Promotion of Liver Lesion Development in the Syrian Hamster by Dietary Fat Following Multi-Organ Initiation is Inhibited by DHEA-S Administration

To obtain a relevant index of the impact of cancer on the Japanese population, considering curable cases as well asmortalities, the probability of developing cancer in the entire life span of a Japanese was estimated. A method basedon the cumulative risk of cancer was employed to estimate the probability. This cumulative risk method gave alifetime probability of developing cancer in any site of 52 % for males and 31 % for females in 1994 up to 85+ yearsof age. and for the average life expectancy of Japanese, 77 years for males and 84 years for females, 32 % and 26 %respectively. The estimated probabilities provide reasonable and practical indices of the impact of cancer today. Thismethod can be also applied to local estimation if population-based cancer registry data are available.     

Probabilities of Developing Cancer over the Life Span of a Japanese - Update

In a previous study, we investigated the probability of developing cancer in the entire life span of a Japanese ‍using population-based cancer incidence data from 1994, to obtain a relevant index of the impact of cancer occurrence ‍on the Japanese population (APJCP, 1: 333-336, 2000). In the present paper, we have updated the information using ‍the latest reports on cancer incidence in Japan in 1998. A method based on the cumulative risk of cancer was ‍employed to estimate the probability of developing cancer up to 84 years of age, the average life expectancy of a ‍Japanese female, and 79 years of age, the average life expectancy of a Japanese male. The time trend was also ‍analyzed from 1975-1998. The cumulative risk of developing cancer in any site up to 84 and 79 years of age was 45% ‍and 36% for males, 27% and 21% for females, and 35% and 28% for both genders, respectively. The cumulative ‍risk showed an increasing time trend before leveling-off after 1985. From our results, it is expected that nearly onethird ‍of Japanese males and one-fourth of Japanese females will develop cancer by the time they reach the average ‍life expectancy. ‍     

Impact of menstrual and reproductive factors on breast cancer risk in Japan: results of the JACC study

The incidence of breast cancer among Japanese women, a traditionally low-risk population, has increased substantially. To evaluate the association of reproductive factors with breast cancer risk, we examined 38,159 Japanese women, aged 40-79 years, who responded to a questionnaire on reproductive and other lifestyle factors from 1988 to 1990 in the Japan Collaborative Cohort Study. During an average 7.6 years of follow-up, we documented 151 incidents of breast cancers. Cox proportional hazards modeling was employed to estimate relative risks (RR) and 95% confidence intervals (CI). There was a significant decline in the risk of breast cancer with increasing parity among parous women (trend P=0.01). Women with four or more parities had a 69% lower risk than uniparous women, a reduced risk was also evident among menopausal women. Breast cancer risk tended to rise with increasing age at first delivery (trend P=0.05), the association being very apparent among menopausal women (trend P=0.02). Compared to the women who had their first delivery before age 25, those who delayed this event until after age 34 had an RR of 2.12 (95% CI: 0.72-6.21) and 3.33 (1.07-10.3) among the overall subjects and the menopausal, respectively. There was no apparent association of breast cancer risk with age at menarche or menopause. Our study concerning reproductive risk factors suggests that breast cancer in Japan is similar to that in Western countries, and that reproductive factors, particularly the number of parity and age at first delivery, might be important in the etiology of breast cancer among Japanese women.     

Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data

Cancer survivors are at excess risk of developing second primary cancers, but the precise level of risk in Japanese patients is not known. To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. The study subjects comprised all reported patients aged 0-79 years who were first diagnosed with cancer between 1985 and 2004 in Osaka and who survived for at least 3 months, followed-up through to December 2005. A metachronous second primary cancer was defined as any invasive second cancer that was diagnosed between 3 months and 10 years after the first cancer diagnosis. The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIR) of second primary cancer. Metachronous second primary cancers developed in 13,385 of 355,966 survivors (3.8%) after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among men than women (except for the 0-49 years age group), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer at 60-69 years of age (16.2% for men, 8.6% for women). The SIR among those with first cancer diagnosed at 0-39 and 40-49 years of age were 2.13 and 1.52, respectively, in both sexes, whereas the SIR among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships. We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared with the general population. Our findings indicate that second primary cancers should be considered as a commonly encountered major medical problem. Further investigations are required to advance our understanding to enable the development of effective measures against multiple primary cancers.     

