Alcohol Intake and Risk of Breast Cancer by Histologic Subtype and Estrogen Receptor Status Among Women Aged 55 to 74 Years

Previous studies suggest that alcohol consumption and risk of breast cancer may differ by histologic subtype and hormone receptor status, though results are not entirely consistent. In this population-based case-control study, we evaluated the association between alcohol consumption and risk of invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and invasive ductal-lobular carcinoma (IDLC) overall and by estrogen receptor (ER) status, among women aged 55–74 years of age. Using polytomous regression, associations between current alcohol consumption, overall and by type of alcohol, and breast cancer risk were evaluated in 891 controls and 905 IDC, 567 ILC, and 489 IDLC cases. Current alcohol use was moderately associated with risk of ILC (odds ratio = 1.25, 95% confidence interval 0.99, 1.58) with a positive dose-response relationship based on average number of drinks per week consumed (P _trend = 0.0005). When further stratified by ER status, alcohol use was positively associated with risk of ER+ ILC (P _trend = 0.002) and ER+ IDC (P _trend = 0.02), but inversely associated with risk of ER?IDC (P _trend = 0.01). No association between alcohol and risk of IDLC tumors was observed. While the link between alcohol consumption and breast cancer risk is well established, our results suggest that the increased risk associated with alcohol is largely limited to ER+ ILC and ER+ IDC. Thus, avoiding or moderating alcohol consumption may be one way that women can lower their risks of these forms of breast cancer.     

Perceived Family Support of Women with Breast Cancer and Affecting Factors in Turkey

Background: The purpose of this study was to examine the percieved family support of the women with breastcancer and the affecting factors. Methods: The subjects were breast cancer cases undergoing treatment (n=240).The sample for this study was formed by women who accepted participation, were in the facility between thedates and hours when the study was applied, and who were selected with a nonprobability sampling technique(n=120). Results: Two thirds of the women with breast cancer were in the 40-59 age group. The lowest scorewomen with breast cancer for perceived family support scale was 0.00, and the highest was 40.0, with a mean of30.1 ±8.85. Conclusion: In this study, it was determined that perceived family support of Turkish women withbreast cancer was reasonable.     

Do Breast Cancer Risk Factors Affect the Survival of Breast Cancer Patients in Southern Sri Lanka?

Background: Breast cancer continues to be a major cause of morbidity among women in Sri Lanka. Possible effects of etiological risk factors on breast cancer specific survival (BCSS) of the disease is not clear.This study was designed to explore the impact of breast cancer risk factors on the BCSS of patients in Southern Sri Lanka. Method: This retro-prospective study included all breast cancer patients who had sought immunohistochemistry services at our unit from May 2006 to December 2012. A pre-tested, interviewer-administered questionnaire was used to gather information on risk factors. BCSS was estimated using the Kaplan-Meier model. Univariate Cox-regression analysis was performed with 95% confidence intervals using the SPSS statistical package. Results: A total of 944 breast cancer patients were included. Five year BCSS was 78.8%. There was a statistically significant difference between the patients who had a family history of breast cancer and no family history of any cancer in terms of the presence/absence of lymph node metastasis (p=0.011) and pathological stage (p=0.042). The majority of the premenopausal patients had associated DCIS (p<0.001) and large tumours (p=0.015) with positive lymph nodes (p=0.016). There was no statistically significant association between hormone receptor subtypes and hormone related risk factors. Univariate analysis revealed that breast cancer risk factors had no significant effect on the BCSS. Conclusion: Even though family history of breast cancer and premenopausal status are associated with poor prognostic features, they, in line with the other breast cancer risk factors, appear to have no significant effect on the BCSS of patients in Southern Sri Lanka.     

Increased Risk of Breast Cancer in Multiparous and Lactating Women Attending A Breast Care Clinic in Pakistan: A Paradigm Shift?

