BREAST-CANCER EPIDEMIOLOGY - SUMMARY AND FUTURE-DIRECTIONS
BREAST-CANCER EPIDEMIOLOGY - SUMMARY AND FUTURE-DIRECTIONS
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DOI：
10.1093/oxfordjournals.epirev.a036112
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发表时间：
1993-01-01
影响因子：
5.5
通讯作者：
KELSEY, JL
中科院分区：
文献类型：
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作者：
KELSEY, JL
PIP：美国女性最常见的癌症和癌症死亡的第二大原因是乳腺癌。1980年至1987年，在美国。按年龄调整的乳腺癌发病率迅速上升。它们在几个亚洲国家也迅速上升（例如，在日本，发病率最低。这些快速增长可能意味着环境因素是负责任的。发病率随着年龄的增长而大幅上升，直到40年代后期。患乳腺癌风险最高的美国女性是犹太女性、城市女性、单身女性和居住在美国北方的女性。风险最低的妇女包括摩门教和基督复临安息日会妇女、西班牙裔和亚裔妇女、农村妇女、生活在美国南部的妇女和已婚妇女。相对危险度大于2的因素是母亲和姐妹有乳腺癌病史，特别是如果在早期诊断;乳头抽吸液中的非典型上皮细胞;乳房X线片上的结节密度; 1个乳房的癌症病史;母亲或姐妹有乳腺癌病史;活检证实的良性增生性乳腺疾病;乳头抽吸液中的增生上皮细胞无淋巴结;胸部受到中到高剂量的辐射卵巢激素似乎刺激乳腺细胞分裂，因此水平升高可能是危险因素。外源性激素也可能增加风险。女性通过雌激素替代疗法、单雌激素丸、口服避孕药、长效注射避孕药和己烯雌酚接触这些外源性激素。绝经后肥胖增加风险，而绝经前肥胖降低风险。儿童和青少年时期的高脂肪饮食可能会增加风险。饮酒也可能增加风险。老年、白色和未生育妇女更容易患雌激素受体阳性癌症。男性乳腺癌往往具有相同的风险因素以及其自身的独特因素。预防绝经后肥胖是唯一建立的一级预防措施。筛查是唯一的二级预防手段。
PIP: The most common cancer in US women and the 2nd leading cause of cancer death is breast cancer. Between 1980-1987 in the US. age-adjusted incidence rates of breast cancer rose rapidly. They are also rising rapidly in several Asian countries (e.g., in Japan) which have the lowest incidence rates. These rapid increases may mean that environmental factors are responsible. Incidence rates rise greatly with age until the late 40s. US women at highest risk of breast cancer are Jewish women, urban women, single women, and women living in the northern US. Women at lowest risk include Mormon and Seventh-Day Adventist women, Hispanic and Asian women, rural women, women living in the southern US, and married women. Factors that have a relative risk greater than 2 are mother and sister with history of breast cancer, especially if diagnoses at an early age; atypical epithelial cells in nipple aspirate fluid; nodular densities on the mammogram; history of cancer in 1 breast; mother or sister with history of breast cancer; biopsy-confirmed benign proliferative breast disease; hyperplastic epithelial cells without atypia in nipple aspirate fluid; and radiation to chest in moderate to high doses. Ovarian hormones appear to stimulate cell division in the breast, thus elevated levels may be risk factors. Exogenous hormones may also increase the risk. Women are exposed to these exogenous hormones through estrogen replacement therapy, progestin only pills, oral contraceptives, long-acting injectable contraceptives, and diethylstilbestrol. Postmenopausal obesity increases the risk while premenopausal obesity decreases the risk. A high fat diet in childhood and adolescence may increase the risk. Alcohol drinking may also increase the risk. Older, white, and nulliparous women are more likely to have estrogen receptor-positive cancers. Breast cancer in males tends to share the same risk factors as well as its own unique factors. Prevention of postmenopausal obesity is the only established primary prevention effort. Screening is the only secondary prevention means.