EFFECT OF FAMILY HISTORY, BODY-FAT DISTRIBUTION, AND REPRODUCTIVE FACTORS ON THE RISK OF POSTMENOPAUSAL BREAST-CANCER
EFFECT OF FAMILY HISTORY, BODY-FAT DISTRIBUTION, AND REPRODUCTIVE FACTORS ON THE RISK OF POSTMENOPAUSAL BREAST-CANCER
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DOI：
10.1056/nejm199205143262004
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发表时间：
1992-05-14
影响因子：
158.5
通讯作者：
FOLSOM, AR
中科院分区：
文献类型：
--
作者：
SELLERS, TA;KUSHI, LH;FOLSOM, AR
背景乳腺癌的家族史反映了共同的文化因素，遗传易感性，或两者兼而有之。有证据表明，与乳腺癌家族史相关的估计风险与其他风险因素相结合成倍增加。我们研究了家族史、人体测量学和生殖因素对绝经后妇女乳腺癌风险的综合影响。利用前瞻性队列研究的数据，我们研究了37，105名55至69岁的女性，以确定已知的乳腺癌危险因素是否被进入研究时报告的家族史所改变。在前四年的随访中，诊断出493例新的乳腺癌。腰臀比与（腰围除以臀围）与乳腺癌风险的关系主要限于有乳腺癌家族史的女性;年龄调整后的乳腺癌的相对风险为妇女以上的第四个五分位数的腰围，与第一个五分位数以下的妇女相比，有乳腺癌家族史的妇女的髋关节比率为3.2，没有这种家族史的妇女为1.2。乳腺癌家族史和活产婴儿数量之间存在相互作用;主要在有乳腺癌家族史的妇女中观察到较高产次的保护作用。同样，与第一次怀孕年龄较晚相关的年龄调整的乳腺癌相对风险（即，大于或等于30岁），有乳腺癌家族史的女性为5.8，无家族史的女性为2.0。在有乳腺癌家族史的女性中，与高腰臀比、低产次或首次怀孕年龄较大相关的乳腺癌风险增加更为明显。这些发现表明家族性乳腺癌和散发性乳腺癌之间的病因差异。
Background. A family history of breast cancer reflects shared cultural factors, genetic predisposition, or both. There is evidence that the estimated risk associated with a family history of breast cancer increases multiplicatively in combination with other risk factors. We examined the combined effect of family history and anthropometric and reproductive factors on the risk of breast cancer in postmenopausal women.Methods. Using data from a prospective cohort study, we studied 37,105 women 55 to 69 years of age to determine whether known risk factors for breast cancer are modified by a reported family history at the time of entry into the study.Results. During the first four years of follow-up, 493 new breast cancers were diagnosed. The association of the waist-to-hip ratio (the circumference of the waist divided by that of the hips) with the risk of breast cancer was limited predominantly to women with a family history of breast cancer; the age-adjusted relative risk of breast cancer for the women above the fourth quintile for waist-to-hip ratio as compared with those below the first quintile was 3.2 in women with a family history of breast cancer and 1.2 for women without such a family history. An interaction was observed between a family history of breast cancer and the number of live-born children; the protective effect of higher parity was observed primarily among women with a family history of breast cancer. Similarly, the age-adjusted relative risk of breast cancer associated with a late age at first pregnancy (i.e., greater-than-or-equal-to 30 years) was 5.8 for women with a family history of breast cancer and 2.0 for women without such a family history.Conclusions. The increase in the risk of breast cancer associated with a high waist-to-hip ratio, low parity, or greater age at first pregnancy is more pronounced among women with a family history of breast cancer. These findings suggest etiologic differences between familial breast cancer and the sporadic form.