Aims and Objectives: A changing paradigm shift with multiparity (MP) and breast feeding (BF) has beenreported in recent years in breast cancer (BC). Our aim was to observe associations of parity, BF and other riskfactors with BC among a local population attending a breast care clinic. Materials and methods: A total of 1,039women (mean age 39 ± 15 years) attended for screening or presented with palpable breast lumps at KIRAN,Pakistan. The majority were in middle and low socioeconomic strata. As per American Cancer Society (ACS)guidelines 2003, mammography and ultrasound were performed, along with fine needle aspiration cytology(FNAC) in 195 women with Breast Imaging Reporting and Data Set (BIRADS) IV/V, high risk patients withBIRADS III on mammography and with suspicious ultrasound findings. Results: The study population wasstratified into two groups; one with BC on FNAC in 181 women (17% p<0.001) and other including 858 healthywomen after screening for cancer. The BC group had relative predominance of MP (86% p<0.001), BF (85%p<0.001), family history FH (8% p=0.106) and post-menopause PM (49% p<0.001) as compared to the healthypopulation. Estimated relative risk (RR) of BC in women with MP, BF, F/H and PM was 3.12 (95% CI=2.05-4.73; p <0.001), 2.47 (95%CI=1.69-3.61; p<0.001), 1.45 (95%CI=0.93-2.41; p=1.06) and 2.33 (95%CI=1.70-3.02;p<0.001) respectively. Higher incidence of BC was observed between 30-40 years 23% (p<0.001) and between40-50 years 38% (p<0.001). Conclusion: MP, BF and PM have significant associations with BC in the studiedPakistani women and this possible paradigm shift now needs to be evaluated for confounding factors.     

Prognostic Factors for Elderly Breast Cancer Patients in University Malaya Medical Centre,Malaysia

Background: Information about elderly breast cancer patients’ outcome is limited. This study aimed to evaluatethe treatment outcomes in women aged 70 and above with specific analysis on prognostic clinicopathologicalfeatures and treatment modalities. Materials and Methods: This retrospective study examined breast cancerpatients between 1st January 1994 and 31st December 2004 in UMMC. Survival analysis was performed usingthe Kaplan-Meier method and comparisons between groups using the log-rank test. Univariate and multivariateanalysis on prognostic factors were carried out using the Cox’s proportionate hazard model for patientdemographics, and tumour and treatment factors. Results: One hundred and thirty six patients were identified,with a median age at diagnosis of 75 years. Most had at least one co-morbidity (61.8%). Only 75.0% had a goodperformance status (ECOG 0-1). Mean tumour size was 4.4cm. Primary tumour stages (T stages) 3 and 4 werepresent in 8.1% and 30.1% of patients respectively, and 30.9% had stage III and 8.8% had stage IV disease basedon overall AJCC staging. ER positivity was 58.1%. PR status was positive in 30.1%. Surgery was performed in69.1% of the patients and mastectomy and axillary clearance were the commonest surgical procedures (50.7%).Some 79.4% of patients received hormonal therapy, 30.1% radiotherapy and only 3.6% chemotherapy. Nonstandardtreatment was given to 39.0% of patients due to a variety of reasons. The cumulative 5 years overall,relapse free and cause specific survivals were 51.9%, 79.7% and 73.3% respectively. Performance status, T3-4tumour, presence of metastasis, tumour grade and ER status were independent prognostic factors for overallsurvival. For cause specific survival they were T4 tumour, presence of metastasis and ER status. Conclusion:The 5 years overall survival rate was 51.9% and 41.8% of deaths were non-breast cancer related deaths. Lowsurvival rate was related to low life expectancy in this population. Locally advanced disease, metastatic diseaseand high ER negative rates play a major role in the survival of elderly breast cancer patients in Malaysia.     

