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Population attributable risk of invasive postmenopausal breast cancer and breast cancer subtypes for modifiable and non-modifiable risk factors.

Abstract

BACKGROUND

The population-level impact of modifiable postmenopausal breast cancer risk factors is incompletely understood, especially regarding potential heterogeneity by estrogen receptor (ER) and progesterone receptor (PR) status.

METHODS

Using data on 3074 cases and 6386 controls from a population-based case-control study of postmenopausal breast cancer conducted in Germany between 2002 and 2005, we calculated multivariable-adjusted odds ratios and population attributable risks (PARs) for modifiable and non-modifiable risk factors. We examined overall postmenopausal invasive breast cancer as well as tumor ER/PR subtypes. A bootstrap method provided estimates of 95% confidence intervals (95%CIs).

RESULTS

The summary PARs (95%CIs) for non-modifiable risk factors (age at menarche, age at menopause, parity, benign breast disease, and family history of breast cancer) were 37.2% (27.1-47.2%) regarding overall invasive tumors, 36.5% (23.3-47.6%) regarding ER+/PR+ tumors, 47.9% (26.4-64.4%) regarding ER+/PR- tumors, and 31.1% (4.0-51.9%) regarding ER-/PR- tumors. Of the modifiable risk factors (hormone therapy (HT) use, physical inactivity, BMI, alcohol consumption), HT use and physical inactivity had the highest impact with PARs of 19.4% (15.9-23.2%) and 12.8% (5.5-20.8%), respectively, regarding overall invasive tumors. For ER+/PR+ tumors, the corresponding PARs were 25.3% (20.9-29.7%) and 16.6% (7.0-26.0%). The summary PARs (95%CIs) for HT use and physical inactivity together were 29.8% (21.8-36.9%) and 37.9% (30.6-46.2%) regarding overall invasive and ER+/PR+ tumors, respectively.

CONCLUSIONS

The population-level impact of modifiable risk factors appears to be comparable to that of non-modifiable risk factors. Alterations in HT use and physical inactivity could potentially reduce postmenopausal invasive breast cancer incidence in Germany by nearly 30%, with the largest potential for reduction among ER+/PR+ tumors, the most frequently diagnosed subtype.

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  • Authors+Show Affiliations

    ,

    Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany.

    , , ,

    Source

    Cancer epidemiology 35:4 2011 Aug pg 345-52

    MeSH

    Aged
    Breast Neoplasms
    Case-Control Studies
    Female
    Germany
    Humans
    Middle Aged
    Postmenopause
    Receptors, Estrogen
    Receptors, Progesterone
    Risk Factors

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    21159569

    Citation

    Barnes, Benjamin B E., et al. "Population Attributable Risk of Invasive Postmenopausal Breast Cancer and Breast Cancer Subtypes for Modifiable and Non-modifiable Risk Factors." Cancer Epidemiology, vol. 35, no. 4, 2011, pp. 345-52.
    Barnes BB, Steindorf K, Hein R, et al. Population attributable risk of invasive postmenopausal breast cancer and breast cancer subtypes for modifiable and non-modifiable risk factors. Cancer Epidemiol. 2011;35(4):345-52.
    Barnes, B. B., Steindorf, K., Hein, R., Flesch-Janys, D., & Chang-Claude, J. (2011). Population attributable risk of invasive postmenopausal breast cancer and breast cancer subtypes for modifiable and non-modifiable risk factors. Cancer Epidemiology, 35(4), pp. 345-52. doi:10.1016/j.canep.2010.11.003.
    Barnes BB, et al. Population Attributable Risk of Invasive Postmenopausal Breast Cancer and Breast Cancer Subtypes for Modifiable and Non-modifiable Risk Factors. Cancer Epidemiol. 2011;35(4):345-52. PubMed PMID: 21159569.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Population attributable risk of invasive postmenopausal breast cancer and breast cancer subtypes for modifiable and non-modifiable risk factors. AU - Barnes,Benjamin B E, AU - Steindorf,Karen, AU - Hein,Rebecca, AU - Flesch-Janys,Dieter, AU - Chang-Claude,Jenny, Y1 - 2010/12/14/ PY - 2010/08/04/received PY - 2010/11/08/revised PY - 2010/11/17/accepted PY - 2010/12/17/entrez PY - 2010/12/17/pubmed PY - 2012/1/31/medline SP - 345 EP - 52 JF - Cancer epidemiology JO - Cancer Epidemiol VL - 35 IS - 4 N2 - BACKGROUND: The population-level impact of modifiable postmenopausal breast cancer risk factors is incompletely understood, especially regarding potential heterogeneity by estrogen receptor (ER) and progesterone receptor (PR) status. METHODS: Using data on 3074 cases and 6386 controls from a population-based case-control study of postmenopausal breast cancer conducted in Germany between 2002 and 2005, we calculated multivariable-adjusted odds ratios and population attributable risks (PARs) for modifiable and non-modifiable risk factors. We examined overall postmenopausal invasive breast cancer as well as tumor ER/PR subtypes. A bootstrap method provided estimates of 95% confidence intervals (95%CIs). RESULTS: The summary PARs (95%CIs) for non-modifiable risk factors (age at menarche, age at menopause, parity, benign breast disease, and family history of breast cancer) were 37.2% (27.1-47.2%) regarding overall invasive tumors, 36.5% (23.3-47.6%) regarding ER+/PR+ tumors, 47.9% (26.4-64.4%) regarding ER+/PR- tumors, and 31.1% (4.0-51.9%) regarding ER-/PR- tumors. Of the modifiable risk factors (hormone therapy (HT) use, physical inactivity, BMI, alcohol consumption), HT use and physical inactivity had the highest impact with PARs of 19.4% (15.9-23.2%) and 12.8% (5.5-20.8%), respectively, regarding overall invasive tumors. For ER+/PR+ tumors, the corresponding PARs were 25.3% (20.9-29.7%) and 16.6% (7.0-26.0%). The summary PARs (95%CIs) for HT use and physical inactivity together were 29.8% (21.8-36.9%) and 37.9% (30.6-46.2%) regarding overall invasive and ER+/PR+ tumors, respectively. CONCLUSIONS: The population-level impact of modifiable risk factors appears to be comparable to that of non-modifiable risk factors. Alterations in HT use and physical inactivity could potentially reduce postmenopausal invasive breast cancer incidence in Germany by nearly 30%, with the largest potential for reduction among ER+/PR+ tumors, the most frequently diagnosed subtype. SN - 1877-783X UR - https://www.unboundmedicine.com/medline/citation/21159569/Population_attributable_risk_of_invasive_postmenopausal_breast_cancer_and_breast_cancer_subtypes_for_modifiable_and_non_modifiable_risk_factors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-7821(10)00203-1 DB - PRIME DP - Unbound Medicine ER -