中国女性乳腺癌危险因素的Meta分析

目的:评价中国女性乳腺癌部分危险因素的作用,探索乳腺癌的病因。方法:运用Meta分析方法对我国1996～2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。结果:各因素合并OR值分别为:初潮年龄(年)OR=1.54(95%CI:1.3437～1.7654);哺乳OR=0.68(95%CI:0.4779～0.9782);口服避孕药OR=1.33(95%CI:1.0627～1.6589);良性乳腺疾病史OR=2.62(95%CI:2.0275～3.3804);吸烟OR=1.86(95%CI:1.5394～2.2415);饮酒OR=0.81(95%CI:0.6196～1.0686);饮茶OR=0.86(95%CI:0.7646～0.9728)。结论:初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。     

The influence of perinatal maternal exposure to dibutyl phthalate on glucolipid metabolism in adult female offspring

BackgroundMaternal exposure to dibutyl phthalate (DBP) may result in obesity in female offspring. However, the underlying mechanisms remain elusive.Materials and methodsSprague-Dawley rats were intraperitoneally injected with different doses of DBP and corn oil from gestational day 7 until the end of lactation. The weights, visceral fat percentage, serum lipid, insulin and glucose, protein levels of PI3K signal pathway in muscle were detected in F1 female offspring.ResultsAlthough the birth weight of F1 female offspring was not different among groups, the weights were heavier in DBP groups from postnatal day 7 to adult (P < 0.001). The visceral adipose percentage in adult female offspring was increased by perinatal exposure to DBP (P < 0.001). Decreased serum level of triglyceride (P = 0.001) in F1 female offspring was found in DBP group as compared to control, especially in medium and high DBP. However, none difference was found for fasting glucose, prolactin, HOMA-IR, fasting insulin, total cholesterol, adiponectin. Different protein levels of GPR30 were observed in muscle of female offspring among four groups (P = 0.016). The protein level of AKT seemed higher in DBP group but without statistical significance (P = 0.05). None difference was observed for the protein levels of PI3K, p-AKT, pAKT/AKT, PTEN, GLUT4, InsR, IRS.ConclusionMaternal perinatal exposure to DBP might induce obesity and accumulation of visceral adipose tissue for the adult female offspring. Serum glucolipid and local signal transduction of PTEN/PI3K/AKT pathway in muscle were not adversely affected by perinatal exposure to DBP for adult female offspring.     

The relation between multiple births and maternal risk of breast cancer.

Data from two case-control studies conducted in New York State during 1982-1986 were used to examine the relation between multiple births and the maternal risk of breast cancer. The cases were 2,561 women between 20 and 79 years of age with a diagnosis of primary breast cancer. Controls (n = 2,616) were selected from driver's license files and matched to cases by year of birth and county of residence. The odds ratio for any multiple birth was 0.94 (95% confidence interval (CI) 0.56-1.56) in women less than 55 years of age and 0.95 (95% CI 0.62-1.46) in women aged 55-79 years. A previous study had shown a multiple last birth to be protective against breast cancer in women less than 55 years of age (odds ratio (OR) = 0.60, 95% CI 0.43-0.85). A decreased risk of breast cancer was also observed for this age group in the present study, but the magnitude of the effect was not as strong and the confidence interval included unity (OR = 0.85, 95% CI 0.43-1.68). A logistic model that controlled for age at first pregnancy, number of live births, age, and county of residence increased the odds ratio to 0.97 for a multiple last birth. The current study does not support an association between multiple births and maternal risk of breast cancer.     

妊娠期糖尿病对后代的影响

妊娠期糖尿病是一种常见疾病,对母儿健康均会产生不良影响,该文着重探讨妊娠期糖尿病对后代的影响.妊娠期糖尿病的胎儿易发生宫内乏氧、窘迫,其发生先天畸形的机率较高;妊娠期糖尿病的新生儿发生心血管异常的死亡率较高,而且出现残疾、神经系统疾病的比率增高;用妊娠期糖尿病母亲的乳汁行母乳喂养,可增加妊娠期糖尿病后代肥胖和糖耐量异常的风险,对后代体格和代谢的影响较大.同时,血糖控制不佳的妊娠期糖尿病后代,精细运动功能较差,易出现多动和注意力不集中.所以对妊娠期糖尿病进行筛查和血糖控制,对孕母和儿童的健康具有重要意义.     