Population-based Case-control Study on Risk Factors for Esophageal Cancer in Five High-risk Areas in China

Objective: To study major etiological factors for esophageal cancer in upper gastrointestinal cancer high riskareas in China. Methods: Five areas with high incidences of esophageal and gastric cancer with good qualitycancer registration data were selected for the study: Cixian, Shexian from Hebei Province, Linxian from HenanProvince, Feicheng from Shandong Province and Zhuanghe from Liaoning Province. A total of 250 cases wererandomly recruited from the cancer registration database diagnosed as arising in the lower esophageal segmentsince January 1, 2009. Three controls were identified and matched with each case as having similar characteristics,such as gender, sex and residency. Questionnaires were applied by face to face interview with trained staff, anddata entry was conducted using EPIDATA software. Conditional logistic models were employed for univariateand multivariate analyses to evaluate odd ratios and 95% confident intervals, with SPSS 13.0 statistic software.Results: In single variable analysis, gastrointestinal history, GERD, smoking, passive smoking, alcohol drinking,hot food, pickled food, overnight vegetable, dried food, no breakfast, false dining posture were found to be riskfactors of esophageal cancer. Eating more fresh vegetables and high BMI were protective factors. Gastrointestinalhistory (OR=12.658), not taking regular meals (3.465), overnight vegetables (OR=3.296), GERD (OR=3.044),hot food (OR=2.510), passive smoking (OR=2.423), pickled food (OR=2.273), alcohol drinking (OR=2.074),seldom eating breakfast(OR=1.987), and false dining posture (OR=1.977) increased the risk of esophageal canceron multivariate logistic analysis, and fresh vegetables (OR=0.279) and BMI≥25 (OR=0.528) continued to beprotective. Conclusions: Esophageal cancer could be caused by genetics acting in synergy with environmentalfactors. Health education for the general population in high risk areas should be strengthened, with interventionprograms of nutrition and lifestyle focusing on effective prevention and control for upper gastrointestinal cancer.     

Lower Circulating Androgens Are Associated with Overall Cancer Risk and Prostate Cancer Risk in Men Aged 25–84 Years from the Busselton Health Study

Androgens, notably testosterone (T), have been implicated in development of several common cancers and prostate cancer; however, precise mechanisms remain unclear. This study assessed prospective associations of serum T, dihydrotestosterone (DHT) and estradiol (E2) with overall cancer (excluding skin cancer), prostate, colorectal and lung cancer risk in 1574 community-dwelling men aged 25–84 years. Sex hormones were assayed using mass spectrometry and men were followed for 20 years with outcomes ascertained using data linkage. Over 20 years, there were 289, 116, 48 and 22 men who developed any cancer, prostate cancer, colorectal cancer and lung cancer, respectively. Androgens in the lowest quartile were associated with an increased overall cancer risk (HR?=?1.36, 95% CI 1.05–1.76, p?=?0.020 for T; and HR?=?1.30, 95% CI 1.00–1.69, p?=?0.049 for DHT comparing the lowest vs other quartiles). T in the lowest quartile was associated with an increased risk of prostate cancer (HR?=?1.53, 95% CI 1.02–2.29, p?=?0.038 comparing the lowest vs other quartiles). The association between androgens and overall cancer risk remained similar after excluding prostate cancer outcomes; however, results were not significant. There were no associations of T, DHT or E2 with colorectal or lung cancer risk; however, LH in the highest quartile was associated with an increased risk of lung cancer (HR?=?4.55, 95% CI 1.70–12.19, p?=?0.003 for the highest vs other quartiles). Whether T is a biomarker of poor health in men with any cancer or prostate cancer requires further confirmation as does the nature and mechanism of the association of a high LH with future lung cancer.     

Epidemiological Pattern of Breast Cancer in Iranian Women: Is there an Ethnic Disparity?

Introduction: Northeastern Iran is known as a high risk area of upper gastrointestinal cancers. Recent reportshave suggested a declining trend for these cancers as well as an increase in the incidence of other malignanciesincluding breast cancer. Our present aim was to describe the epidemiological pattern of breast cancer in thisregion during 2004-2009. Methods: All new cancer cases from public and private diagnostic and therapeuticcenters of Golestan province were registered. A structured questionnaire was prepared and used based on thestandards of the International Association of Cancer Registries. The international classification of diseases foroncology was considered for coding. Age standardized incidence rates (ASR) of breast cancer were calculated.Results: A total of 11,038 new cancer cases were registered during 2004-2009, of which, 1,101 (10%) were femaleswith breast cancer. The median age of the breast cancer patients was 46 years. The ASR for breast cancer was 28per 100,000 person-years. We found an unusual rapid increase in breast cancer rate at the age of 25 years. TheASR of breast cancer was significantly lower in females from Turkmen ethnicity and those from rural areas (Pvalue <0.01). Conclusion: Our study showed high rate of breast cancer in Golestan province of Iran. We foundan unusual peak of breast cancer in young women. So, the age of starting screening programs may need to berevised in this area. The rate of breast cancer was significantly lower in women from Turkmen ethnicity. Furtherstudies are warranted to clarify the role of important determinants, especially regarding the ethnic disparity,on breast cancer in this region.     

