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。     

成都地区女性乳腺癌危险因素的病例对照研究

目的　调查成都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　对过去3年中成都地区经病理证实的乳腺癌265例进行1∶1配对病例对照研究。结果在单因素分析中,达到显著性水平的危险因素为行经期≥35年、服用避孕药、良性乳腺疾病史、被动吸烟及常食用蜂王浆等,达到显著性水平的保护因素为哺乳及常食豆类食品。条件logistic多元回归分析显示,重要的有统计学显著意义的乳腺癌危险因素是良性乳腺疾病史、被动吸烟,重要保护性因素是常食豆制品及哺乳。结论　成都地区女性乳腺癌重要危险因素为良性乳腺疾病史及被动吸烟。     

北京市乳腺癌危险因素病例对照研究

目的：探索北京地区乳腺癌的主要危险因素。方法：采用１：１配对的病例对照研究方法，共押取３５０对样本，进行了多变量的筛检分析。结果：精神、心理因素和良性乳腺疾病史是生物效应较强的主要危险因素，而产后哺乳及常吃玉米为乳腺癌的保护因子。结论：此次研究结果与因内其它城市相关研究结果基本一致，但亦存在一定的地区性差异。     

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。     

上海市某区妇女乳腺癌危险因素的病例对照研究

目的探讨上海市某区女性乳腺癌发病的危险因素,为建立有效的预防及控制措施提供依据。方法在上海市某区随机抽取1家三甲医院,通过简单随机抽样的方法选取2013年3—6月确诊的95例乳腺癌患者,按1∶3比例进行病例对照试验设计,并综合运用单因素与多因素Logistic回归进行乳腺癌危险因素分析。结果单因素分析表明,主要危险因素为被动吸烟、乳腺良性疾病史、BMI≥24 kg/m2、绝经、初产年龄和精神创伤,而豆制品(≥3次/周)、大蒜类(≥3次/周)、生育史、哺乳史和生育子女数则为保护因素;多因素分析表明,主要危险因素有BMI≥24 kg/m2、绝经、乳腺良性疾病史、初产年龄和精神创伤,而仅大蒜类为保护因素。结论乳腺癌发病是生理因素、心理因素和社会行为因素综合作用的结果,要有效地控制乳腺癌,应针对不同类别的患者进行差异化防控。     

女性乳腺癌危险因素及其变化

目的 探讨女性乳腺癌的危险因素及其变化,为有效防制乳腺癌发生及发展提供科学依据.方法 (1)危险因素研究.通过1:1病例对照方法,调查某市2002～2003年新发女性乳腺癌患者,调查内容主要有生理因素、生育因素、环境因素、精神心理因素和生活方式等,统计分析方法为条件logistic回归分析.(2)危险因素变化研究.将在中分析获得的危险因素与已有的Meta 分析结果进行比较,了解危险因素的变化情况.结果 (1)单因素分析结果表明,有12个暴露因素与该市女性乳腺癌发病有关,多因素分析获得的主要危险因素有乳腺良性疾病史、职业接触、性格内向、高脂饮食、睡觉时不摘文胸.(2)部分乳腺癌危险因素发生变化,其中以职业接触、高脂饮食和睡觉时不摘文胸表现明显.结论 乳腺癌发病及其危险因素的变化是生物因素、心理因素和社会行为因素综合作用的结果,要有效控制乳腺癌,必须采取综合措施.     