Effect of body size on breast‐cancer risk among Japanese women

With the use of data from the hospital‐based epidemiologic research program at Aichi Cancer Center (HERPACC), the effect of body size on the risk of breast cancer was evaluated among Japanese women, who are generally leaner than white women. In total, 1,359 breast‐cancer cases were included, and 24,207 women, confirmed as free of cancer, were recruited as a reference group. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by multiple‐logistic regression analysis. Separate analyses were performed for pre‐ and post‐menopausal women. Furthermore, stratification by decade of age was done to evaluate the effect of body size on the development of breast cancer. The results obtained from the present study were as follows. (1) Current body‐mass index (BMI) was positively associated with post‐menopausal breast cancer (OR 2.08, 95% CI 1.49–2.92 for highest quintile vs. lowest), although higher BMI did not affect the risk in pre‐menopausal women. (2) Estimates of risk were below unity for BMI at around age 20 in post‐menopausal women. (3) After stratifying BMI at around age 20, gaining BMI in later life was positively associated with increased risk, regardless of BMI in early life. These findings suggest that avoidance of marked weight gain during adult life, especially after natural menopause and/or after age 60, may reduce the risk of breast cancer. Int. J. Cancer 80:349–355, 1999. © 1999 Wiley‐Liss, Inc.     

Lifetime and age-conditional probabilities of developing or dying of cancer in Japan

The concepts of lifetime and age-conditional probabilities of developing and dying of cancer are introduced as indexes to understand the risk of cancer. In this paper, we estimated the lifetime and age-conditional probabilities of developing and dying of cancer in 2001 and 2005, respectively, in Japan. It is estimated that one in two Japanese males and one in three females will develop cancer, and one in four Japanese males and one in six females will die of cancer. Moreover, the probabilities of developing cancer within specific decades of age are obtained as the short-term risks.     

Systemic therapy for older women with breast cancer

Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient's wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols.     

Clinical and epidemiological issues in mammographic density

High mammographic density is associated with an increased risk of breast cancer, and of all known breast cancer risk factors has the greatest attributable fraction. Mammographic density is estimated to account for 16% of all breast cancers, but can be altered by endogenous and exogenous hormonal factors, and generally declines with age. Confounding factors such as age, parity, menopausal status and BMI make the interpretation of mammographic density particularly challenging. Furthermore, none of the established means of measuring mammographic density are entirely satisfactory because they are time consuming or subjective. It is hoped that by adding information regarding mammographic density to existing models of breast cancer risk assessment, the accuracy of individual risk assessments can be improved. Although mammographic density has clearly been shown to be a powerful factor for predicting the risk of developing breast cancer, its potential role in assessing hormonal preventive regimens and helping to tailor screening algorithms cannot be fully realized until we have more-precise, simple and reproducible density measures.     

Risk factors for breast cancer in Japan, with special attention to anthropometric measurements and reproductive history

BACKGROUND: Breast cancer incidence has increased rapidly in Japan recently, but there have been only a few studies on the risk factors for breast cancer in Japan. A case-control study was conducted to evaluate the roles of anthropometric and reproductive factors in the etiology of breast cancer in Osaka. METHODS: Based on information from a self-administered questionnaire at Osaka Medical Center for Cancer and Cardiovascular Diseases, body mass index, body weight and height were compared between 376 cases and 430 controls, together with other factors such as age at menarche, age at first delivery and family history of breast cancer by menopausal status. Logistic regression analysis was employed for adjusting confounding factors and estimating odds ratios with their 95% confidence interval for breast cancer. RESULTS: A body mass index of >25 was significantly associated with the risk among post-menopausal women (age-adjusted odds ratio: 1.90, 95% confidence interval: 1.10-3.24) as compared with the risk for a body mass index of < or = 20. A weight of > or =58 kg showed significantly increased risk compared with a weight of < or = 47 kg among post-menopausal women (1.83, 1.10-3.01), while height of > or = 159 cm showed a significantly elevated risk than height of < or = 149 cm among pre-menopausal women (2.51, 1.17-5.39). Age at menarche of < or = 13 years resulted in a higher risk of breast cancer among post-menopausal women, while age at first delivery of > or = 28 years was associated with the risk among pre-menopausal women. Family history of breast cancer was associated with the risk for breast cancer. CONCLUSIONS: These results were all very consistent with findings observed in western countries.     

