Risk Factors for Specific Histopathological Types of Postmenopausal Breast Cancer in the NIH-AARP Diet and Health Study
Risk Factors for Specific Histopathological Types of Postmenopausal Breast Cancer in the NIH-AARP Diet and Health Study
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DOI：
10.1093/aje/kws471
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发表时间：
2013-08-01
影响因子：
5
通讯作者：
Brinton, Louise A.
中科院分区：
文献类型：
--
作者：
Nyante, Sarah J.;Dallal, Cher M.;Brinton, Louise A.
罕见乳腺癌变异的危险因素关联通常不精确，掩盖了肿瘤类型之间的差异。为了澄清差异，我们在美国国立卫生研究院-AARP 饮食与健康研究中检查了 5 种组织学类型乳腺癌的危险因素。风险因素信息是自我报告的。从 19951996 年到 2006 年，我们对 192,076 名年龄 5071 岁的绝经后妇女进行了跟踪调查。在此期间，诊断出 5,334 例导管癌、836 例小叶癌、639 例混合导管-小叶癌、216 例粘液性乳腺癌和 132 例管状乳腺癌。使用 Cox 比例风险回归估计风险比和 95 置信区间。使用仅案例逻辑回归评估异质性。最大的差异是绝经期激素治疗（P-异质性 0.01）和第一胎年龄（P-异质性 0.01）。与当前绝经激素治疗相关的管状癌风险（当前使用与从未使用，风险比（HR）4.39，95置信区间（CI）：2.77，6.96）比其他组织学类型的风险强几倍（HR范围，1.391.75）。首次生育年龄较大与粘液性肿瘤（30 岁 vs. 2024 岁，HR 0.62，95 CI：0.27，1.42）或管状肿瘤（HR 1.08，95 CI：0.51，2.29）风险无关，而与小叶肿瘤（HR 1.82，95 CI：1.39， 2.37）和混合性导管小叶肿瘤（HR 1.87，95 CI：1.39，2.51）。激素因素与粘液癌和管状癌的不同关联表明其病因与常见乳腺癌不同。
Risk factor associations for rare breast cancer variants are often imprecise, obscuring differences between tumor types. To clarify differences, we examined risk factors for 5 histological types of breast cancer in the National Institutes of Health-AARP Diet and Health Study. Risk factor information was self-reported. We followed 192,076 postmenopausal women aged 5071 years from 19951996 through 2006. During that time period, 5,334 ductal, 836 lobular, 639 mixed ductal-lobular, 216 mucinous, and 132 tubular breast cancers were diagnosed. Hazard ratios and 95 confidence intervals were estimated using Cox proportional hazards regression. Heterogeneity was evaluated using case-only logistic regression. The strongest differences were for menopausal hormone therapy (P-heterogeneity 0.01) and age at first birth (P-heterogeneity 0.01). Risk of tubular cancer in relation to current menopausal hormone therapy (for current use vs. never use, hazard ratio (HR) 4.39, 95 confidence interval (CI): 2.77, 6.96) was several times stronger than risk of other histological types (range of HRs, 1.391.75). Older age at first birth was unassociated with risk of mucinous (for 30 years vs. 2024 years, HR 0.62, 95 CI: 0.27, 1.42) or tubular (HR 1.08, 95 CI: 0.51, 2.29) tumors, in contrast to clear positive associations with lobular (HR 1.82, 95 CI: 1.39, 2.37) and mixed ductal-lobular (HR 1.87, 95 CI: 1.39, 2.51) tumors. Differing associations for hormonal factors and mucinous and tubular cancers suggest etiologies distinct from those of common breast cancers.