乳腺癌早期危险因素分析及高频超声的应用价值

目的分析早期乳腺癌的危险因素,探讨高频超声诊断早期乳腺癌的应用价值。方法回顾性分析2016年2月-2017年2月来该院因乳腺肿块就诊的68例患者的临床资料,经病理结果证实,其中早期乳腺癌32例(早期乳腺癌组),良性病变36例;另选取同期在该院进行健康体检的女性32例为对照组。对早期乳腺癌组患者及对照组女性一般资料、临床疾病资料进行单因素、Logistic多因素回归分析;所有患者均经高频超声检测,并将诊断结果与病理结果进行对比,绘制ROC曲线分析其诊断价值。结果单因素分析结果显示,体质量指数、乳腺癌家族史、哺乳史、初潮年龄、乳腺增生、长期口服避孕药、精神压抑、饮茶习惯、被动吸烟及经常锻炼是发生早期乳腺癌的相关因素(P0.05)。Logistic多因素回归分析结果显示,体质量指数≥25 kg/m~2、初潮年龄13岁、乳腺增生、长期口服避孕药、精神压抑是诱发早期乳腺癌的独立危险因素(OR1,P0.05)。而哺乳史与饮茶习惯是早期乳腺癌的保护因素(OR1,P0.05)。高频超声诊断早期乳腺癌的敏感度、特异度与病理结果比较,差异均无统计学意义(均P0.05)。高频超声ROC曲线下面积为0.910,诊断价值较高。结论体质量指数≥25 kg/m~2、初潮年龄较早、乳腺增生、长期口服避孕药、精神压抑是乳腺癌的独立危险因素,哺乳史、饮茶习惯是乳腺癌的保护因素,女性平时应加强体育锻炼,避免肥胖,保持良好的精神状态及生活习惯,对防治乳腺癌有重要意义。高频超声诊断早期乳腺癌有一定应用价值,值得在临床推广使用。     

雌激素相关基因及生殖因素对乳腺癌协同作用

目的研究CYP1A1 MspⅠ，ERα PvuⅡ，ERα XbaⅠ基因多态性与生殖、生育因素在乳腺癌发生中的协同作用。方法本研究样本来自1999年1月-2001年4月，在上海市进行的以人群为基础的乳腺癌病例对照研究。采用PCR-限制性酶切长度多态性法（PIER—RFLP）对282例乳腺癌病例和298例口腔黏膜细胞对照标本进行3个候选基因位点的检测，拟合Logistic回归模型，估计基因多态与生殖、生育因素对乳腺癌协同作用OR值和95％CI，并采用Rothman方法对基因一环境的协同作用进行估计。结果良性乳腺疾病史与CYPIA1 MspⅠ多态存在正相加协同作用。与基准组比较，OR为5．66（95％CI=3．28-9．76），协同作用指数S=2．05，协同作用归因比AP=0．42，经检验差异有统计学意义（P〈0．05）。未发现其他生殖、生育因素与3个基因位点有显著的协同作用。结论良性乳腺疾病史与CYP1A1 MspⅠ基因之间存在增加乳腺危险的协同作用。     

女性乳腺癌危险因素病例一对照研究

为了确定四川地区女性乳腺癌危险因素,我们于1989-1990年对四川省111例乳腺癌病例进行1:2配比病例一对照研究。每一病例配比一个恶性肿瘤对照和一个“健康”对照,调查结果表明:乳腺癌家族史(OR=16.98 95％CI=1.95-147.8),乳腺疾患史(OR=5.66 95％CI=2.65-12.10),双侧哺乳机会不等(OR=4.51 95％CI=1.47-13.85),痛经(OR=2.21 95％CI     

乳腺癌发病危险因素的Meta分析

目的探讨中国女性良性乳腺疾病、乳腺癌家族史和月经生育因素与乳腺癌的发病风险之间的关系。方法检索中外数据库,按照一定的标准获得有关乳腺癌危险因素的病例对照研究资料并使用Review man 5.0软件进行Meta分析。结果共纳入文献14篇,累计乳腺癌病例5 282例,对照6 409例,与对照人群相比,病例组合并后的OR值(95%CI):良性乳腺疾病(benign breast disease,BBD)为2.24(1.23,4.09),乳腺癌家族史(family history of breast cancer,FHBC)为2.05(1.47,2.86),月经生育因素中绝经(menopause)为0.93(0.61,1.41),母乳喂养(breastfeeding)为0.76(0.62,0.92),流产(abortion)为1.47(1.04,2.07)。结论良性乳腺疾病、乳腺癌家族史及流产为中国女性乳腺癌发病的危险因素,母乳喂养为中国女性乳腺癌的保护因素,绝经与否与中国女性的乳腺癌发病没有显著性联系。     

Risk factors predicting the incidence of second primary breast cancer among women diagnosed with a first primary breast cancer.