女性居民肿瘤危险因素及乳腺癌认知情况调查

目的 调查北京市社区女性居民对肿瘤危险因素以及乳腺癌的认知情况,为在社区开展肿瘤防治的健康教育干预提供依据.方法 采用横断面研究方法,调查北京市某社区40岁～妇女2 952人.问卷调查妇女的人口学信息、肿瘤危险因素认知情况、乳腺癌认知情况、肿瘤知识来源途径等.结果 调查人群对肿瘤危险因素认知水平较低,对乳腺癌认知情况更低,有28.2%的女性每年至少一次到专业诊所进行乳腺检查,23.1%的女性每月进行乳房自我检查.26.4%的女性认为体重过胖的女性更容易诱发乳腺癌,51.0%的女性知道乳腺癌有遗传因素.乳腺癌的认知途径主要来源于电视(61.3%).年龄与乳腺癌认知情况差异有统计学意义(χ2=12.386,P=0.002).文化程度与乳腺癌认知情况差异有统计学意义(χ2=63.523,P=0.000),且Cochran-Armitage趋势检验差异有统计学意义(P<0.000 1).结论 北京市社区女性对肿瘤危险因素以及乳腺癌知晓率较低,需要通过社区健康教育提高女性对乳腺癌知晓程度.     

The influence of graphic format on breast cancer risk communication

Graphic displays can enhance quantitative risk communication. However, empiric data regarding the effect of graphic format on risk perception is lacking. We evaluate the effect of graphic format elements on perceptions of risk magnitude and perceived truth of data. Preferences for format also were assessed. Participants (254 female primary care patients) viewed a series of hypothetical risk communications regarding the lifetime risk of breast cancer. Identical numeric risk information was presented using different graphic formats. Risk was perceived to be of lower magnitude when communicated with a bar graph as compared with a pictorial display (p < 0.0001), or with consecutively versus randomly highlighted symbols in a pictorial display (p = 0.0001). Data were perceived to be more true when presented with random versus consecutive highlights in a pictorial display (p < 0.01). A pictorial display was preferred to a bar graph format for the presentation of breast cancer risk estimates alone (p = 0.001). When considering breast cancer risk in comparison to heart disease, stroke, and osteoporosis, however, bar graphs were preferred pictorial displays (p < 0.001). In conclusion, elements of graphic format used to convey quantitative risk information effects key domains of risk perception. One must be cognizant of these effects when designing risk communication strategies.     

Occupational exposure to metalworking fluids and risk of breast cancer among female autoworkers

BACKGROUND: Metalworking fluids (MWF) are used for lubrication during metal manufacturing. Previous studies have observed increased risks of several cancers among MWF-exposed workers. We hypothesized that MWF may be associated with risk of breast cancer because they can contain carcinogenic or endocrine-disrupting chemicals. METHODS: We conducted a case-control study nested in a cohort of 4,680 female automobile workers employed for at least 3 years between 1/1/41 and 1/1/85, with follow-up through 1994. Cases were identified using the National Death Index (NDI), Michigan cancer registries, and company records. Detailed quantitative MWF exposure data were available for each subject, although data on known breast cancer risk factors were not. RESULTS: Ninety-nine cases of breast cancer and 626 matched controls were identified. There was a weak positive association between lifetime cumulative exposure to soluble MWF and breast cancer risk, but no evidence of association with either straight or synthetic fluids. When exposure was divided into time-windows, the association was strongest for soluble MWF in the decade preceding diagnosis. Controlling for earlier exposures, there was an odds ratio of 1.18 (95% CI=1.02-1.35) per mg/m3-year of cumulative exposure to soluble MWF in this 10-year period. CONCLUSION: This hypothesis-generating study provides some preliminary evidence for an association between exposure to soluble MWF and increased risk of breast cancer. Additional studies of MWF and breast cancer, with data on known breast cancer risk factors, are warranted.     

