A meta-analysis on overweight, obesity and the risk of breast cancer in Chinese female population

INTRODUCTION: Breast cancer represents a serious public health problem worldwide, for its high incidence, morbidity, mortality, especially among women. It’s a multifactorial disease and the role of obesity in the etiology of breast cancer is found mainly in postmenopausal women in whom the increase in body weight and changes in fat distribution are common. MATERIALS AND METHODS: It is a multi-institutional case-control study. We studied 703 women, 268 of these were the case group and 435 represented the control group for subsequent evaluation of selected risk factors in one year from August 2009 to 2010. Data collection was performed by applying a protocol and an informed consent approved by the ethics committee of Federal University of Alagoas. All patients were weighed and measured for height and waist and hip circumferences. Data were entered and analyzed by Epi-Info 3.5.1. Windows version. Statistical tests were: Chi-square test, Bartlett s test, ANOVA and Mann-Whitney/Wilcoxon (Kruskal-Wallis test for two groups). RESULTS: The mean age of women with cancer was 52.40 years. of the 325 (46.2%) patients who were in menopause 157 (48.3%) were carriers of breast cancer and 168 (51.7%) were healthy. Among the 378 (58.3%) in premenopausal patients, 111 (29.4%) belonged to the case group and 267 (70.6%) to the control group. (OD: 2.2479, 95% CI, 1.6481 to 3.066). The body mass index (BMI) didn’t show any significant relationship between cases and controls (p = 0.9713). The waist-hip ratio (WHR) showed an average of 0.9295 in the case patients and average less than 0.8714 in the control patients (p = 0.0000). DISCUSSION: The incidence of breast cancer increases rapidly with age. The average age of the patients with breast cancer was 52.40 years. Among controls the mean age was 46.78 years. The results showed BMI of postmenopausal women with an average of 26.15 kg/m2 and an average of 25.65 kg/m2 in women in reproductive age (p = 0.0136). The excessive body weight is associated with increased risk of breast cancer in postmenopausal women. In contrast, excess weight does not seem to be associated or even often associated with a lower risk of cancer in premenopausal women. In our study we observed no statistically significant difference in BMI between cases and controls (p = 0.9887), which agrees with other results already described in the literature. It is noteworthy that the incidence of obesity and/or breast cancer in the populations studied may have influenced the results. The mean WHR found among all patients was 0.89. The mean WHR in patients with breast cancer was higher (0.92) compared to controls (0.87) (p: 0.000). The combination of higher ratio circumference and WHR with the incidence of breast cancer portrayed in this study agrees with the studies conducted to investigate this same variable as a risk factor for breast cancer. Considering menopausal status, patients in reproductive age had resulted in a mean waist-hip ratio of 0.87 and an average of 0.91 menopausal (P: 0.000). Significant result and it also represents what is found in other studies. CONCLUSION: For menopausal status, it was found that to be in menopause was a risk factor for breast cancer. The BMI did not show statistical significance for cancer and waist-hip ratio had its association with proven cases of cancer.

Objective To estimate the association of plasma sex steroid hormone levels with risk of breast cancer among premenopausal women.Methods By use of case-control study,levels of plasma estradiol(E2),testosterone(T) and progesterone(P) were measured in 75 premenopausal women with breast cancer patients and 78 matched control subjects by radioimmunoassay during the follicular phase of their menstrual cycles.Conditional logistic regression models,controlling for breast cancer risk factors,were used to examine their associations with breast cancer risk.All statistical tests were two-sided.Results(1)The plasma levels of E2 and T of case group were significantly higher than those of control group.The plasma level of P was lower than that of the control group,but the resuts as not statistically significant.(2)Increased risks of breast cancer were positively associated with elevated plasma concentration of testosterone(adjusted odds ratio for highest versus lowest quartile=3.63,95% confidence interval=1.82-7.45,Ptrend=0.015).Elevated serum progesterone concentrations was associated with a statis tically significant reduction in breast cancer risk(adjusted OR=0.43,95%CI=0.20-0.85,Ptrend=0.023).Higher level of estradiol was associated with modest,non-statistically significant increase in risk of breast cancer(adjusted OR=2.48,95%CI=1.27-5.14,Ptrend=0.270).Conclusion Results suggested that high plasma level of testosterone was positively associated with breast cancer risk,while high plasma level of progesterone was negatively associated with breast cancer risk in premenopausal women.

