月经生育因素与乳腺癌关系的Meta分析

[目的]运用Meta分析方法综合分析评价月经生育因素与中国女性乳腺癌的关系。[方法]收集国内有关乳腺癌月经生育因素的病例对照研究文献22篇,采用可信区间方差分析法计算各相关因素的ORc及95%CI。[结果]各研究因素的ORc及95%CI分别为:初潮年龄ORc=0.540(0.450～0.648)、结婚年龄1.376(0.815～2.322)、初产年龄1.558(1.253～1.937)、生育与否0.718(0.320～1.616)、生育胎数0.97(0.705～1.335)、哺乳0.391(0.253～0.605)、哺乳时间0.94(0.884～0.999)、人工流产1.844(1.442～2.358)、绝经与否1.869(1.014～3.444)、绝经年龄1.034(0.706～1.515)、行经期1.223(1.034～1.446)、月经紊乱3.217(2.278～4.542)、月经周期0.446(0.372～0.535)、口服避孕药1.400(0.977～2.006)。[讨论]初潮年龄、哺乳和哺乳时间是乳腺癌的保护因素,初产年龄、人工流产、绝经及行经期是乳腺癌的危险因素,结婚年龄、生育、生育胎数、绝经年龄、月经紊乱、月经周期和口服避孕药与乳腺癌关系尚不明确,有待进一步研究。     

建德地区166例30～70岁女性乳腺癌发病影响因素调查

目的分析建德地区30～70岁女性乳腺癌发病影响因素,为女性乳腺癌防治提供参考。方法选取2017年7月-2019年4月在该院就诊且经组织病理检查证实为乳腺癌的166例患者为观察组,另选取同期在该院健康体检的正常健康女性166例为对照组。调查两组研究对象基本资料,包括乳腺癌家族史、生育史、既往月经状况、服药情况及乳腺疾病状况等。结果两组研究对象在生育史、初产年龄、哺乳史、流产史、初潮年龄、自然绝经年龄、行经时间、家族史、使用激素类药物、既往乳腺疾病史方面比较,差异均有统计学意义(均P0. 05)。经调整年龄和绝经状态等因素后,多因素分析结果显示,乳腺癌家族史、服用激素类药物、既往存在乳腺疾病史及初潮初产间隔时间长是女性发生乳腺癌的高危因素(均P0. 05);而生育史、哺乳史及初潮年龄晚是女性发生乳腺癌的保护性因素(均P0. 05)。以绝经状态进行分析,绝经女性中,初潮年龄晚、有生育史及无流产史是女性发生乳腺癌的保护性因素(均P0. 05);未绝经女性中,初潮初产间隔时间超过17年是发生乳腺癌的高危因素(P0. 05)。结论女性发生乳腺癌的影响因素较多,包括乳腺癌家族史、既往存在乳腺疾病史和初潮年龄等,生育史和哺乳史是有效保护女性的重要因素,因此可加强宣教,鼓励女性尽早母乳喂养,降低乳腺癌发病率,同时做好健康体检,做到早发现、早治疗。     

深圳市宝安区女性乳腺癌发病情况及危险因素的调查分析

目的了解及掌握深圳市宝安区女性人群乳腺癌的发病情况及其危险因素，以便确定高危人群，为制定预防措施提供科学依据。方法对2004—2007年累积观察的7518名女性乳腺病人中乳腺癌患者的数量、年龄进行了统计分析。将232例经病理证实的乳腺癌患者同非乳腺癌患者进行1：1配对病例对照研究。研究其妇科史、肿瘤家族史、乳腺良性疾病史、服用避孕药物史、吸烟史及饮酒史等。结果本地区该病的多发年龄为40-60岁，20-29岁妇女中也发现乳腺癌病患者。提示该病的流行出现年轻化倾向良性。乳腺疾病史、肿瘤家族史、流产次数多、服避孕药及被动吸烟是乳腺癌的危险因素，而哺乳是保护因素。月经初潮年龄、第一胎生育年龄及饮酒嗜好与乳腺癌发生无相关性。结论深圳宝安区女性乳腺癌流行出现年轻化倾向，重要危险因素为良性乳腺疾病史、肿瘤家族史及流产次数多。     