Comparisons of two breast cancer risk estimates in women with a family history of breast cancer.

There is an increasing need for accurate prediction methods of assessing individual risk for breast cancer for both clinical and research purposes. The purpose of this study is to compare the Gail and Claus model risk estimates of breast cancer among women with a family history of breast cancer. This study presents risk estimates from two models of breast cancer risk in 491 women 18 to 74 years of age with a family history of breast cancer who were recruited to risk counseling clinical trials in Seattle, Washington between 1996 and 1997. These trials included women from the general population and additional samples of Ashkenazi Jewish, African-American, and lesbian women. We estimated and compared lifetime (to age 79) and 5-year risk for developing breast cancer using the National Surgical Adjuvant Breast and Bowel Project adaptation of the Gail model and the Claus model. About one-quarter of participants fell into the Gail "high" risk category (> or =1.7% risk of developing breast cancer in the next 5 years). The average lifetime risk was estimated at 13.2% by the Gail model and 11.2% by the Claus model. Estimates from the two models were moderately and positively correlated (r = 0.55) with the Gail model yielding a higher estimate than the Claus model for most participants. If women with a family history of breast cancer are being counseled regarding decisions on genetic testing, tamoxifen use, or other preventive measures, presenting both Claus and Gail estimates may be the best option.     

Interest in breast cancer chemoprevention among older women

Objectives: The study aim is to describe interest in breast cancer chemoprevention among older women without a history of breast cancer and to determine whether aging-related factors such as diminished life expectancy, increasing comorbidity and medication burden attenuate chemoprevention interest. Design: Cross-sectional survey. Setting: University of Pennsylvania Health System. Participants: Four-hundred fifty-seven community-dwelling women aged 60–65 years old who were potentially eligible for breast cancer chemoprevention according to guidelines linking risk and eligibility to age. Measurements: Interest in breast cancer chemoprevention, Gail model breast cancer risk, perceived breast cancer risk, breast cancer worry, self-reported health status and comorbidities, and self-reported perceived life expectancy. Results: Of 457 participants, 11.2% reported being interested in taking chemoprevention, 40.9% reported no interest, and 47.9% reported being unsure about their interest in chemoprevention. Overall, interest in chemoprevention was not associated with individual Gail model breast cancer risk. In adjusted analysis, lack of interest among high-risk women was associated with low breast cancer worry and low perceived risk. Conversely, interest in chemoprevention among low risk women was associated with greater breast cancer worry. Age-related factors hypothesized to affect chemoprevention interest, including subjective life expectancy, increased comorbidity, and number of daily medications did not attenuate chemoprevention interest. Conclusion: Breast cancer worry and perceived breast cancer risk contribute to the lack of correlation between interest in breast cancer chemoprevention and objective breast cancer risk. Perceived life expectancy, increased comorbidity, and medication burden do not attenuate chemoprevention interest among older women.     

Does Life Expectancy Affect Treatment of Women Aged 80 and Older with Early Stage Breast Cancers?