Background: Physical activity has been identified as a modifiable risk factor for breast cancer. Varying definitions of physical activity have made the evaluation difficult to analyze. In a state with high prevalence of obesity and elevated rates of breast cancer incidence and mortality, physical activity may be an important element for risk reduction. Women’s participation in physical activity and the relation to breast cancer incidence has rarely been determined in the southern states where obesity are prevalent. Methods: Associations between various levels of physical activity and incident breast cancer cases among 21,665 subjects residing in Arkansas from 2007–2018 were completed. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI), adjusting for various risk factors such as age, alcohol use, education, region, ethnicity, age at menarche, ever had children, and history of breastfeeding and family history of breast cancer. Stratification on menopausal status was performed to observe any breast cancer differences within the different biological pathways. Results: Among premenopausal subjects, inverse associations were observed among increase time in walking (OR =0.63, 95% CI: 0.36–1.11 and OR =0.47, 95% CI: 0.26–0.83) and overall weekly physical activity (OR =0.89, 95% CI: 0.50–1.57 and OR =0.52, 95% CI: 0.30–0.90) and breast cancer. No association was evident between the risk for breast cancer and physical activity among postmenopausal subjects. The relationship between physical activity and risk for breast cancer differed between menopausal statuses. The most apparent association was seen among premenopausal subjects with an increase in walking (P=0.01). Conclusions: Although physical activity has been demonstrated to have a beneficial effect on breast cancer prevention among postmenopausal women, results from this study do not sufficiently support the hypothesis in this population. Results varied among menopausal status as well as among different definitions of physical activity. Further investigation is needed to identify factors contributing to de-attenuating the relationships.

To assess the association of smoked meat intake, SULT1A1 polymorphism as well as their combined effects with breast cancer risk. A total of 400 newly diagnosed breast cancer cases from a cancer hospital in Sichuan province and 400 healthy controls from participants of physical examination in a hospital in Chengdu city were recruited from May 2007 to July 2009. A valid questionnaire was designed to collect their demographic characteristics and breast cancer risk factors. Daily intake of foods was collected using semi-quantitative frequency questionnaire and then the daily intake of smoked meat was calculated and transformed to energy-adjusted smoked meat intake by the residual method. Gene sequencing was used to analyze SULT1A1 Arg213His genotypes. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs). The energy-adjusted daily intake of smoked meat (Median (P₂₅, P₇₅)) was 8.65 (3.63, 18.44) g/d in cases and 4.44 (0.19, 8.71) g/d in controls. The frequency of SULT1A1 variant allele was 14.75% (59/400) among cases and 12.75% (51/400) among controls. High energy-adjusted daily intake of smoked meat (≥ 4.44 g/d) was significantly associated with breast cancer risk among premenopausal (OR = 2.31, 95%CI: 1.46 - 3.66) and postmenopausal subjects (OR = 3.13, 95%CI: 1.89 - 5.17). High energy-adjusted daily intake of smoked meat combined with carrying SULT1A1 variant allele elevated breast cancer risk among premenopausal (OR = 3.31, 95%CI: 1.66 - 6.62) and postmenopausal subjects (OR = 3.81, 95%CI: 1.79 - 8.10). High smoked meat intake contributes to high risk of breast cancer. SULT1A1 variant allele increases breast cancer risk among subjects who were exposed to high smoked meat intake.