三招预防乳腺癌

正乳腺癌发病率越来越高,而且年轻化趋势越来越明显,是名副其实的"红颜杀手"。怎样才能预防乳腺癌?想要预防乳腺癌,先要知晓乳腺癌发病的风险因素。目前比较得到认可的乳腺癌危险因素主要包括:不育或未育、生育次数少、第一胎足月产年龄晚(大于30岁)、月经初潮年龄小、绝经年龄晚、有良性乳腺疾病(乳腺囊性增生病等)、乳腺癌家族史、一     

女性乳腺癌疾病状况及乳腺癌发生危险因素分析

[目的]了解以及掌握某地区女性乳腺癌疾病的发病情况和危险因素,对高危人群及时确定,为及时有效的预防措施提供科学的依据。[方法]对某院自2002年6月～2010年10月积累观察的546名女性乳腺病患者的确诊数量、年龄进行统计分析,同时将148例经病理学证实的乳腺癌患者与非乳腺癌患者进行1︰1的配比病例对照性研究。研究包括妇科史、肿瘤家族史、精神创伤、乳腺良性疾病史、服用避孕药物史、吸烟、饮酒史等。[结果]该地区乳腺癌的多发年龄为38～58岁,20～29岁妇女中亦发现乳腺癌患者,该病的流行出现年轻化趋势。哺乳是降低乳腺癌患病几率的保护因素;乳腺疾病史、肿瘤家族史、流产次数多、服用避孕药物以及被动的吸烟是患乳腺癌的危险因素。而月经初潮年龄、生育第一胎的年龄以及饮酒嗜好与乳腺癌的发生无相关性。[结论]该地区女性乳腺癌的发病有逐渐年轻化的趋向,重要危险因素为患有乳腺疾病史、肿瘤家族史以及流产次数多。     

无锡地区女性乳腺癌危险因素的病例对照研究

[目的]调查无锡地区女性乳腺癌危险因素,为确定高危人群、提出预防措施提供依据。[方法]采用以医院为基础的病例对照研究,对无锡地区经病理证实的223例乳腺癌患者,按照年龄和地区匹配,选取对照223例进行统一的问卷调查,用SPSS13.0软件进行单因素和多因素Logistic分析。[结果]在单因素分析中,达到显著性水平的危险因素为女性良性生殖系病史、胆固醇高、初潮年龄小、绝经年龄晚、行经期≥35年、有绝经症状、末次怀孕年龄晚、BMI≥25、近几年有精神创伤与压抑、被动吸烟、每月家用油量高等,达到显著性水平的保护因素为40岁前卵巢摘除、经常锻炼及有饮茶习惯。条件Logistic多元回归分析显示,有统计学意义的乳腺癌危险因素是女性良性生殖系病史、精神创伤与压抑、被动吸烟,重要保护性因素是40岁前卵巢摘除。[结论]无锡地区女性乳腺癌发病重要危险因素为良性乳腺疾病史精神、创伤与压抑及被动吸烟。     

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。     

152例乳腺癌患者发病危险因素调查

目的 探讨乳腺癌发病相关危险因素.方法 采用自拟乳腺癌患者发病危险因素调查表调查152例乳腺癌患者发病相关危险因素.结果 152例患者乳腺癌发病年龄以40～60岁为主,且初潮年龄在12岁以下者、初次足月产年龄在35岁以后者、绝经年龄55岁以上者、高脂低膳食纤维饮食者、肥胖者、有电离辐射等职业接触者多见.既往有乳腺良性病变患者乳腺癌远处转移率显著升高(χ2=23.53,P<0.001).结论 40～60岁妇女、初潮年龄提前(小于12岁)、初产年龄晚(大于35岁)、绝经晚(大于55岁)、喜食高脂低膳食纤维食物、肥胖、有电离辐射等职业接触及既往有乳房良性病变均属于乳腺癌发病相关危险因素.     

