Cigarette smoking, physical activity, and alcohol consumption as predictors of cancer incidence among women at high risk of breast cancer in the NSABP P-1 trial.
Cigarette smoking, physical activity, and alcohol consumption as predictors of cancer incidence among women at high risk of breast cancer in the NSABP P-1 trial.
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在NSABP P-1试验中，吸烟，体育锻炼和饮酒是乳腺癌高风险的癌症发病率的预测因素。
DOI：
10.1158/1055-9965.epi-13-1105-t
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Ganz PA
中科院分区：
文献类型：
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作者：
Land SR;Liu Q;Wickerham DL;Costantino JP;Ganz PA
NSABP P-1为研究行为因素与前瞻性监测的癌症发病率和与他莫昔芬的相互作用之间的关系提供了机会。从1992年到1997年，13,388名估计5年乳腺癌（BC）风险大于1.66%或有小叶原位癌病史的妇女（87%年龄在65岁以下; 67%绝经后）被随机分配到他莫昔芬组和安慰剂组。浸润性BC、肺癌（LC）、结肠癌（CC）和子宫内膜癌（EC）采用考克斯回归分析。预测因素为基线吸烟、闲暇时间体力活动、饮酒和已确定的危险因素。在中位7年随访时，我们分别观察到395、66、35和74例BC、LC、CC和EC。与从不吸烟的女性相比，吸烟的女性患BC（P= 0.007;吸烟15-35年的风险比（HR）=1.3，≥35年的风险比（HR）=1.6），LC（P<0.001; 15-35年的风险比=3.9; ≥35年的风险比=18.4）和CC（P<0.001; ≥35年的风险比=5.1）的风险增加。低活动仅在分配到安慰剂组的女性中预测BC风险增加（P= 0.021活动主效应，P= 0.013活动-治疗相互作用;安慰剂组HR=1.4），在所有女性中预测EC风险增加（P= 0.026，HR=1.7）。与不饮酒相比，适量饮酒（>0-1杯/天）与CC风险降低相关（P=.019; HR=.35）。这些行为与癌症风险之间没有其他显着关联。在BC风险升高的女性中，吸烟对BC风险的影响甚至比过去在一般人群中的研究中观察到的更大。吸烟或不活动的妇女应被告知多种癌症的风险增加。
NSABP P-1 provides an opportunity to examine the association of behavioral factors with prospectively monitored cancer incidence and interactions with tamoxifen. From 1992–1997, 13,388 women with estimated 5-year breast cancer (BC) risk greater than 1.66% or a history of lobular carcinoma in situ (87% under age 65; 67% post-menopausal) were randomly assigned to tamoxifen versus placebo. Invasive BC, lung (LC), colon (CC), and endometrial cancers (EC) were analyzed with Cox regression. Predictors were baseline cigarette smoking, leisure-time physical activity, alcohol consumption, and established risk factors. At median 7 years follow-up, we observed 395, 66, 35, and 74 BC, LC, CC, and EC, respectively. Women who had smoked were at increased risk of BC (P=.007; hazard ratio (HR)=1.3 for 15–35 years smoking, HR=1.6 for ≥35 years), LC (P<.001; HR=3.9 for 15–35 years; HR=18.4 for ≥35 years), and CC (P<.001; HR=5.1 for ≥35 years) versus never-smokers. Low activity predicted increased BC risk only among women assigned to placebo (P=.021 activity main effect, P=.013 activity-treatment interaction; HR=1.4 for placebo group) and EC among all women (P=.026, HR=1.7). Moderate alcohol (>0–1 drink/day) was associated with decreased risk of CC (P=.019; HR=.35) versus no alcohol. There were no other significant associations between these behaviors and cancer risk. Among women with elevated risk of BC, smoking has an even greater impact on BC risk than observed in past studies in the general population. Women who smoke or are inactive should be informed of the increased risk of multiple types of cancer.