To evaluate the association and its strength between body mass index (BMI, kg/m(2)) and cancer incidence in a large-scale population-based cohort study. A dynamic cohort was established on May 1, 2006. Baseline information on demography, lifestyle, anthropometry such as body height and weight, were collected during the first interview, and cancer incidence, mortality and other related outcome information were obtained through active follow-up every two years and passive follow-up every year. Cancer cases diagnosed within 1 year follow-up period were excluded. Multivariable Cox proportional-hazards regression model was used to calculate the hazard ratios (HRs)and 95% confidence interval (CI) between BMI and cancer incidence after adjusted for age group, education level, tobacco smoking (smokers and non-smokers), alcohol consumption (drinkers or non-drinkers) and HBsAg status (positive or negative, for liver cancer only) when appropriate. Repeated analysis was carried out on male lung cancer, male liver cancer and female breast cancer, stratified by tobacco smoking, HBsAg status and menopausal status respectively. By December 31, 2011, a total of 133 273 subjects, including 106 630 (80.01%)males and 26 643(19.99%)females were enrolled in the cohort. There were 570 531.02 person-years of follow-up and 4.28-year of average follow-up period. According to the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults, study subjects were divided into groups as: underweight (BMI<18.5 kg/m(2)), normal weight (BMI 18.5 kg/m(2)-23.9 kg/m(2)), overweight (BMI 24.0 kg/m(2)-27.9 kg/m(2)) and obese(BMI≥28.0 kg/m(2)). In males, 2 387 (2.24%) were underweight, 45 090(42.29%)were normal weight, 43 774 (41.05%) were overweight and 15 379 (14.42%) were obese. Meanwhile, in females, 858 (3.22%)were underweight, 14 037 (52.69%) were normal weight, 8 507 (31.93%) were overweight and 3 241 (12.16%) were obese. A total of 1 647 incident cancer cases among different cancers were collected during the follow-up, including 1 348 in men and 299 in women. Results from Multivariate Cox proportional-hazards regression model showed that 'underweight' increased the risk on both gastric cancer incidence (adjusted HR = 3.82, 95% CI: 1.97-7.38) and liver cancer incidence (adjusted HR = 3.00, 95% CI:1.36-6.65) in males, while both 'overweight' (adjusted HR = 1.98, 95% CI:1.03-3.82) and 'obesity' (adjusted HR = 2.75, 95% CI: 1.25-6.06) increased the risk of colon cancer incidence in males. But for bladder cancer incidence in males, overweight seemed being protective (adjusted HR = 0.44, 95%CI:0.23-0.84). And for lung cancer incidence in males, both overweight and obesity were protective as well (adjusted overweight vs. normal weight, HR = 0.59, 95%CI: 0.46-0.76;adjusted obese vs. normal weight, HR = 0.64, 95%CI: 0.44-0.92). In females, obesity increased the risk of breast cancer incidence(adjusted HR = 1.86, 95%CI:1.05-3.31). Further analysis for lung cancer cases stratified by tobacco smoking, data showed that overweight decreased the risk of lung cancer in both male non-smokers (adjusted HR = 0.50, 95%CI:0.35-0.72) and male smokers (adjusted HR = 0.70, 95%CI:0.50-0.98) while obesity decreased the risk of lung cancer in male non-smokers(adjusted HR = 0.57, 95% CI:0.33-0.97), but not in smokers (adjusted HR = 0.72, 95%CI:0.43-1.21). Stratified analysis in females by menopausal status, data showed that obesity increased the incidence of breast cancer in postmenopausal subjects (adjusted HR = 1.97, 95% CI:1.01-3.82), but not in premenopausal subjects. The association between BMI and cancer incidence varied by cancer site. Underweight increased the risk of gastric cancer and liver cancer in males, and obesity increased the risk of colon cancer in males, breast cancer and ovarian cancer in females. However, overweight might played a protective role in lung cancer incidence and bladder cancer incidence in males and obesity might play a protective role in lung cancer incidence in male non-smokers.

Breast cancer is the most commonly diagnosed invasive cancer among women both globally and within the United States and the number one cause of cancer-related deaths among women globally ([1, 2][1]). Less than 1% of diagnosed breast cancers occur in men ([2][2]) and, therefore, male breast cancer is

Despite carbohydrate hypothesis related to breast cancer development, the inter-relationships of carbohydrate measures with risk of breast cancer are unclear. We evaluated the association between the risk of breast cancer and total carbohydrate intake, glycemic load, and glycemic index, and types of rice in a hospital-based case-control study. Cases were 362 women aged 30-65 years old who were histologically confirmed to have breast cancer. Controls visiting the same hospital were matched to cases according to their age (+/-2 years) and menopausal status. Food intake was estimated by a quantitative food frequency questionnaire (FFQ) with 121 items. Conditional and unconditional logistic regression analysis was used to obtain the odds ratios (ORs) and corresponding 95% confidence intervals. There were no associations between risk of breast cancer and carbohydrate intake and glycemic load. A positive association with white rice (OR=1.19 per 100g/d increment, 95% confidence interval (CI)=1.01-1.40), no association with mixed white rice (OR=0.95 per 100g/d increment, 95% CI=0.80-1.13), and an inverse association with mixed brown rice (OR=0.76 per 100g/d increment of mixed brown rice, 95% CI=0.61-0.95) was found. Additional analysis showed a positive association for white rice and an inverse association f mixed brown rice with breast cancer risk among overweight, postmenopausal women. These results do not support an association between breast cancer and diets high in carbohydrate, glycemic index, or glycemic load. However, a higher consumption of mixed brown rice may be associated with a decreased risk of breast cancer, especially in overweight, postmenopausal women.