Occupational Risk Factors for Lung Cancer in Men and Women: A Population-Based Case–Control Study in Italy

OBJECTIVE: We investigated the role of occupation in lung cancerogenesis in two Northern Italian areas. METHODS: During 1990-1992, occupational histories were obtained for 1171 incident lung cancer cases (956 men, 176 women) and 1553 population controls (1253 men, 300 women) and were evaluated for having been employed in jobs entailing exposure to known or suspected lung carcinogens. A further exploratory analysis on other job titles and branches of industry was conducted. RESULTS: Among men, we found a smoking-adjusted odds ratio (OR) of 2.1 (95% confidence interval: 1.6-2.8) for exposure to known carcinogens, corresponding to a population attributable risk of 9.5% (6.0-13.0). Non-ferrous metal workers and painters had a significantly increased risk. No association was found for exposure to suspected carcinogens. In the exploratory analysis, the OR was increased for cleaners (OR: 2.7; 1.0-7.4), bakers (5.7; 1.4-24), tailors (6.9; 1.2-39), plumbers and pipe fitters (2.6; 1.0-6.4), welders and flame-cutters (5.6; 2.1-15), dockers and freight handlers (1.7; 1.0-2.7) and construction workers (1.4; 1.1-1.9). Female glass workers, laundry/dry cleaners and workers in rubber industry had an increased risk. CONCLUSIONS: The study indicates that a sizable proportion of lung cancers among men may be due to occupational exposures and suggests that exposure to lung carcinogens occurs in different jobs in women compared to men.     

Body Mass Index and its Change in Adulthood and Breast Cancer Risk in China

Objective: To investigate the association between the risk of breast cancer and body mass index (BMI) andits change in adulthood. Methods: A population-based case-control study was conducted in China from 2008to 2009. The study sample included 643 cases with pathologically-confirmed breast cancer and 590 controls.Information on adult height and weight at diagnosis, at five years before diagnosis, and at age 21 years wascollected by face-to-face interview using a structured questionnaire. Odds ratios (ORs) and 95% confidenceintervals (CIs) were obtained using unconditional logistic regression analyses. Results: There was an increasedrisk of breast cancer associated with overweight or obesity in adulthood in Chinese women. Compared with thewomen who never had overweight or obesity in their adulthood, the adjusted ORs of breast cancer were 1.99(1.42-2.79) for a BMI ≥25.0 at age 21 and just before diagnosis. This rose to 3.04 (1.18-7.86) if, in addition, BMI≥25.0 was also present five years before diagnosis. Conclusion: Weight gain throughout adulthood is associatedwith an increased risk of breast cancer in Chinese women.     

Saudi Women’s Interest in Breast Cancer Gene Testing: Possible Influence of Awareness,Perceived Risk and Sociodemographic Factors

