Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies.
Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies.
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DOI：
10.1016/s1470-2045(12)70425-4
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发表时间：
2012-11
期刊：
影响因子：
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通讯作者：
Collaborative Group on Hormonal Factors in Breast Cancer
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作者：
Collaborative Group on Hormonal Factors in Breast Cancer
月经初潮和更年期分别标志着与生殖有关的卵巢活动的开始和停止，并影响乳腺癌的风险。我们的目的是评估它们的作用强度，并确定它们是否取决于肿瘤的特征或受影响的妇女。来自117项流行病学研究的个人数据被纳入分析，其中包括118964名患有浸润性乳腺癌的妇女和306091名没有这种疾病的妇女，她们都没有使用更年期激素治疗。我们根据肿瘤组织学和雌激素受体表达计算了与乳腺癌总体初潮和更年期相关的校正相对危险度（rr）。初潮年龄越小，乳腺癌风险增加1·050 (95% CI 1·044-1·057;p< 0.0001)，绝经年龄越大，乳腺癌风险增加较小（1·029,1·025-1·032;p< 0.0001）。绝经前妇女患乳腺癌的风险高于相同年龄的绝经后妇女（45-54岁的RR为1.43,1.33 - 1·52,p< 0.001）。所有这三种关联都随着绝经后妇女肥胖的增加而减弱，但与妇女的出生年份、种族、生育史、吸烟、饮酒或使用激素避孕药没有实质性的变化。小叶肿瘤与导管肿瘤的相关性均高于导管肿瘤（p< 0.006）。雌激素受体阳性疾病对相同年龄妇女绝经的影响和绝经年龄趋势强于雌激素受体阴性疾病（两组比较均p< 0.01）。初潮和更年期对乳腺癌风险的影响可能不仅仅是通过延长女性的总生育年限来发挥作用。内源性卵巢激素与雌激素受体阳性疾病的相关性高于雌激素受体阴性疾病，与小叶肿瘤的相关性高于导管肿瘤。英国癌症研究中心。
Menarche and menopause mark the onset and cessation, respectively, of ovarian activity associated with reproduction, and affect breast cancer risk. Our aim was to assess the strengths of their effects and determine whether they depend on characteristics of the tumours or the affected women. Individual data from 117 epidemiological studies, including 118 964 women with invasive breast cancer and 306 091 without the disease, none of whom had used menopausal hormone therapy, were included in the analyses. We calculated adjusted relative risks (RRs) associated with menarche and menopause for breast cancer overall, and by tumour histology and by oestrogen receptor expression. Breast cancer risk increased by a factor of 1·050 (95% CI 1·044–1·057; p<0·0001) for every year younger at menarche, and independently by a smaller amount (1·029, 1·025–1·032; p<0·0001), for every year older at menopause. Premenopausal women had a greater risk of breast cancer than postmenopausal women of an identical age (RR at age 45–54 years 1·43, 1·33–1·52, p<0·001). All three of these associations were attenuated by increasing adiposity among postmenopausal women, but did not vary materially by women's year of birth, ethnic origin, childbearing history, smoking, alcohol consumption, or hormonal contraceptive use. All three associations were stronger for lobular than for ductal tumours (p<0·006 for each comparison). The effect of menopause in women of an identical age and trends by age at menopause were stronger for oestrogen receptor-positive disease than for oestrogen receptor-negative disease (p<0·01 for both comparisons). The effects of menarche and menopause on breast cancer risk might not be acting merely by lengthening women's total number of reproductive years. Endogenous ovarian hormones are more relevant for oestrogen receptor-positive disease than for oestrogen receptor-negative disease and for lobular than for ductal tumours. Cancer Research UK.