Could Modification of Lifestyle Factors Prevent Second Primary Breast Cancers?

Advances in Screening, Diagnosis, and Treatment of Breast Cancer

Background and Objectives: Breast cancer is the second most common malignancy which is a life threatening disease among young premenopausal women affecting their sexuality, femininity, body image, and maternal issues following mastectomy may lead the women to face psychiatric co-morbidity.Methods: The data was collected from hospital records, patients documents and annual reports which were verified with respective authorities. Collected data was analyzed by using SPSS 17.0 and was considered statistically significant at p-value ? 0.05. The adjusted Odds Ratios (OR) and 95% confidence Interval (CI) was also estimated.Results: The risk of developing breast cancer differed significantly by ABO blood type in each of the two cohorts (p = 0.97) and this association between blood group and breast cancer risk was highly similar between the two independent populations. The adjusted risks of breast cancer associated with blood groups A, B, and AB were insignificant with risk factors for the disease. The association between ABO blood group and the subsequent risk of breast cancer was not modified to a statistically significant extent by age, BMI, age at menarche, menopausal status, marital status and smoking status.Conclusion: The association between blood group and breast cancer risk was insignificant and is still controversial. Further studies are necessary to identify the mechanisms by which ABO blood type may influence the risk of breast cancer.

Introduction: A history of benign breast disease (BBD) is common and certain established pathologic features are associated with increased breast cancer risk. These associations have been reported primarily from studies of white women, where incidence of BBD peaks in the 4th or 5th decade of life. Previous work in an African American (AA) cohort of women with BBD showed AA women were younger at their first BBD diagnosis. Thus investigating whether different features of benign lesions may be associated with age and/or subsequent breast cancer risk in this population is warranted. Methods: Benign breast biopsies from 1,867 AA women with BBD diagnosed from 1997-2003 were microscopically reviewed for 15 benign features (apocrine metaplasia (AM), ductal hyperplasia (DH), atypical ductal hyperplasia (ADH), lobular hyperplasia (LH), calcifications (Calc), cysts, duct ectasisa (DE), fibroadenoma (FA), fibrosis, intraductal papilloma (IDP), radial scar (RS), sclerosing adenosis (SA), columnar cell alterations (CC), mucocele-like tumors (MLT), and atropy), and followed for subsequent breast cancer in metropolitan Detroit, Michigan. Data from 439 women under 40 and 1,428 women 40 and older at BBD diagnosis were available for analysis, with a mean follow-up time of 14 years. Differences between age categories for BBD features were compared using chi-square tests, and risk of breast cancer was estimated with odds ratios (OR) and 95% confidence intervals (95% CI) calculated from logistic regression analysis. Results: Women 40 and over were more likely to be diagnosed with nearly all of the benign characteristics compared to younger women, including: AM, DH, Calc, cysts, CC, and ADH (all p-values &amp;lt;0.001). Younger women were more likely to present with FA (56% to 43%, p-value&amp;lt;0.001) and no atrophy (44% versus 24%, p-value&amp;lt;0.001) compared to older women. Risk of subsequent breast cancer was associated with cysts (OR=3.95, 95% CI: 1.09, 14.29) in the younger age group, but not the older (OR=1.25, 95% CI: 0.76, 2.03). CC were also associated with breast cancer risk in the young (OR=5.35, 95% CI: 1.45, 19.73) but not the older women (OR=1.44, 95% CI: 0.82, 2.50). RS were associated with increased risk in both groups, but only statistically significant for the older women (OR=3.60, 95% CI: 1.54, 8.39), and not the younger women (OR=6.64, (95% CI: 0.73, 60.67). Similarly, risk of cancer was associated with a diagnosis of ADH in both groups, but only statistically significant among older women (OR=3.02, 95% CI: 1.34, 6.79), and not younger women (OR=6.75, 95% CI: 0.71, 64.43). Conclusions: Characteristics of BBD differ by age, with more women over the age of 40 being diagnosed with various conditions. Risk of subsequent cancer also varies, although RS, CC and ADH appear to increase risk in both age groups. Citation Format: Michele L Cote, Julie J Ruterbusch, Sudeshna Bandyopadhyay, Quratulain Ahmed, Barra Alosh, Eman Abdulfatah, Haitham Arabi, Rouba Lynn Ali-Fehmi. Characteristics of benign breast disease and subsequent risk of breast cancer differ by age among African Americans [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-06.