口服避孕药与乳腺癌

服口服避孕药(OC)者发生乳腺癌的相对危险性,多年来存在争论。争论与下列因素有关:月经初潮年龄、开始服OC 的年龄、在第一次足月妊娠前或后、服OC 时间的长短、有无良性乳腺病史及OC 所含雌激素及孕激素的剂量等。     

武汉地区女性乳腺癌危险因素的病例对照研究

目的 探讨武汉地区女性乳腺癌的危险因素及其变化情况。方法 以病例对照研究方法,对经病理确诊的213例乳腺癌患者及430例匹配对照进行危险因素的条件logistic回归分析。结果 单因素分析显示:文化程度、乳腺良性肿瘤、初潮年龄、绝经年龄、肉类摄入量、油炸烧烤食物摄入、豆类食品摄入、水果摄入、哺乳时间。体重指数、10～19岁胸透次数、精神心理因素等28项因素与乳腺癌的危险性有关。联合多因素及分组多因素条件1ogistic回归分析显示:文化程度高、精神创伤、乳腺良性肿瘤史、绝经晚、行经年数和初产前行经年数长、体重指数高、常食油炸烧烤和烟熏腊制食物为乳腺癌的危险因素;初潮晚、哺乳时间长、豆类或水果摄入量高、常饮茶为保护因素。绝经前与绝经后的危险因素种类及效应强度有一定差别。经多因素分析,绝经前主要相关因素为乳腺良性肿瘤、初潮年龄、豆类摄入量;绝经后主要与绝经年龄、体重指数、腰臀比和水果摄入量有关。另外,精神创伤及哺乳时间为绝经前后共同的危险因素和保护因素。结论 武汉地区女性乳腺癌危险因素中,饮食习惯和内源性雌激素暴露等相关因素起着重要作用。     

福州市妇女乳腺癌危险因素的病例对照研究

「目的」探讨福州市妇性乳腺癌的危险因素。「方法」对近２年在福州市各大医院进行手术并经病理确诊为乳腺癌的１４５名患者开展１：１配对的病例对照研究。资料使用Ｅｐｉ－Ｉｎｆｏ软件和ＳＡＳ６．０４版软件进行统计分析。「结果」采因素分析,达到统计学显著性水平的危险因素有乳腺良性疾病史、ＢＭＩ指数高、初潮年龄早、肿瘤家庭史、初产年龄大、流产次数多、未产年龄大和行经时乳房涨痛。哺乳和饮用井水是保护因素。条件Ｌｏ     

Pre- and postmenopausal breast cancer

It has been postulated that breast cancer is not a single disease, and that the risk factors occurring in premenopausal women are different from those occurring in postmenopausal women. This case-control study of pre- and postmenopausal breast cancer was designed to investigate a variety of variables including age of menarche, parity, age at first full-term birth, breast feeding patterns, age at menopause, and history of oral contraceptive use. The study compared 60 breast cancer cases and 125 matched controls from the same breast cancer screening population. Cases and controls were matched for race, age, place of birth, marital status, education, and annual family income. More cases than controls used oral contraceptives; the differences were statistically significant. The risk ratio estimates were 2.9 (confidence intervals 1.19-7.15). The mean duration of oral contraceptive use was more than two times longer among premenopausal breast cancer cases than controls and five times longer among postmenopausal cases than the controls. The breast cancer cases had significantly more relatives with a history of other cancers than the control group (risk ratio estimate 2.3, P < 0.03). No association was found between height and breast cancer; however, cases were found to be significantly heavier than controls. No differences were found in reproductive variables between breast cancer patients and their matched controls. In addition, a subdivision of breast cancer cases into pre- and postmenopausal groups did not reveal any clear differences in reproductive variables that would support the hypothesis that different specific risk factors are operating during pre- and postmenopausal periods.     