Multiple births and maternal risk of breast cancer

Data from the Cancer and Steroid Hormone Study, a large nationwide population-based case-control study conducted in the United States in 1980-1982, were analyzed to investigate whether pregnancies ending in a multiple birth affect the risk of subsequent breast cancer. The cases were 3,918 parous women who were aged 20-54 years and newly diagnosed with breast cancer; controls were 4,047 parous women selected randomly from the same geographic areas as the cases. Multiple births were reported by 118 cases and 161 controls. After adjustment for other reproductive variables, having a multiple last birth was found to be protective against breast cancer (odds ratio (OR) = 0.60, 95% confidence interval (CI) 0.43-0.85), whereas having a multiple birth prior to the last birth was not (OR = 1.11, 95% CI 0.79-1.57). To the authors' knowledge, this study is the first investigation to report such a protective effect, and thus the finding warrants replication. One mechanism that might account for the effect involves the increased output of alpha-fetoprotein by multiple fetal livers.     

女性乳腺癌危险因素的Meta分析

目的运用Meta分析方法综合分析评价国内外女性乳腺癌的危险因素。方法收集1997-2007年国内外有关乳腺癌危险因素的研究文献,采用Meta分析的随机效应模型,计算有关危险因素的比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）。结果共筛选出相关文献31篇,其中,国内15篇,国外16篇。良性乳腺病史（AORs=1.95,95% CI：1.59～2.38）、乳腺癌家族史（AORs=1.58,95% CI：1.35～1.85）、绝经年龄〉50岁（ORs=1.39,95% CI：1.22～1.57）和口服避孕药（AORs=2.12,95% CI：1.24～3.62）为乳腺癌的危险因素;足月妊娠数≥1胎（AORs=0.63,95% CI：0.60～0.68）和母乳喂养（ORs=0.76,95% CI：0.64～0.90）为乳腺癌的保护因素。结论控制人群乳腺癌的发生,应从降低良性乳腺疾病、提倡母乳喂养和注意高危人群筛检等方面采取有效措施。     

女性乳腺癌危险因素的病例对照研究

目的探求女性乳腺癌的危险因素,为乳腺癌的防治提供依据。方法采用病例对照研究方法,问卷调查2003年1月~2005年4月入院的经病理组织学确诊的女性乳腺癌生存病例及同时段入院的外伤患者。利用SPSS进行数据录入和分析,用logistic回归模型进行单因素和多因素分析筛选出有意义的危险因素。结果经单因素及多因素分析,与乳腺癌发病有关的因素为:月经经期不规则、行经期长、流产史、青霉素过敏史等,月经初潮晚能降低乳腺癌的发病风险。结论月经经期不规则、行经期长、流产史及青霉素过敏史等是乳腺癌危险因素,而月经初潮晚对乳腺癌有保护作用。     

女性乳腺癌影响因素病例对照研究

目的 探讨女性乳腺癌影响因素,为乳腺癌防治提供依据.方法 采用病例对照研究方法,于2007年1～12月对黑龙江省哈尔滨市3家三级甲等医院经病理组织学确诊乳腺癌生存病例及同期入院的外伤患者进行调查,采用Logistic回归模型筛选乳腺癌危险因素.结果 多因素分析结果表示,流产次数 (OR=1.633,95% CI=1.232～4.152)、肿瘤家庭史 (OR=3.328,95% CI=1.953～5.549)、体质指数 (OR=1.779,95% CI=1.146～5.091)、精神刺激 (OR=2.487,95% CI=1.753～4.436)、初潮年龄 (OR=0.623,95% CI=0.312～0.884)、母乳喂养时间 (OR=0.832,95% CI=0.421～0.998)、生育胎数 (OR=0.635,95% CI=0.312～0.972)、水果食用频率 (OR=0.532,95% CI=0.318～0.893)为乳腺癌的影响因素.结论 流产次数多、有肿瘤家庭史、体质指数高、精神刺激是乳腺癌危险因素;初潮年龄晚、母乳喂养时间长、生育胎数多、水果蔬菜食用频率高对乳腺癌有保护作用.     

