Weight gain, body mass index, hormone replacement therapy, and postmenopausal breast cancer in a large prospective study
Weight gain, body mass index, hormone replacement therapy, and postmenopausal breast cancer in a large prospective study
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DOI：
10.1158/1055-9965.epi-03-0301
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发表时间：
2004-02-01
影响因子：
3.8
通讯作者：
Calle, EE
中科院分区：
文献类型：
--
作者：
Feigelson, HS;Jonas, CR;Calle, EE
过度肥胖和激素替代疗法（HRT）是绝经后乳腺癌风险的重要因素。HRT已被证明可以改变体重和乳腺癌风险之间的关联，尽管很少有研究足够大，可以在当前HRT使用者和非使用者中分别检查与体重指数（BMI）和体重增加相关的乳腺癌风险。这项研究包括癌症预防研究-II营养队列中62,756名绝经后妇女中发生的1,934例乳腺癌病例。计算经校正的发病率，并使用考克斯比例风险模型来检查BMI和成人体重增加（自18岁起）与乳腺癌风险的相关性，这些风险通过HRT的使用分层。成年人总体重增加强烈预测了以前和从未使用HRT的乳腺癌风险（趋势P < 0.0001）。体重增加21-30磅与1.4的比率相关（95%置信区间1.1-1.8）;与18岁时体重保持在5磅以内的女性相比，体重增加>70磅的女性的比率翻了一番。在考虑体重增加后，最近的BMI和18岁时的BMI都不是风险的独立预测因素。在目前的HRT使用者中，没有发现乳腺癌与BMI或体重增加之间存在关联。在这项研究中，成年体重增加仅在非HRT使用者中与绝经后乳腺癌密切相关。这些数据说明了检查乳腺癌危险因素的重要性，分别由HRT的使用，其他危险因素的影响可能会减弱或模糊的妇女之间采取HRT。
Excess adiposity and hormone replacement therapy (HRT) are important contributors to postmenopausal breast cancer risk. HRT has been shown to modify the association between body weight and breast cancer risk, although few studies are sufficiently large to examine the risk of breast cancer associated with body mass index (BMI) and weight gain separately among current HRT users and nonusers. This study includes 1,934 incident breast cancer cases occurring among 62,756 postmenopausal women in the Cancer Prevention Study-II Nutrition Cohort. Age-adjusted incidence rates were calculated, and Cox proportional hazards models were used to examine the association of BMI and adult weight gain (since age 18 years) with breast cancer risk stratified by HRT use. Total adult weight gain strongly predicted breast cancer risk among former and never HRT users (P for trend < 0.0001). Weight gain of 21-30 pounds was associated with a rate ratio of 1.4 (95% confidence interval 1.1-1.8); rates doubled among women gaining >70 pounds compared with women who maintained their weight within 5 pounds of their weight at age 18. After accounting for weight gain, neither recent BMI nor BMI at age 18 were independent predictors of risk. Among current HRT users, no association was seen between breast cancer and either BMI or weight gain. Adult weight gain is strongly associated with postmenopausal breast cancer only among non-HRT users in this study. These data illustrate the importance of examining breast cancer risk factors separately by HRT use; the effects of other risk factors may be attenuated or obscured among women taking HRT.