Relationship of blood prolactin levels and the risk of subsequent breast cancer.

Between 1968 and 1976 a total of 5162 women volunteers were enrolled into a prospective study conducted on the Island of Guernsey. Up to February 1990 145 women subsequently developed breast cancer. Blood samples were taken at the time of enrollment and prolactin levels were known for 85% of the volunteers. In calculating the relationship between blood prolactin levels and subsequent breast cancer risk, women were excluded if they had a hysterectomy or an oophorectomy or had cancer at any site before enrollment. The final analysis was based on 2596 premenopausal and 1180 naturally postmenopausal women and, of these respectively, there were 71 and 40 volunteers who subsequently developed breast cancer. The total follow-up for these two groups was 49,941 and 22,360 woman-years, respectively. In assessing the relationship between blood prolactin levels and risk of subsequent breast cancer the cohort was divided into quintiles according to prolactin concentration and relative risks (RR) were estimated. In calculating these values possible confounding by age at entry, age at menarche, parity, age at first birth, years since menopause, body build, history of benign breast disease and family history of breast cancer were taken into consideration. There was no significant relation between risk of breast cancer and prolactin in either pre- or postmenopausal women. Hence prolactin appears not to be an important determinant of breast cancer risk.     

A pilot study of mammographic density patterns among Japanese women.

Mammographic density patterns, which refer to the distribution of fat, connective, and epithelial tissue in the healthy female breast, have been shown to be related to breast cancer risk. We used a quantitative method to assess mammographic densities in 41 mammograms from women in Japan without a diagnosis of breast cancer. Information about reproductive behavior and family history for breast cancer was available from a questionnaire. The statistical analysis applied Spearman correlation coefficients and multiple linear regression. The breast size as measured on the cranio-caudal view of the mammogram was approximately 12% larger, the size of the dense areas was 20% smaller, and the mean percent mammographic densities were 30% greater among premenopausal than among postmenopausal women. We found a strong relation between age at menarche and mammographic densities in premenopausal women and significant associations for age, family history of breast cancer, and age at menopause with mammographic densities in postmenopausal women. These preliminary data will be used to plan a future study that will compare mammographic density patterns and the relative importance of dietary, reproductive, and anthropometric factors between women in Japan and in the United States.     

胰岛素样生长因子-Ⅰ在绝经前后乳腺癌患者血清中的表达及临床意义

目的:探讨绝经前后乳腺癌患者血清中胰岛素样生长因子-I(IGF-I)的表达及临床意义。方法:采集68例乳腺癌患者(绝经前43例,绝经后25例),22例乳腺良性疾病(绝经前15例,绝经后7例),16例健康体检者(绝经前9例,绝经后7例)血液样本,用酶联免疫吸附法检测乳腺癌组、乳腺良性疾病组及正常对照组血清IGF-I的浓度。结果:乳腺癌组血清中IGF-I含量高于乳腺良性疾病组和正常对照组(P<0.05);乳腺良性疾病组与正常对照组无统计学差异(P>0.05);乳腺癌组血清中IGF-I浓度绝经前高于绝经后(P<0.05)。结论:IGF-I在乳腺癌患者中具有高表达趋势,并且绝经前乳腺癌患者血清IGF-I浓度高于绝经后。提示IGF-I可能在乳腺癌的发生和演变中起重要作用。     

Relationship of mammographic parenchymal patterns with breast cancer risk factors and risk of breast cancer in a prospective study