BACKGROUND: Data are needed on how life expectancy affects treatment decisions among women ≥80 years with early stage breast cancer. METHODS: We used the linked Surveillance Epidemiology and End Results-Medicare claims dataset from 1992-2005 to identify women aged ≥80 newly diagnosed with lymph node negative, estrogen receptor positive tumors, ≤5 centimeters. To estimate life expectancy, we matched these women to women of similar age, region, and insurance, not diagnosed with breast cancer. We examined 5-year mortality of matched controls by illness burden (measured with the Charlson Comorbidity Index [CCI]) using Kaplan-Meier statistics. We examined treatments received by estimated life expectancy within CCI levels. We further examined factors associated with receipt of radiotherapy after breast conserving surgery (BCS). RESULTS: Of 9,932 women, 39.6% underwent mastectomy, 30.4% received BCS plus radiotherapy, and 30.0% received BCS alone. Estimated 5-year mortality was 72% for women with CCIs of 3+, yet 38.0% of these women underwent mastectomy and 22.9% received radiotherapy after BCS. Conversely, estimated 5-year mortality was 36% for women with CCIs of 0 and 26.6% received BCS alone. Age 80-84, urban residence, higher grade, recent diagnosis, mammography use, and low comorbidity, were factors associated with receiving radiotherapy after BCS. Among women with CCIs of 3+ treated with BCS, 36.9% underwent radiotherapy. CONCLUSIONS: Many women aged ≥80 with limited life expectancies receive radiotherapy after BCS for treatment of early stage breast cancers while many in excellent health do not. More consideration needs to be given to patient life expectancy when considering breast cancer treatments. KEY WORDS: Breast cancer, older women, treatment, life expectancy, radiation.     

Swedish studies link hormone use to higher breast cancer risk

2 more reports on heightened risk of breast cancer in certain subsets of oral contraceptive and menopausal estrogen-progestin users have appeared from Sweden, in addition to 3 studies published in early 1989 that prompted the U.S. F.D.A. to re-evaluate its warning labels on pill packages inserts. The 1st study on 10 cases among 23,244 women from Uppsala found that women who took hormone replacement therapy briefly for menopausal symptoms had a 10% increased risk of breast cancer, while those taking hormones for 9 years or more had a 70% higher risk. The report estimated that women using combined estrogen-progestins for 6 years or more had a 4.4-fold risk of breast cancer appearing in the pre- menopausal age group. Women who used pills 5 or more years before the age of 25 had a 5.3-fold risk of breast cancer. Those using for 8 or more years before the 1st pregnancy had a 2.0-fold risk. These data analyzed 174 pre-menopausal women diagnosed with breast cancer in the early 1980s, and included many women who began pills in the 1960s. The author noted that we have no studies yet on the modern, lower-dose oral contraceptive pills.     

Reproductive factors,exogenous female hormone use and breast cancer risk in Japanese: the Miyagi Cohort Study

The incidence of breast cancer among Japanese women is substantially increasing. This population-based prospective cohort study in Japan evaluated the associations of reproductive factors and exogenous female hormone use with breast cancer risk, both overall and separately among premenopausal and postmenopausal women. A total of 24,064 women aged 40–64 were followed from 1990 to 2003. During 309,424 person-years of follow-up, 285 breast cancer cases were documented. In overall evaluation, nulliparity was significantly associated with an increased risk of breast cancer. There was a significant decrease in risk with increasing parity number among parous women (trend P = 0.008). No association was observed between age at menarche or age at first birth and breast cancer risk. Neither oral contraceptive (OC) use nor the use of exogenous female hormones other than OC was associated with breast cancer risk. The evaluation according to menopausal status revealed that nulliparity and parity number were significantly related to breast cancer risk only among postmenopausal women. Later age at natural menopause was associated with an increased risk of breast cancer among postmenopausal women (trend P = 0.02). Our findings suggest that parity number and age at menopause have great effects on breast cancer risk among Japanese women.     

