Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa Women's Health Study
Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa Women's Health Study
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DOI：
10.1158/1055-9965.epi-04-0001
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发表时间：
2005-03-01
影响因子：
3.8
通讯作者：
Sellers, TA
中科院分区：
文献类型：
--
作者：
Harvie, M;Howell, A;Sellers, TA
肥胖和成年体重增加是绝经后乳腺癌的公认危险因素。虽然有一些研究证明了成年体重增加对乳腺癌风险的贡献，但在关键时间段内体重增加是否与风险特别相关，或者体重增加的女性随后的体重减轻是否会降低过度风险，尚未确定。我们使用两种风险因素模型研究了体重变化（体重减轻或增加超过体重的5%）的相关性：（a）年龄18 - 30岁和30岁至绝经，（B）年龄30岁至绝经和绝经后至1986年对爱荷华州33，660名绝经后妇女进行的绝经后乳腺癌风险的前瞻性队列研究。在15年的随访中，发生了1，987例乳腺癌。使用比例风险回归模型对数据进行分析，该模型针对已确定的乳腺癌风险因素进行了调整。随着时间的推移，最常观察到的体重模式是持续增加;观察到这些妇女的乳腺癌发病率最高，并将其作为所有比较的参考类别。风险最低的人群是：（a）18岁至30岁体重维持或减轻，然后从30岁至绝经体重减轻的女性[风险比（RR），0.36; 95%置信区间（95%CD，0.22-0.60）和（B）从30岁到绝经保持或减轻体重，然后在绝经后减轻体重的妇女（RR，0.48; 95% CI，0.22-0.65）。从30岁到更年期体重增加但在更年期后体重减轻的女性经历了风险降低（RR，0.77; 95%CI，0.64-0.92），尽管幅度可能略小于在两个时间段内保持体重的女性（RR，0.63; 95%CI，0.55-0.73）。从18岁到30岁体重增加，然后从30岁到绝经体重减轻的女性与在两个时间间隔内保持体重的女性（RR，0.73; 95% CI，0.64 - 0.84）具有可比的风险降低（RR，0.61; 95% CI，0.46 - 0.8）。在30岁至绝经期间体重增加但绝经后体重稳定的妇女的比例与参考组相似。这些数据表明，在18岁至绝经期间预防体重增加或在这些年期间减肥和维持体重可降低绝经后乳腺癌的风险。
Obesity and adult weight gain are well-established risk factors for postmenopausal breast cancer. Although there are a few studies demonstrating the contribution of adult weight gain to breast cancer risk, whether weight gain during a critical time period is specifically associated with risk, or whether subsequent weight loss among women who have gained weight will reduce the excess risk, is not firmly established. We investigated the association of changes in weight (loss or gain in excess of 5% of body weight) using two risk factor models: (a) age 18 to 30 years and age 30 years to menopause and (b) age 30 years to menopause and after the menopause to the baseline study in 1986 on risk of postmenopausal breast cancer in a prospective cohort of 33,660 postmenopausal women in Iowa. Over 15 years of follow-up, 1,987 cases of breast cancer occurred. Data were analyzed using proportional hazards regression models adjusted for established breast cancer risk factors. The most frequently observed pattern of body weight over time was a consistent increase; these women were observed to have the highest rates of breast cancer and served as the reference category for all comparisons. The lowest-risk groups were (a) women who maintained or lost weight from age 18 to 30 years and then lost weight from age 30 years to menopause [risk ratio (RR), 0.36; 95% confidence interval (95% CD, 0.22-0.60] and (b) women who maintained or lost weight from age 30 years to menopause and then lost weight after the menopause (RR, 0.48; 95% Cl, 0.22-0.65). Women who gained weight from age 30 years to menopause but then lost weight after the menopause experienced risk reductions (RR, 0.77; 95% CI, 0.64-0.92) although perhaps slightly smaller in magnitude than women who maintained their weight in both time intervals (RR, 0.63; 95% CI, 0.55-0.73). Women who gained weight from age 18 to 30 years and then lost weight from age 30 years to menopause had comparable risk reductions (RR, 0.61; 95% Cl, 0.46-0.8) with women who maintained their weight in both time intervals (RR, 0.73; 95% Cl, 0.64-0.84). Women who gained weight during the period from age 30 years to menopause but who had stable weight after menopause had rates similar to the reference group. These data suggest prevention of weight gain between age 18 years and menopause or weight loss and maintenance during these years reduces risk of postmenopausal breast cancer.