Background: Development of effective educational strategies should accompany increases in publicawareness and the availability of genetic testing for breast cancer (BC). These educational strategies shouldbe designed to fulfill the knowledge gap while considering factors that influence women’s interest in orderto facilitate decision making. Objective: To determine the possible correlates of Saudi women’s interest inBC genes testing including socio-demographics, the level of awareness towards BC genes, the family historyof BC and the perceived personal risk among adult Saudi women in Al Hassa, Saudi Arabia. Subjects andmethods: This cross-sectional study was carried out during the second BC community-based campaign in AlHassa, Saudi Arabia. All Saudi women aged ≥ 18 years (n=781) attending the educational components of thecampaign were invited to a personal interview. Data collection included gathering information about sociodemographics,family history of BC, the perceived personal risk for BC, awareness and attitude towardsBC genes and the women’s interest in BC genes testing. Results: Of the included women (n=599), 19.5%perceived higher risk for BC development, significantly more among < 40 years of age, and with positivefamily history of BC before 50 years of age. The participants demonstrated a poor level of awarenessregarding the inheritance, risk, and availability of BC genetic testing. The median summated knowledgescore was 1.0 (out of 7 points) with a knowledge deficit of 87.8%. The level of knowledge showed significantdecline with age (> 40 years). Of the included women 54.7% expressed an interest in BC genetic testingfor assessing their BC risk. Multivariate regression model showed that being middle aged (Odds Ratio‘OR’=1.88, confidence intervals ‘C.I’=1.14-3.11), with higher knowledge level (OR=1.67, C.I=1.08-2.57) andperceiving higher risk for BC (OR=2.11, C.I=1.61-2.76) were the significant positive correlates for Saudiwomen interest in BC genetic testing. Conclusion: Saudi women express high interest in genetic testingfor BC risk despite their poor awareness. This great interest may reflect the presence of inappropriateinformation regarding BC genetic testing and its role in risk analysis.     

Assessment of Risk Factors in Laryngeal Cancer in India : A Case- Control Study

Cancer of the larynx is fourteenth most common cancer in the world. Limited data are available from India on ‍associations with risk factors and hence the present hospital based matched case-control study was conducted. ‍Three hundred and five laryngeal cancer patients and an equal number of healthy controls matched for their age ‍within 2 years, sex and place of residence constituted the study population. A pre-tested, semi-structured questionnaire ‍was administered to each individual to elicit information on their socio-demographic profile, food habits and risk ‍factors and dietary consumption patterns. Univariate logistic regression analysis and multivariate forward stepwise ‍conditional logistic analysis were performed. In the univarite analysis a lower consumption of roots and tubers ‍green leaf vegetable other vegetables and fruits, and higher consumption of milk, eggs, meat, tea, alcohol , smoking, ‍consumption of betel leaf with tobacco as well as a preference for spicy and fried foods emerged as significant ‍positive variables. After adjusting for education, years of use of alcohol, smoking, chewing of betel leaf with tobacco ‍in the model, low green leafy vegetables and preference for spicy foods were found to be positively related to the risk ‍of laryngeal cancer. There was a significant difference in the dietary consumption patterns of laryngeal cancer ‍patients and controls, indicating a role for nutritional factors in the etiology of laryngeal cancer in the Indian ‍population. ‍     

No Detection of ‘High-risk’ Human Papillomaviruses in a Group of Iranian Women with Breast Cancer

The presence of viral DNA in breast cancer cells is controversial. However, some studies have revealed apossible role for the human papillomavirus in the pathogenesis of breast cancer. The aim of the present studywas to investigate the presence of HPV-DNA in breast tissue in a group of Iranian women with and withoutbreast cancer and identification of the detected HPV types. Paraffin-embedded specimens from 65 malignantbreast cancer cases and 65 cases with benign breast lesions were investigated for presence of HPV-DNA by nestedpolymerase chain reaction. We found HPV-DNA in 22 (33.8%) of the breast cancer specimens. All non-cancerousspecimens were negative. Low and high-risk HPV types, including HPV-6 (26.2%), HPV-16 (1.5%), HPV-35(1.5%), HPV-52 (1.5%), and HPV-11 (1.5%) were detected in our study. HPV-6 was the most prevalent typein the breast cancer specimens. Although high-risk HPV types have been shown to have a major role in cervixcancer, there have been no data that support the same relevance for other types of malignancies. Furthermore,presence of low-risk HPV types in malignancies still is a matter of debate. The data presented in this studyindicates a strong need for epidemiological studies correlating different HPV types in human breast cancer.     

