Premenopausal Hormone Levels and Risk of Breast Cancer

描述（由申请人提供）：乳腺癌的流行病学表明绝经前激素的主要病因作用，但有限的数据表明哪些特定激素是最重要的，以及在什么水平上风险增加。最近，我们观察到绝经前乳腺癌发病率与性类固醇雌二醇、雄烯二酮、睾酮和硫酸脱氢表雄酮的血浆水平之间存在显著的正相关。在本申请中，我们建议扩展这些初步发现-例如，我们将更好地确定血浆水平与疾病之间的剂量-反应关系，并通过肿瘤特征（例如，ER+/PR+对比ER-/PR-）。此外，我们计划使用一种新开发的检测方法来评估尿雌激素代谢产物。我们还提出了几个新的类固醇激素相关的目标，包括血浆肠内酯（一种植物雌激素），25-OH维生素D和维生素D途径的遗传变异的评估。最后，为了更好地了解这些因素对乳腺癌风险的贡献，我们建议将其加入Gail和Rosner统计风险预测模型中进行评估。在这项研究中，我们将使用1996-99年从29,611名护士健康研究II（NHSII）参与者中收集的血液和尿液样本，这些参与者在收集时年龄为32至54岁。其中18，521份样本根据女性的月经周期进行计时;对于这些女性，可获得早期卵泡和黄体中期血液样本。样本自采集以来一直储存在-130 ℃或更低温度的液氮冷冻箱中。我们将分析来自在血液采集后被诊断患有乳腺癌的女性和保持无疾病的匹配对照（即，巢式病例对照设计），从而有效地利用这些前瞻性收集的样本。到2009年，我们预计将确认766例乳腺癌病例，其中435例将发生在定时采样的人群中。NHSII是为数不多的队列研究之一，为研究这些关系提供了理想的背景。世界上很少有其他研究有大量的血液和尿液样本，主要来自绝经前妇女。此外，该队列的随访率仍然很高（血液队列为98%），自1989年以来收集了大量关于生殖因素、饮食、体力活动和其他变量的数据，并将继续收集这些数据（CA 50385; Willett，PI）。因此，我们提出的研究应该大大有助于我们了解激素和年轻女性乳腺癌之间的关系。此外，确认维生素D或肠内酯的保护性关联，这些因素可以通过生活方式的选择而改变，这将对公共卫生产生重要影响。

DESCRIPTION (provided by applicant): The epidemiology of breast cancer suggests a central etiologic role for premenopausal hormones, yet limited data exist to indicate which specific hormones are of greatest importance and at what levels risk is increased. Recently, we observed significant positive associations between incident premenopausal breast cancer and plasma levels of the sex steroids estradiol, androstenedione, testosterone, and dehydroepiandrosterone sulfate. In this application, we propose to extend these initial findings - for example, we will better determine the dose-response relation between plasma levels and disease and assess associations by tumor characteristics (e.g., ER+/PR+ vs. ER-/PR-). Further, we plan to evaluate urinary estrogen metabolites using a newly developed assay. We also propose several new steroid- hormone related aims, including the assessment of plasma enterolactone (a phytoestrogen), 25-OH vitamin D, and genetic variation in the vitamin D pathway. Finally, to better understand the contribution of these factors to breast cancer risk, we propose to evaluate their addition to both the Gail and Rosner statistical risk prediction models. In this study, we will utilize blood and urine samples collected in 1996-99 from 29,611 participants in the Nurses' Health Study II (NHSII) who were 32 to 54 years of age at collection. 18,521 of these samples were timed according to the woman's menstrual cycle; for these women, both early follicular and midluteal blood samples are available. Samples have been stored at -130oC or colder in liquid nitrogen freezers since collection. We will assay samples from women who were diagnosed with breast cancer after blood collection and matched controls who remained disease-free (i.e., a nested case-control design), thus efficiently utilizing these prospectively collected samples. By 2009, we expect to confirm 766 incident cases of breast cancer, 435 of which will have occurred among those with timed samples. The NHSII is one of a few cohort studies that provides an ideal context in which to investigate these relationships. Few other studies worldwide have a large number of blood and urine samples from predominantly premenopausal women. Also, follow-up in this cohort remains high (98% in the blood cohort) and a wealth of data on reproductive factors, diet, physical activity, and other variables has been collected since 1989 and continues to be collected (CA50385; Willett, PI). Hence, our proposed study should contribute substantially to our understanding of the relationships between hormones and breast cancer in younger women. Further, confirmation of protective associations for vitamin D or enterolactone, factors amenable to change through lifestyle choices, would have important public health implications.