This study examined risk factors for development of a contralateral breast cancer among 4,660 US women diagnosed with a first primary breast cancer between 1980 and 1982. The authors believe it to be the first prospective cohort study on this topic that has employed direct patient interviews. All subjects were interviewed within 6 months of the diagnosis of their initial tumor as part of the multi-center, population-based, case-control Cancer and Steroid Hormone Study, and they were followed until the end of 1986 through the Surveillance, Epidemiology, and End Results program. Exclusive of those diagnosed during the initial 6 months after diagnosis of a first primary, 136 second primary breast cancers were identified. Proportional hazards models were used to assess the independent effects of multiple predictors. Specific risk factors evaluated included: age at diagnosis of first primary, exposure to exogenous hormones, menstrual and reproductive histories, tumor characteristics, demographic variables, and treatment modalities. The age-specific incidence rates of second primary breast cancer were higher in all age categories than are the incidence rates of breast cancer in the general population, yet the age at diagnosis of first primary breast cancer was not an important predictor of contralateral breast cancer. The risk of contralateral breast cancer was increased among cohort members who reported a personal history of benign breast biopsy (multivariable-adjusted rate ratio (RR) = 1.69, 95% confidence interval (CI) 1.13-2.53) and in those with an initial tumor that was classified as lobular carcinoma (multivariable-adjusted RR = 1.96, 95% CI 1.17-3.27). Treatment with chemotherapy for the first primary was associated with a lower risk of development of a second breast cancer (multivariable-adjusted RR = 0.56, 95% CI 0.33-0.96), while radiation therapy had little effect on the risk (multivariable-adjusted RR = 1.19, 95% CI 0.78-1.80).     

Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses' Health Study

Because of the temporal relations between reproductive risk factors and incidence of breast cancer, the authors developed a nonlinear Poisson regression that accounts for time and summarizes risk to age 70 years. Reproductive risk factors, benign breast disease, use of postmenopausal hormones, weight, and alcohol intake were evaluated as risk factors. Among 58,520 women aged 30-55 years in 1980, followed through June 1, 1994, 1,761 incident invasive breast cancer cases were identified. All risks are multivariate adjusted. History of benign breast disease is associated with a 57% increase (95% confidence interval (CI): 43%, 73%) in cumulative risk of breast cancer by age 70 years. Use of unopposed postmenopausal estrogen from ages 50-60 years increases risk of breast cancer to age 70 by 23% (95% CI: 6%, 42%) compared with a woman who never uses hormones. Ten years of use of estrogen plus progestin increases risk to age 70 years by 67% (95% CI: 18%, 136%). Compared with never drinking alcohol, one drink per day from age 18 years increases risk to age 70 by 7% (95% CI: 0%, 13%). Use of unopposed postmenopausal hormones for 10 years significantly increases the risk of breast cancer, and the addition of progestin further increases the risk.     

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。     

Are patients with skin cancer at lower risk of developing colorectal or breast cancer?

Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.     

A prospective study of the development of breast cancer in 16,692 women with benign breast disease