Cancer patterns among Koreans in Japan, Koreans in Korea and Japanese in Japan in relation to life style factors

Cancer incidences for major sites were compared among Koreans in Osaka, Japan, Koreans in Korea and Japanese in Osaka by calculating standardized proportional incidence ratios (SPIR's), in addition to updating the findings on cancer mortality experiences of Koreans and Japanese in Osaka reported before. Compared with Japanese, Koreans in Osaka had significantly higher mortality rates from cancers of the esophagus, liver and lung in males, and liver in females. Mortality rates among Koreans in Osaka were significantly lower for stomach cancer in both sexes and for breast cancer in females. Compared with Korean counterparts in the homeland, Koreans in Osaka had a reduced risk for cancers of the stomach in males and the uterus in females. On the other hand, an elevated risk was observed for cancers of the esophagus, colon, liver and lung among Korean males in Osaka and for cancers of the colon and liver among Korean females in Osaka. The risk for cancer of the breast in females was similar among Koreans in the host and home countries. These different cancer patterns among Koreans in the host and home countries and Japanese are discussed in relation to their life styles, such as smoking, drinking and dietary habits, which have been investigated by means of questionnaire surveys.     

Should menopausal women at increased risk for breast cancer use tamoxifen,raloxifene, or hormone therapy?: A framework for personalized risk assessment and counseling

Background. Menopausal women with a family history of breast cancer have several treamment options, including tamoxifen, raloxifene, and hormone therapy. This complex decision should be based on each woman’s risk to develop breast cancer, menopausal symptoms, preferences, and risks for other conditions. Current models in use do not include pedigree analysis, personalized risk assessment, or genetic testing in this process.Methods. We created a personalized risk assessment and genetic counseling intervention for healthy women with a first-degree relative with breast cancer. Participants were given a personalized risk assessment for breast cancer, heart disease, osteoporosis, and uterine cancer based on family history and personal health data.Counseling Model. The effectiveness of this novel genetic counseling intervention was demonstrated in a randomized trial and these results are published elsewhere. The framework for this counseling model, with case examples from the clinical trial, is outlined in this article.Conclusions. As more menopausal therapies are developed, each with its own risks and benefits, it will become even more critical to have a personalized counseling model for use in this process. Clinicians and educators can utilize the framework presented here for counseling women with a family history of breast cancer.     

Assessment of the Risk of Breast Cancer Development Applying NCI Tool among Iraqi Women

Objective: As part of the bioinformatics studies, we utilized National Cancer Institute (NCI)’s Breast Cancer Risk Assessment Tool to estimate the five-year period and lifetime risk of breast cancer development among Iraqi risky women. Methods: Totally, 110 risky women aged 21-67 (mean=36±7.4) years were interviewed by a series of questions regarding the risk of breast cancer development. Moreover, 100 cases with mutation in the BRCA1 or BRCA2 genes were included. Results: Our results demonstrated that the patient’s estimated risk of breast cancer development during the next five years and lifetime (until the age 90 years) included 0.96% (p=0.211) and 9.97% (p=0.002), respectively being relatively low. Accordingly, the lifetime risk for the breast cancer development was significantly higher (10.38%) than that of 5-year. However, the age of patients was not significantly associated to the breast cancer development as there was no significant difference among various age groups. Conclusion: It was concluded that long-term or lifetime period plays as a significant risk factor for developing breast cancer among female patients who had had a screening episode in Iraq.     

The average cumulative risks of breast and ovarian cancer for carriers of mutations in BRCA1 and BRCA2 attending genetic counseling units in Spain.

PURPOSE: It is not clear that the published estimates of the breast and ovarian cancer penetrances of mutations in BRCA1 and BRCA2 can be used in genetic counseling in countries such as Spain, where the incidence of breast cancer in the general population is considerably lower, the prevalence of BRCA2 mutations seems to be higher, and a distinct spectrum of recurrent mutations exists for both genes. We aimed to estimate these penetrances for women attending genetic counseling units in Spain. EXPERIMENTAL DESIGN: We collected phenotype and genotype data on 155 BRCA1 and 164 BRCA2 mutation carrier families from 12 centers across the country. Average age-specific cumulative risks of breast cancer and ovarian cancer were estimated using a modified segregation analysis method. RESULTS: The estimated average cumulative risk of breast cancer to age 70 years was estimated to be 52% [95% confidence interval (95% CI), 26-69%] for BRCA1 mutation carriers and 47% (95% CI, 29-60%) for BRCA2 mutation carriers. The corresponding estimates for ovarian cancer were 22% (95% CI, 0-40%) and 18% (95% CI, 0-35%), respectively. There was some evidence (two-sided P = 0.09) that 330A>G (R71G) in BRCA1 may have lower breast cancer penetrance. CONCLUSIONS: These results are consistent with those from a recent meta-analysis of practically all previous penetrance studies, suggesting that women with BRCA1 and BRCA2 mutations attending genetic counseling services in Spain have similar risks of breast and ovarian cancer to those published for other Caucasian populations. Carriers should be fully informed of their mutation- and age-specific risks to make appropriate decisions regarding prophylactic interventions such as oophorectomy.     

