Relative weight, weight change, height, and breast cancer risk in Asian-American women
Relative weight, weight change, height, and breast cancer risk in Asian-American women
复制标题
DOI：
10.1093/jnci/88.10.650
复制
发表时间：
1996-05-15
期刊：
影响因子：
--
通讯作者：
Fraumeni, JF
中科院分区：
文献类型：
--
作者：
Ziegler, RG;Hoover, RN;Fraumeni, JF
背景：历史上，美国的乳腺癌发病率是中国或日本的四到七倍，尽管原因仍然难以捉摸。当中国、日本或菲律宾女性移民到美国时，她们患乳腺癌的风险会在几代人的时间内上升，并达到美国白人女性的水平，这表明涉及可改变的暴露。在之前的一份关于亚裔美国女性乳腺癌病例对照研究的报告中，旨在利用其风险和生活方式的多样性，我们证明了移民历史造成的风险的六倍梯度，与乳腺癌发病率的国际差异相当。目的：在这项分析中，我们研究了成人身高、肥胖和体重变化在乳腺癌病因中的作用。方法：对 1983 年 4 月 1 日至 1987 年 6 月 30 日期间居住在旧金山-奥克兰 (CA)、洛杉矶 (CA) 和瓦胡岛 (HI) 的年龄 20-55 岁的中国、日本和菲律宾族裔女性进行乳腺癌病例对照研究。我们成功采访了 852 名符合条件的病例受试者中的 597 名 (70%) 和 966 名受试者。 (75%) 1985 年 8 月至 1989 年 2 月期间的 1287 名合格对照受试者中。受试者被询问当前身高、成人正常体重以及每十年的正常体重，不包括最近 3 年和任何怀孕时期。结果：在对公认的乳腺癌危险因素进行调整后，身高、近期肥胖（当前十年的体重/身高（1.5））和近期体重变化（当前和前几十年的体重变化）是乳腺癌风险的有力预测因素。在身高 7 英寸（17.8 厘米）范围内（趋势的两侧 P = 0.003），风险加倍（相对风险 [RR] = 2.01；95% 置信区间 [CI] = 1.16-3.49），绝经前和绝经后女性的效果相当。除了体重较重的年轻女性（体重/身高(1.5) > 29 kg/m(1.5) 且< 40 岁）的风险降低外，风险与通常的成人肥胖呈正相关。随着成年后每个十年的肥胖情况被考虑在内，风险趋势变得更加引人注目。 50 多岁和肥胖程度最高的五分之一女性的乳腺癌风险 (RR = 2.13; 95% CI = 1.17-3.87) 是最低五分之一女性的两倍（趋势的两侧 P = .004）。 50 多岁、肥胖程度高于同龄组中值且近期体重增加超过 10 磅的女性，其风险是肥胖程度低于中值且近期体重没有变化的女性的三倍（RR = 3.01；95% CI = 1.45-6.25）。相对于近期体重没有变化，近期体重减轻始终与风险降低相关（RR 约为 0.7）。结论：成人肥胖、体重变化和身高是乳腺癌风险的关键决定因素。诊断前十年的肥胖和体重增加尤其具有影响力，表明体重过重可能起到晚期促进剂的作用。 意义：成年后体重维持和/或减轻，可能伴随饮食和身体活动的特定变化，可能对乳腺癌风险产生显着而快速的影响。
Background: Breast cancer incidence rates have historically been four to seven times higher in the United States than in China or Japan, although the reasons remain elusive. When Chinese, Japanese, or Filipino women migrate to the United States, their breast cancer risk rises over several generations and reaches that for white women in the United States, indicating that modifiable exposures are involved. In a previous report on this case-control study of breast cancer in Asian-American women, designed to take advantage of their diversity in risk and lifestyle, we demonstrated a sixfold gradient in risk by migration history, comparable to the international differences in breast cancer incidence rates. Purpose: In this analysis, we have examined the roles of adult height, adiposity, and weight change in breast cancer etiology. Methods: A population-based, case-control study of breast cancer was conducted among women of Chinese, Japanese, and Filipino ethnicities, aged 20-55 years, living in San Francisco-Oakland (CA), Los Angeles (CA), and Oahu (HI) during the period from April 1, 1983, through June 30, 1987. We successfully interviewed 597 (70%) of 852 eligible case subjects and 966 (75%) of 1287 eligible control subjects from August 1985 through February 1989. Subjects were asked about current height, usual adult weight, and usual weight in each decade of life, excluding the most recent 3 years and any periods of pregnancy. Results: Height, recent adiposity (weight in the current decade of life/height(1.5)), and recent weight change (between the current and preceding decades of life) were strong predictors of breast cancer risk after adjustment was made for accepted breast cancer risk factors. Risk doubled (relative risk [RR] = 2.01; 95% confidence interval [CI] = 1.16-3.49) over the 7-inch (17.8-cm) range in height (two-sided P for trend = .003), with comparable effects in both premenopausal and postmenopausal women. Except for reduced risk in the heavy, younger women (weight/height(1.5) > 29 kg/m(1.5) and < 40 years old), risk was positively associated with usual adult adiposity. Trends in risk became more striking as adiposity in each succeeding decade of adult life was considered. Women in their 50s and in the top quintile of adiposity for their age group had twice the breast cancer risk (RR = 2.13; 95% CI = 1.17-3.87) of women in the bottom quintile (two-sided P for trend = .004). Women in their 50s, above the median adiposity for their age group, and with a recent gain of more than 10 pounds had three times the risk (RR = 3.01; 95% CI = 1.45-6.25) of women below the median adiposity and with no recent weight change. Recent weight loss was consistently associated with reduced risk (RRs of approximately 0.7) relative to no recent weight change. Conclusions: Adult adiposity, weight change, and height are critical determinants of breast cancer risk. Increased adiposity and weight gain in the decade preceding diagnosis are especially influential, suggesting that excess weight may function as a late stage promoter, Implications: Weight maintenance and/or reduction as an adult, possibly accompanied by specific changes in diet and physical activity, may have a significant and rapid impact on breast cancer risk.