Relationship of established risk factors with breast cancer subtypes

乳腺癌 医学 肿瘤科 内科学 雌激素受体 家族史 孕酮受体 体质指数 人口 妇科 风险因素 比例危险模型 三阴性乳腺癌 乳腺癌的危险因素 优势比 癌症 队列 逻辑回归 置信区间 危险系数 环境卫生
作者
Anne Marie McCarthy,Tara Friebel-Klingner,Sarah Ehsan,Wei He,Michaela Welch,Jinbo Chen,Despina Kontos,Susan M. Domchek,Emily F. Conant,Alan Semine,Kevin S. Hughes,Aditya Bardia,Constance D. Lehman,Katrina Armstrong
出处
期刊:Cancer Medicine [Wiley]
卷期号:10 (18): 6456-6467 被引量:42
标识
DOI:10.1002/cam4.4158
摘要

Breast cancer is a heterogeneous disease, divided into subtypes based on the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Subtypes have different biology and prognosis, with accumulating evidence of different risk factors. The purpose of this study was to compare breast cancer risk factors across tumor subtypes in a large, diverse mammography population.Women aged 40-84 without a history of breast cancer with a screening mammogram at three United States health systems from 2006 to 2015 were included. Risk factor questionnaires were completed at mammogram visit, supplemented by electronic health records. Invasive tumor subtype was defined by immunohistochemistry as ER/PR+HER2-, ER/PR+HER2+, ER, and PR-HER2+, or triple-negative breast cancer (TNBC). Cox proportional hazards models were run for each subtype. Associations of race, reproductive history, prior breast problems, family history, breast density, and body mass index (BMI) were assessed. The association of tumor subtypes with screen detection and interval cancer was assessed using logistic regression among invasive cases.The study population included 198,278 women with a median of 6.5 years of follow-up (IQR 4.2-9.0 years). There were 4002 invasive cancers, including 3077 (77%) ER/PR+HER2-, 300 (8%) TNBC, 342 (9%) ER/PR+HER2+, and 126 (3%) ER/PR-HER2+ subtype. In multivariate models, Black women had 2.7 times higher risk of TNBC than white women (HR = 2.67, 95% CI 1.99-3.58). Breast density was associated with increased risk of all subtypes. BMI was more strongly associated with ER/PR+HER2- and HER2+ subtypes among postmenopausal women than premenopausal women. Breast density was more strongly associated with ER/PR+HER2- and TNBC among premenopausal than postmenopausal women. TNBC was more likely to be interval cancer than other subtypes.These results have implications for risk assessment and understanding of the etiology of breast cancer subtypes. More research is needed to determine what factors explain the higher risk of TNBC for Black women.

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