DDE and DDT in breast adipose tissue and risk of female breast cancer.

A case-control study was conducted in Connecticut from 1994 to 1997 to investigate the relation between dichlorodiphenyldichloroethane (DDE) and dichlorodiphenyltrichloroethane (DDT) exposure and breast cancer risk. Cases and controls were women aged 40-79 years, who had breast-related surgery at the Yale-New Haven Hospital and from whose surgical specimen the authors could obtain at least 0.4 g of breast adipose tissue for chemical analyses. A total of 304 incident breast cancer cases (including 62 in situ carcinomas) and 186 benign breast disease controls were recruited into the study. Tissue levels of DDE and DDT were measured using gas chromatography. Statistical significance for comparisons of mean levels of DDE and DDT was calculated using analysis of variance and rank sum tests. A logistic regression model was used to estimate the association and to control confounding. The age-adjusted geometric mean tissue level of DDE for cases (736.5 ppb) was similar to that for the controls (784.1 ppb). DDT levels were also similar for cases (51.8 ppb) and controls (55.6 ppb). The adjusted odds ratio is 0.9 (95% confidence interval: 0.5, 1.5) for DDE and 0.8 (95% confidence interval: 0.5, 1.5) for DDT when the highest quartile was compared with the lowest. These results do not support an association between adipose tissue levels of DDE and DDT and breast cancer risk.     

Variation in female breast cancer risk by occupation

Data from a population-based case control study were used to estimate occupation-specific relative risks for female breast cancer, adjusted for established breast cancer risk factors. Breast cancer cases under age 75 were identified from tumor registries in four states. Controls were randomly selected from driver's license and Medicare beneficiary lists. Information on usual occupation and risk factors was obtained by telephone interview. Odds ratios from logistic regression adjusted for age, state, body mass index, benign breast disease, family history of breast cancer, menopausal status, age at menarche, parity, age at first birth, lactation history, education, and alcohol consumption were calculated for each of 26 occupational groups. Complete occupational information was obtained for 6,835 cases and 9,453 controls. Of 26 occupational groups, only “administrative support occupations” had a statistically significantly increased risk of breast cancer (OR = 1.15, 95% Cl 1.06–1.24). In these data, no specific occupational group had an unusual risk of breast cancer. Increased risks reported elsewhere for nurses and teachers were not corroborated. © 1996 Wiley-Liss, Inc.     

Knowledge of antioxidants and breast cancer risk among women attending breast cancer risk assessment clinics

This qualitative study used semistructured interviews to examine the accuracy of knowledge concerning antioxidants and health among a convenience sample of 79 women attending a breast cancer risk assessment clinic. Despite a high level of familiarity (98%) with the word antioxidant, few participants could name more than one of these compounds and most relied on print media (41.6%) and radio/TV (22.2%) for antioxidant information. Thematic content analysis revealed participants' beliefs that antioxidants were strongly linked to reduced breast cancer risk and improved health. They described antioxidant functions that take place before (e.g., "Prevention . . . a best defense mechanism" and "To boost strength and good health") or after (e.g., "Fights diseases, free radicals, and cancer," "Acts as a cleanser or purifier," and "Undoes the harm that I am consciously or unconsciously doing to my body") a health threat. Participants' understandings of the links between antioxidant intake and breast cancer risk did not accurately reflect the scientific evidence. This large priority population group needs tailored, evidence-based nutrition communications to address inaccurate understandings about antioxidant intake and breast cancer risk.