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Risk factors for breast cancer according to estrogen and progesterone receptor status.

Abstract

BACKGROUND

Evaluations of epidemiologic risk factors in relation to breast cancer classified jointly by estrogen receptor (ER) and progesterone receptor (PR) status have been inconsistent. To address this issue, we conducted a prospective evaluation of risk factors for breast cancer classified according to receptor status.

METHODS

During 1 029 414 person-years of follow-up of 66 145 women participating in the Nurses' Health Study from 1980 through 2000, we identified 2096 incident cases of breast cancer for which information on ER/PR status was available: 1281 were ER+/PR+, 318 were ER+/PR-, 80 were ER-/PR+, and 417 were ER-/PR-. We fit a log-incidence model of breast cancer and used polychotomous logistic regression to compare coefficients for breast cancer risk factors in patients with different ER/PR status. To test for differences in risk factor odds ratios based on marginal ER/PR categories, we evaluated ER status controlling for PR status and vice versa. The predictive ability of our log-incidence model to discriminate between women who would develop ER+/PR+ breast cancer and those who would not (and similarly for ER-/PR- breast cancer) was evaluated by using receiver operator characteristic curve analysis. All statistical tests were two-sided.

RESULTS

We observed statistically significant heterogeneity among the four ER/PR categories for some risk factors (age, menopausal status, body mass index [BMI] after menopause, the one-time adverse effect of first pregnancy, and past use of postmenopausal hormones) but not for others (benign breast disease, family history of breast cancer, alcohol use, and height). The one-time adverse association of first pregnancy with incidence was present for PR- but not for PR+ tumors after controlling for ER status (P =.007). However, the association of BMI after menopause with incidence was present for PR+ but not PR- tumors (P =.005). Statistically significant differences in the incidence of ER+ and ER- tumors were seen with age, both before and after menopause (P =.003), and with past use of postmenopausal hormones (P =.01). Area under the receiver operator characteristic curve, adjusted for age, was 0.64 (95% confidence interval [CI] = 0.63 to 0.66) for ER+/PR+ tumors and 0.61 (95% CI = 0.58 to 0.64) for ER-/PR- tumors.

CONCLUSIONS

Incidence rates and risk factors for breast cancer differ according to ER and PR status. Thus, to accurately estimate breast cancer risk, breast cancer cases should be divided according to the ER and PR status of the tumor.

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  • Authors+Show Affiliations

    ,

    Cancer Epidemiology Program, Dana-Farber/Harvard Cancer Center, and Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115-5899, USA. graham.colditz@channing.harvard.edu

    , , ,

    Source

    Journal of the National Cancer Institute 96:3 2004 Feb 04 pg 218-28

    MeSH

    Adult
    Aged
    Biomarkers, Tumor
    Breast Neoplasms
    Female
    Health Surveys
    Humans
    Incidence
    Life Style
    Mathematical Computing
    Middle Aged
    Models, Statistical
    Nurses
    Predictive Value of Tests
    Receptors, Estrogen
    Receptors, Progesterone
    Risk Factors
    United States

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    14759989

    Citation

    Colditz, Graham A., et al. "Risk Factors for Breast Cancer According to Estrogen and Progesterone Receptor Status." Journal of the National Cancer Institute, vol. 96, no. 3, 2004, pp. 218-28.
    Colditz GA, Rosner BA, Chen WY, et al. Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst. 2004;96(3):218-28.
    Colditz, G. A., Rosner, B. A., Chen, W. Y., Holmes, M. D., & Hankinson, S. E. (2004). Risk factors for breast cancer according to estrogen and progesterone receptor status. Journal of the National Cancer Institute, 96(3), pp. 218-28.
    Colditz GA, et al. Risk Factors for Breast Cancer According to Estrogen and Progesterone Receptor Status. J Natl Cancer Inst. 2004 Feb 4;96(3):218-28. PubMed PMID: 14759989.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk factors for breast cancer according to estrogen and progesterone receptor status. AU - Colditz,Graham A, AU - Rosner,Bernard A, AU - Chen,Wendy Y, AU - Holmes,Michelle D, AU - Hankinson,Susan E, PY - 2004/2/5/pubmed PY - 2004/2/28/medline PY - 2004/2/5/entrez SP - 218 EP - 28 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 96 IS - 3 N2 - BACKGROUND: Evaluations of epidemiologic risk factors in relation to breast cancer classified jointly by estrogen receptor (ER) and progesterone receptor (PR) status have been inconsistent. To address this issue, we conducted a prospective evaluation of risk factors for breast cancer classified according to receptor status. METHODS: During 1 029 414 person-years of follow-up of 66 145 women participating in the Nurses' Health Study from 1980 through 2000, we identified 2096 incident cases of breast cancer for which information on ER/PR status was available: 1281 were ER+/PR+, 318 were ER+/PR-, 80 were ER-/PR+, and 417 were ER-/PR-. We fit a log-incidence model of breast cancer and used polychotomous logistic regression to compare coefficients for breast cancer risk factors in patients with different ER/PR status. To test for differences in risk factor odds ratios based on marginal ER/PR categories, we evaluated ER status controlling for PR status and vice versa. The predictive ability of our log-incidence model to discriminate between women who would develop ER+/PR+ breast cancer and those who would not (and similarly for ER-/PR- breast cancer) was evaluated by using receiver operator characteristic curve analysis. All statistical tests were two-sided. RESULTS: We observed statistically significant heterogeneity among the four ER/PR categories for some risk factors (age, menopausal status, body mass index [BMI] after menopause, the one-time adverse effect of first pregnancy, and past use of postmenopausal hormones) but not for others (benign breast disease, family history of breast cancer, alcohol use, and height). The one-time adverse association of first pregnancy with incidence was present for PR- but not for PR+ tumors after controlling for ER status (P =.007). However, the association of BMI after menopause with incidence was present for PR+ but not PR- tumors (P =.005). Statistically significant differences in the incidence of ER+ and ER- tumors were seen with age, both before and after menopause (P =.003), and with past use of postmenopausal hormones (P =.01). Area under the receiver operator characteristic curve, adjusted for age, was 0.64 (95% confidence interval [CI] = 0.63 to 0.66) for ER+/PR+ tumors and 0.61 (95% CI = 0.58 to 0.64) for ER-/PR- tumors. CONCLUSIONS: Incidence rates and risk factors for breast cancer differ according to ER and PR status. Thus, to accurately estimate breast cancer risk, breast cancer cases should be divided according to the ER and PR status of the tumor. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/14759989/Risk_factors_for_breast_cancer_according_to_estrogen_and_progesterone_receptor_status_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djh025 DB - PRIME DP - Unbound Medicine ER -