The authors studied the relation between benign breast disease and subsequent breast cancer in 16,692 women with biopsy-diagnosed benign breast disease who had participated in the Breast Cancer Detection Demonstration Project throughout the United States. Women were classified into one of five benign breast disease categories: atypical hyperplasia, proliferative disease without atypia, nonproliferative disease, fibroadenoma, and other benign breast disease. A total of 485 incident cases of breast cancer were identified in the women from August 1973 to February 1986 after a median follow-up period of 8.3 years from the diagnosis of benign breast disease. Age-adjusted incidence rates were calculated for benign breast disease types stratified by family history and calcification status. Relative risk (RR) estimates of breast cancer for women in the five benign breast disease categories, compared with the screened women who did not develop recognizable breast disease (normal subjects), were computed using the proportional hazards model. Results indicated that risk was associated with the degree of epithelial atypia. Over all age groups, women with nonproliferative disease, proliferative disease without atypia, and atypical hyperplasia displayed progressively increasing risks of 1.5, 1.9, and 3.0, respectively, compared with normal subjects, with 95% confidence intervals (CI) exceeding unity. Particularly high risk was seen among women under age 46 years with atypical hyperplasia (RR = 5.7, 95% CI 3.0-10.6). Women with fibroadenoma as the only indication of their benign breast disease had a relative risk of 1.7, with a lower 95% confidence limit of 1.0. No increased risk was seen for women with other benign breast disease. Positive family history (RR = 1.8) and calcification (RR = 1.2) significantly increased a woman's risk proportionately over the risk associated with each benign breast disease subtype. The authors conclude that the risk of developing breast cancer varies by category of benign breast disease and is directly related to the degree of epithelial atypia.     

Benign breast disease among first-degree relatives of young breast cancer patients

Benign breast disease is associated with increased risk of breast cancer. To further clarify whether there is a genetic link between benign and malignant breast lesions, the authors identified 14,648 first-degree female relatives of 8,807 patients in whom breast cancer was diagnosed at <50 years of age by using Danish nationwide cancer and population registers. Hospital register data were used to follow the relatives for occurrence of benign breast disease from 1977 to 2003 and to calculate rates of benign breast disease in the general population of Danish women for comparison. Risk for relatives was increased for benign breast diseases (observed/expected ratio = 1.54, 95% confidence interval: 1.42, 1.66), particularly for relatives aged <40 years. Higher risks were observed after breast cancer had been diagnosed in the family; however, an increased risk for relatives aged <50 years (observed/expected ratio = 1.24, 95% confidence interval: 1.02, 1.51) was present before breast cancer was diagnosed in the family. Enhanced surveillance of close relatives of breast cancer patients seems to be an important factor to address when investigating the association between benign breast disease and familial breast cancer. A genetic link between benign breast disease and breast cancer was indicated by our data but needs to be confirmed in future studies.     

The contribution of risk factors to the higher incidence of invasive and in situ breast cancers in women with higher levels of education in the European prospective investigation into cancer and nutrition

The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.     

Incidence of cancer in Bradford Asians.

STUDY OBJECTIVE--The aim of the study was to investigate the incidence of cancer in Asians living in Bradford. DESIGN--Cancer registrations were obtained from the Yorkshire Regional Cancer Registry for the six year period 1979-1984. Registrations relating to persons of Asian background were extracted using forenames and surnames. Data were analysed by disease category and age and sex specific incidence rates were calculated. These were compared with expected incidence rates for the non-Asian population and with rates for the Indian subcontinent derived from the Bombay Cancer Registry. SETTING--Data collection was confined to the Bradford Metropolitan District, population 449,897 (1981). SUBJECTS--The Asians studied originated from Pakistan (65%), India (28%), Bangladesh (4%), and East Africa (3%). The total Asian population of the Bradford Metropolitan District was approximately 45,000. MAIN RESULTS--Over the study period there were 178 Asian cancer registrations. The overall standardised registration ratio was 53.7 for males (100 cases, 95% confidence interval 43-64), and 43.5 for females (78 cases, 95% CI 34-53). The standardised registration ratios for cancer of the hypopharynx in males and gall bladder in females were significantly raised. There was a particularly low incidence of cancer of the stomach, large bowel, lung, skin, and bladder in males, and of skin, breast, cervix (in situ), and ovary in females. The analyses suggested that lung and breast cancer incidence may be increasing towards the non-Asian level. In situ cancer of cervix in Asians shows no evidence of the high rates found in younger non-Asian age groups. CONCLUSIONS--Lower incidence of many cancers in Asians may be due to lower exposure to major risk factors. Demographic change resulting in increased exposure to these risk factors can be expected to result in an increase in cancer incidence in Asians.