INCREASED INCIDENCE OF CARCINOMA OF THE BREAST ASSOCIATED WITH ABDOMINAL ADIPOSITY IN POSTMENOPAUSAL WOMEN
INCREASED INCIDENCE OF CARCINOMA OF THE BREAST ASSOCIATED WITH ABDOMINAL ADIPOSITY IN POSTMENOPAUSAL WOMEN
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DOI：
10.1093/oxfordjournals.aje.a115570
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发表时间：
1990-05-01
影响因子：
5
通讯作者：
WALLACE, RB
中科院分区：
文献类型：
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作者：
FOLSOM, AR;KAYE, SA;WALLACE, RB
流行病学研究已经证实，体重增加与绝经后妇女患乳腺癌的几率增加有关。作者假设腹部肥胖进一步增加绝经后乳腺癌的风险。因此，他们对41837名年龄在55-69岁的爱荷华州绝经后妇女进行了巢式病例对照研究，调查了腰臀围比与乳腺癌发病率的关系。1986年1月，研究人员通过邮件调查招募了一些女性，要求有人用卷尺和书面说明测量她们的身长。癌症发病率是通过全州癌症登记来确定的。在最初的2年随访期间（1986-1987），高危妇女共发生229例乳腺癌。与随机选择的对照组（n = 1,839）相比，乳腺癌患者的年龄调整后平均腰臀比更高（0.013单位，p = 0.030），平均体重（1.7 kg, p = 0.07），体重指数（0.6 kg/m2, p = 0.08）， 18岁后体重增加（2.7 kg, p < 0.01）。在多元logistic回归模型中，年龄和当前体重指数是腰臀比与乳腺癌相关性的显著调节因子。在较年轻和较轻的绝经后妇女中，腰臀比增加两个标准偏差（0.168单位）与乳腺癌的相对风险没有增加相关。然而，在年龄较大、体重较重的绝经后妇女中，腰臀比的同样增加会带来超过两倍的相对风险。其他乳腺癌风险因素的调整并没有实质性地改变这一发现。对于腹部肥胖女性乳腺癌发病率增高，有两种可能的解释：1)由于性激素结合球蛋白减少，非蛋白结合雌激素浓度增加；2)腹部肥胖患者肾上腺雄激素向雌激素转化增加。
Epidemiologic studies have established that increased body weight is associated with a greater incidence of breast cancer in postmenopausal women. The authors hypothesized that abdominal adiposity further increases risk of postmenopausal breast cancer. They therefore investigated the waist-to-hip circumference ratio in relation to breast cancer incidence in a nested case-control study of 41,837 postmenopausal Iowa women aged 55-69 years. Women were recruited through a mail survey in January 1986 and were asked to have someone measure their body circumferences using a paper tape measure and written instructions. Cancer incidence was ascertained using a statewide cancer registry. A total of 229 incident breast cancers occurred among at-risk women during the first 2 years of follow-up (1986-1987). Compared with randomly selected controls (n = 1,839), women with incident breast cancer had a higher age-adjusted mean waist-to-hip ratio (by 0.013 units, p = 0.030), as well as greater mean weight (by 1.7 kg, p = 0.07), body mass index (by 0.6 kg/m2, p = 0.08), and weight gain since age 18 (by 2.7 kg, p < 0.01). In multiple logistic regression models, age and current body mass index were significant effect modifiers of the association between the waist-to-hip ratio and breast cancer. A two-standard deviation increase in the waist-to-hip ratio (0.168 units) was associated with no increase in the relative risk of breast cancer in younger and lighter postmenopausal women. However, in older, heavier postmenopausal women, the same increase in the waist-to-hip ratio carried greater than a twofold excess relative risk. Adjustment for other breast cancer risk factors did not materially alter this finding. Two plausible explanations for elevated breast cancer incidence in women with abdominal adiposity include 1) increased concentrations of non-protein-bound estrogens due to reduced sex hormone binding globulin, or 2) increased conversion of adrenal androgens to estrone with abdominal adiposity.