No increase of breast cancer incidence in Japanese women who received hormone replacement therapy: overview of a case-control study of breast cancer risk in Japan

Hormone replacement therapy (HRT) has been considered one of the main risk factors for breast cancer. Studies demonstrating the relationship between HRT and breast cancer incidence were conducted in Western countries and the target populations were mainly Caucasians. Since the Women’s Health Initiatives demonstrated that HRT increased the risk of breast cancer with statistical significance, the number of HRT users in the United States has dramatically decreased. A recent case-control study has investigated the relationship between HRT and breast cancer in Japan, and here we review the results of this study to compare any discrepancy in breast cancer risk between Japanese and Western populations. For this case-control study, at seven institutions, women between the ages of 45 through 69 years, with histologically confirmed breast cancer, were selected as the case group. An age-adjusted control group was selected, using hospital-based data, including records of those screened for lung, gastrointestinal, and gynecological cancer. Questionnaires were administered, and items questioned included various factors related to the incidence of breast cancer: age at diagnosis, body mass index (BMI), smoking habit, age at menopause, birth history, number of births, number of children, history of breast feeding, familial background, and menopausal status. In total, 6183 samples (98.4% of the estimated samples) were put into the database. Data from 276 samples were excluded due to ineligibility. Finally, 5861 samples (3434 cases and 2427 controls) were analyzed. In 3316 cases, 164 (5.0%) patients received hormone-replacement therapy (HRT); on the other hand, 253 (10.7%) of 2355 controls received HRT. The odds ratio was 0.432 (95% confidence intervals [CI], 0.352–0.53), and there was a significantly negative correlation between HRT use and breast cancer. The risk factors in Japanese women showed similar profiles to those in women in Western countries. However, we did find some different profiles of breast cancer risk in the Japanese women. Changing of lifestyle may increase breast cancer risk in Japan.     

Hormonal factors and the risk of breast cancer according to estrogen- and progesterone-receptor subgroup.

Evidence suggests hormonal factors may be more strongly associated with estrogen receptor+progesterone receptor+ (ER+PR+) than ER-PR- breast cancer risk. This study evaluated risk factors according to ERPR tumor status among pre- and postmenopausal women participating in two recent population-based case-control studies. Breast cancer cases, ages 25-74 years, and diagnosed 1995-1998 were sampled from the Ontario Cancer Registry. Controls were a random sample of women identified using the Ontario Ministry of Finance rolls and were frequency-matched to cases within 5-year age groups. Epidemiological data were collected from breast cancer cases and controls using two self-administered questionnaires. ERPR data were obtained for 87% of the breast cancer cases (3,276 of 3,748). Multivariate polytomous logistic regression was used to obtain odds ratios estimates and 95% confidence intervals. The following significant differences were observed in the risk factor profiles for ER+PR+ and ER-PR- breast cancer: among premenopausal women, late age at menarche was only associated with a reduction in ER+PR+ breast cancer risk; obesity was associated with an increased ER-PR- and decreased ER+PR+ cancer risk; and the association between alcohol intake and breast cancer risk was heterogeneous across ERPR subgroups, although the direction varied across the levels of alcohol intake. Among postmenopausal women, there were no statistically significant differences observed in the risk factor profiles for ER+PR+ and ER-PR- breast cancer. Some heterogeneity exists in the risk factor profiles of ER+PR+ and ER-PR- premenopausal breast cancer; however, risk factor profiles did not differ markedly for postmenopausal breast cancer.