A Case Control Study on Risk Factors for Stomach Cancer in Urban Shanghai

Objective To examine the possible risk factors for stomach cancer among men and women in Shanghai, China. Methods In urban Shanghai, in-person interviews were completed for 311 cases newly diagnosed with stomach cancer of ages 30 -74. Data were collected from April 1999 to October 1999 and compared to 1579 population-based controls (controls in three cancer studies used together). Information on demographic variables, smoking, diet consumption and others was collected from all subjects. Unconditional logistic regression was used to adjust the possible factors. Results Stomach cancer risk in men rose with smoking, eating hot and fried foods, chronic gastritis and a family history of gastric cancer among men; the risk among women was associated with the consumption of preserved, pickled and fried foods, heavy drinking, chronic gastritis, a history of ulcer disease and a family history of gastric cancer. A dose-response relationship was found (trends test,P<0.01) among men smokers. In contrast, the consumption of fresh vegetables and fruits, beans (especially soybeans) and soy products, plant oil, and eggs and egg products, was inversely associated with stomach cancer risk. After adjustment of the potential confounding variables, these associations remained significant. Conclusions The present findings provide further evidence that smoking, eating salted foods (especially salted vegetables), oil-fried foods(including fried cereal, eggs, and peanuts), chronic gastritis, a family history of gastric cancer and so on increase the risk of stomach carcinoma in Shanghai. Fresh vegetables and fruits, beans and soybean products (even after adjusted for use of fresh vegetables and fruits), plant oil, and so on may have protective effects.     

Dietary Habits and Breast Cancer Risk: A Hospital-Based Case–Control Study in Chinese Women

PurposeTo investigate the relationship between dietary habits and breast cancer (BC) risk in Chinese women.Patients and MethodsWe performed a hospital-based matched case–control study that included 654 BC cases and 654 healthy controls matched by age and residence. A qualified structured questionnaire was used to collect detailed sociodemographic factors and information about dietary habits. The odds ratios (ORs) and 95% confidence intervals were calculated with unconditional logistic regression analysis; the patients were grouped according to their estrogen receptor (ER) status and analyzed separately. The propensity score analysis was performed according to different postmenopause status.ResultsER-negative BC participants with intake of cured foods had increased BC risk (adjusted OR, 2.72, P = .017). Participants diagnosed as having ER-positive BC with intake of grilled foods had increased BC risk compared to those who did not consume such foods (adjusted OR, 2.14, P = .026). After propensity score analysis, fried (OR, 3.19, P = .001) and grilled (OR, 1.77, P = .031) food were considered to be risk factors for BC in premenopausal women; and fried (OR, 1.61, P = .006), grilled (OR, 4.62, P = .001), and smoked foods (OR, 2.28, P = .001) are considered risk factors for BC in postmenopausal women.ConclusionChinese women who ate cured, grilled, and fried foods had higher BC risk. Consumption of smoked food might contribute to increased BC risk in Chinese women.     

Breast Cancer Risk Assessment Using the Gail Model and It’s Predictors in Saudi Women

Background: The Gail Model has been widely implemented in developed and developing countries and is considered to be the best available instrument to estimate breast cancer (BC) risk for early prevention. Objective: The goals of the study were to determine five-year and lifetime BC risks and to assess BC predictors among female Saudi teachers using the Gail model. Methods: A cross sectional study with convenience sampling was conducted among 180 female Saudi secondary school teachers. The Gail model was used to evaluate the five-year and lifetime risks of developing BC. Included were a one-day 24-hour recall to assess daily serving sizes and food groups for food intake and questions regarding daily exercise, BMI, and demographic data. Result: The mean age of the teachers was 41±7.2 years, with a 0.87±0.93 mean for the five-year risk and a 9.6±5.4 mean lifetime risk of developing BC. According to the general linear model, the BC risk predictors were age, age at menarche, age at first pregnancy, family history, BMI, fruit and vegetable intake, and meat intake. Conclusion: The present study provided new information regarding the potential factors for five-year and lifetime invasive BC risk among Saudi women. Moreover, we could confirm that the Gail model is an appropriate BC risk assessment tool for Saudi women for early prevention, particularly among women at high risk of BC.