EPIDEMIOLOGY OF BREAST-CANCER - FINDINGS FROM THE NURSES HEALTH STUDY
EPIDEMIOLOGY OF BREAST-CANCER - FINDINGS FROM THE NURSES HEALTH STUDY
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DOI：
10.1002/cncr.2820710413
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发表时间：
1993-02-15
期刊：
影响因子：
6.2
通讯作者：
COLDITZ, GA
中科院分区：
文献类型：
--
作者：
COLDITZ, GA
背景乳腺癌的流行病学的背景下，激素，遗传，组织学和饮食的危险因素进行了审查。文献综述.结果.月经初潮年龄较晚和首次生育年龄较早可以降低乳腺癌的风险，绝经年龄较早也可以降低乳腺癌的风险。这些危险因素与乳腺组织终生暴露于卵巢激素有关。虽然早期的第一胎与乳腺癌风险的短暂增加有关，可能是由于乳腺在终末分化之前暴露于高水平的激素，但在老年妇女中，产次与乳腺癌风险降低有关。在绝经后妇女中，肥胖与雌激素水平较高和乳腺癌风险增加有关。在乳腺癌诊断阶段的分层中，肥胖与死亡率增加相关，再次支持内源性雌激素对这种疾病的发病率，复发率和生存率的影响。与这些关系相一致，目前绝经后妇女使用雌激素治疗与乳腺癌风险增加有关。乳腺癌的家族史与乳腺癌风险增加约两倍有关，如果在女性母亲年轻时进行诊断，这种风险更大，尽管即使是年长母亲的诊断也与女儿的风险增加有关。对有良性乳腺活检史的妇女的随访结果显示，与无增生变化的活检标本相比，不典型增生的风险增加了4倍。畸形会使风险加倍。这些数据支持了乳腺癌前病变的概念，并可能保证其作为标记物在进一步的研究中使用。回顾性和前瞻性研究的一致数据显示，适度饮酒与乳腺癌风险之间存在正相关。这可能反映了在饮酒的女性中观察到的雌激素水平增加。前瞻性研究的数据不支持膳食脂肪摄入与绝经前或绝经后妇女乳腺癌风险之间的关系。这些关联中很少有提供干预以降低乳腺癌风险的可能性。
Background. The epidemiology of breast cancer was reviewed in the context of hormonal, hereditary, histologic, and dietary risk factors.Methods. Literature review.Results. Late age at menarche and early age at first birth decrease the risk of breast cancer as does an early age at menopause. These risk factors relate to the lifetime exposure of the breast tissue to ovarian hormones. Although an early first birth is associated with a transient increase in the risk of breast cancer, perhaps as a result of the breast's exposure to high levels of hormones before terminal differentiation, in older women, parity is associated with a decreased risk of breast cancer. Among postmenopausal women, obesity is associated with higher levels of estrogens and an increased risk of breast cancer. Within the strata of breast cancer stages at diagnosis, obesity is associated with increased mortality, again supporting the influence of endogenous estrogens on this disease's incidence, recurrence, and survival rates. Consistent with these relationships, current use of estrogen therapy among postmenopausal women is associated with an increased risk of breast cancer. A family history of breast cancer is associated with approximately a two-fold increase in the risk of breast cancer, and this risk is greater if the diagnosis was made when the woman's mother was young, although even a diagnosis in an older mother is associated with an increased risk in her daughters. The follow-up of women with a history of benign breast biopsy results shows that atypical hyperplasia is associated with a fourfold increase in risk compared with a biopsy specimen without proliferative changes. Atypia doubles the risk. These data support the concept of atypia as a precursor lesion for breast cancer and may warrant its use as a marker in further studies. Consistent data from retrospective and prospective studies show a positive association between moderate alcohol intake and the risk of breast cancer. This may reflect the increase in estrogen levels observed among women who consume alcohol. Data from prospective studies do not support a relationship between dietary fat intake and the risk of breast cancer either in premenopausal or postmenopausal women.Conclusions. Few of these associations offer the potential for intervention to reduce the breast cancer risk.