breast Surgery
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China 2Epidemiology and Statistics
- Institute of Basic Medical Sciences
- Chinese Academy of Medical Sciences & Peking Union Medical Colle
- 徐雅莉
- 孙强
- 单广良
- 张瑾
- 廖海波
- 李世拥
- 姜军
- 邵志敏
- 蒋宏传
- 沈念春
- 石岳
- 尉承泽
- 张保宁
- 陈妍华
- 段学宁
- 李波
XU Ya-li1- SUN Qiang1
- SHAN Guang-liang2
- Zhang Jin3
- Liao Hai-bo4
- Li Shi-yong5
- JIANG Jun6
- Shao Zhi-min7
- JIANG Hong-chuan8
- SHEN Nian-chun9
- SHI Yue10
- YU Cheng-ze11
- ZHANG Bao-ning12
- CHEN Yan-hua13
- DUAN Xue-ning14
- LI Bo15 1Department of Breast Surgery
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China 2Epidemiology and Statistics
- Institute of Basic Medical Sciences
- Chinese Academy of Medical Sciences & Peking Union Medical Colle