A prospective study has been conducted on 4954 female volunteers from the Island of Guernsey between 1977 and 1985 to examine risk factors for breast cancer and their relationship to mammographic parenchymal patterns as assessed by Wolfe's method of grading. Up to September 1988, 69 women had developed breast cancer, 11 of whom were prevalent cases being diagnosed within six months of mammography. The remaining incident cases were diagnosed six to 126 months (median 65 months) after entry to the study. Univariate analysis showed that the distribution of Wolfe grades in the population was significantly associated with menopausal status, age, parity, adiposity, age at menarche, age at first childbirth and use of oral contraception, but not with a family history of breast cancer. Multivariate analysis of the data for these variables from either pre- and/or post-menopausal women indicated that age, parity and adiposity were significantly related to Wolfe grade pattern. Age had an opposite effect in pre- compared with postmenopausal women thus the probability of either a P2 or DY pattern increased with increasing age in premenopausal but decreased in postmenopausal women so that incidence peaked around the menopause. Other variables did not achieve significance in the multivariate analysis. Odds ratios (ORs) were calculated for women with P2 or DY patterns using those with N1 or P1 grades as the reference group. The ORs were determined at two censoring times; one at five years and the other to include the most recent follow-up of this cohort. The ORs were adjusted for years of follow-up, age and adiposity and in postmenopausal women adjustment was also made for age at menarche.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relationship between risk factors for breast cancer and hormonal status

A total of 512 breast cancer patients and 540 controls were compared to examine the risk factors for different categories of breast cancer as defined by age, menopausal status and estrogen receptor (ER) tumor status. Significant differences were found by menopausal status, for age at first birth and age at menarche for all women, and for age at first birth and family history for women between 45 and 54 years old. No significant differences were found with ER status alone; however there was a significant difference between ER status and body weight in premenopausal women; the above significant differences with menopausal status were not found when stratified by ER tumour status. These findings support the hypothesis for aetiological differences for pre- and postmenopausal breast cancer and suggest that ER tumour status may influence the risk associated with body weight.     

Heterogeneity of the effect of family history on breast cancer risk

We studied the effects of family history on breast cancer risk among 2,908 cases and 3,180 controls, selected from participants in a nationwide screening project. First-degree family history was associated with a twofold risk increase. Second-degree family history effects were minimal, after adjusting for effects of first-degree relatives. Family history effects were not confounded by age at menarche, age at first full-term birth, age at natural menopause, or previous benign breast disease. Risks from mother's and sister's history were independent. The odds ratio (OR) from a maternal history, 1.9 (95% confidence interval [CI]: 1.6-2.3), varied little by the subject's age at diagnosis, menopause status, or disease laterality. Interactions of maternal history effects with multiple breast biopsies and age at menopause were greater than additive, indicating common mechanistic pathways. The OR from a sister's history was 2.3 (95% CI: 1.9-2.8) and was increased among women who were less than 45 (OR = 6.9), had bilateral disease (OR = 4.7), or were premenopausal (OR = 4.4). The effects from a mother's history and a sister's history are modified in different directions by different factors, providing further indication of the separate roles of a mother's and sister's history in breast cancer etiology.     

Lactation and breast cancer. Evidence for a negative association in premenopausal women

The authors report a case-control study of breast cancer based on an analysis of data collected by interview between the years 1957-1965 from women residing in the communities of Buffalo and Kenmore, New York. Prior reproductive factors, including a detailed lactation history, were examined for 453 white females with breast cancer and 1,365 white females without breast cancer who were selected randomly from the population of Buffalo and Kenmore. There is evidence of a negative association between length of nursing and breast cancer risk in premenopausal women which is not seen in the postmenopausal women. This apparent "protective" effect of lactation persists after statistical control for the potential confounding factors of age, parity, age at first pregnancy, age at menarche, and education. Cases are more likely than controls to have reported unsuccessful lactations due to "insufficient milk." The findings of this study, in conjunction with the authors' review of previously published studies that have examined prior lactation as related to breast cancer risk, suggest that there may be an independent negative association between nursing and subsequent breast cancer risk in premenopausal women. Whether this means that breast feeding is protective or that some women who are unsuccessful at lactation are at increased risk for subsequent breast cancer is not clear. A detailed reanalysis of existing data and more careful attention to detailed prior breast function/dysfunction in future studies are recommended.