PROPORTION OF BREAST-CANCER CASES IN THE UNITED-STATES EXPLAINED BY WELL-ESTABLISHED RISK-FACTORS
PROPORTION OF BREAST-CANCER CASES IN THE UNITED-STATES EXPLAINED BY WELL-ESTABLISHED RISK-FACTORS
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DOI：
10.1093/jnci/87.22.1681
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发表时间：
1995-11-15
期刊：
影响因子：
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通讯作者：
HOOVER, RN
中科院分区：
文献类型：
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作者：
MADIGAN, MP;ZIEGLER, RG;HOOVER, RN
背景：很少有关于可归因于已知危险因素的乳腺癌病例比例的估计已经发表，所有的估计都是基于选定的群体，使其对美国人口的推广不确定。我们的目标是估计美国乳腺癌病例可归因于确定的危险因素的比例（即，晚育、无产、较高的家庭收入和乳腺癌的一级家族史），使用的数据来自第一次国家健康和营养检查调查（NHANES I）流行病学随访研究（NHEFS），对美国人口的概率样本进行调查和随访。在20世纪70年代初接受调查的7508名女性参与者中，在1982年至1984年和1987年之间进行了随访，共收集了193例乳腺癌病例进行研究。我们计算了乳腺癌危险因素的发病率、相对危险度（rr）和人群归因危险度（PAR），并通过使用NHANES I调查的样本权重将我们的结果扩展到美国女性人群。结果：我们的PAR估计表明，晚育和无产占美国乳腺癌病例的很大一部分，为29.5%(95%置信区间[CI] = 5.6%-53.3%)；高收入占18.9% (95% CI = -4.3% ~ 42.1%)，乳腺癌家族史占9.1% （95% CI = 3.0% ~ 15.2%）。总的来说，在NHEFS队列中，这些确定的危险因素约占乳腺癌病例的47% (95% CI = 17%-77%)，在美国人群中约占41% （95% CI = 2%-80%）。结论：大多数这些危险因素的相对危险度是适度的，但它们作为一个群体的患病率很高，导致估计表明美国相当大比例的乳腺癌病例是由确定的危险因素解释的。为了进一步了解乳腺癌的病因并帮助制定预防策略，需要阐明潜在的公认因素的决定因素，并研究可能带来风险或保护的其他因素。
Background: Few estimates of the fraction of cases of breast cancer attributable to recognized risk factors have been published, All estimates are based on selected groups, making their generalizability to the U.S. population uncertain, Purpose: our goal was to estimate the fraction of breast cancer cases in the United States attributable to well-established risk factors (i.e,, later age at first birth, nulliparity, higher family income, and first-degree family history of breast cancer), using data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS), the survey and follow-up of a probability sample of the U.S. population, Methods: From a cohort of 7508 female participants surveyed in the early 1970s, and followed up between 1982 and 1984 and again in 1987, 193 breast cancer cases were accrued for study. We calculated incidence rates, relative risks (RRs), and population attributable risks (PARs) for breast cancer risk factors and extended our results to the U.S. female population by using sample weights from the NHANES I survey, Results: Our PAR estimates suggest that later age at first birth and nulliparity accounted for a large fraction of U.S. breast cancer cases, 29.5% (95% confidence interval [CI] = 5.6%-53.3%); higher income contributed 18.9% (95% CI = -4.3% to 42.1%), and family history of breast cancer accounted for 9.1% (95% CI = 3.0%-15.2%). Taken together, these well-established risk factors accounted for approximately 47% (95% CI = 17%-77%) of breast cancer cases in the NHEFS cohort and about 41% (95% CI = 2%-80%) in the U.S. population, Conclusions: The RRs for most of these risk factors were modest, but their prevalence as a group was high, leading to estimates that suggest that a substantial proportion of breast cancer cases in the United States are explained by well-established risk factors, Implications: Elucidation of the determinants underlying recognized factors and study of other factors that may confer risk or protection are needed in efforts to advance understanding of breast cancer etiology and to aid in devising strategies for prevention.