Objective To investigate the association between single Nucleotide polymorphisms (SNPs) of breast cancer susceptibility gene 1 interacting protein C-terminal helicase 1 (BACH1) gene and susceptibility of early-onset breast cancer in Uygur women in Xinjiang. Methods Detecting and analyzing BACH1 gene exon sites by DNA direct sequencing method and Snapshot genotyping technology, in 80 early-onset breast cancer cases and 240 cases of Uygur women (≤40 years). Results In breast cancer and control groups of Uygur women, the frequencies of genotypes of rs4986764、rs4986765 and c. 587A>G of BACHI gene showed differences between breast cancer and control groups (P=0.001, P=0.011, P=0.049), rs4986764 site of TC (OR=0.086), CC (OR=0.044)and TC+ CCdominant model (OR=0.058) significantly reduced the risk of breast cancer. rs4986765 site of GG (OR=5.617), AG+ GG dominant model (OR=4.254) and c. 587A>G site of GG (OR=7.590), AG+ GG dominant model (OR=7.590) significantly increased the risk of breast cancer. In addition, the SNP-SNP interactions of dominance-genotypes (TC+ CC, AG+ GG) reduced 0.4% risk of breast cancer. Conclusion SNP of rs4986764 of BACHl gene was associated with significantly reduces risk of early-onset breast cancer in Xinjiang women of Uygur, SNP of rs4986765 and c. 587A>G were associated with significantly increases risk of breast cancer in Uygur women. Key words: Breast cancer susceptibility gene 1 interacting protein C-terminal helicase 1 gene; Single nucleotide polymorphism; Uygur; Breast cancer

Background: Circulating branched-chain amino acid (BCAA) levels reflect metabolic health as well as dietary intake and have been linked to some cancers. Associations with breast cancer are unclear. Methods: We evaluated the association between circulating BCAA levels and risk of breast cancer by menopausal status at the time of sample collection in a prospective nested case-control study (1,997 cases, 1,997 controls) within the Nurses' Health Study (NHS) and NHSII. Two-thirds of women in NHS (592 cases) donated two blood samples collected 10 years apart. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) of breast cancer risk in multivariable models which included BMI at age 18 and adulthood weight gain, in addition to other risk factors. We conducted an external validation with secondary analyses in the Women's Health Study (WHS) (1,297 cases). Results: Among NHSII participants (predominantly premenopausal at blood collection), elevated circulating BCAA levels were associated with suggestively lower breast cancer risk (e.g., isoleucine highest vs. lowest quartile, multivariable OR (95% CI)= 0.86 (0.65-1.13), p-trend=0.20), with significant linear trends among fasting samples (e.g., isoleucine OR (95% CI)=0.74 (0.53-1.05), p-trend=0.05). In contrast, among postmenopausal women, proximate measures (within 10y from sample collection) were associated with increased breast cancer risk (e.g., isoleucine highest vs. lowest quartile multivariable OR (95% CI)=1.63 (1.12-2.39), p-trend=0.01), with slightly stronger associations among fasting samples (OR (95% CI)=1.73 (1.15-2.61), p-trend=0.01). Distant measures (10-20y since sample collection) were not statistically significantly associated with risk (OR (95% CI)=1.15 (0.87-1.52), p-trend=0.35). We did not observe significant heterogeneity by ER status or BMI. In the WHS, a suggestive positive association was observed for distant measures of leucine among postmenopausal women: OR (95% CI)=1.31 (0.97-1.75), p-trend=0.05. Conclusion: Although elevated circulating BCAA levels were associated with lower breast cancer risk among premenopausal NHSII women and higher risk of postmenopausal breast cancer in NHS when assessed within 10 years of diagnosis, independent of established risk factors, including adiposity, results were not validated in WHS. Additional independent studies are needed to reassess and understand the complex relationship between BCAAs, menopausal status and timing, and risk of breast cancer. Citation Format: Oana A. Zeleznik, Raji Balasubramanian, Yumeng Ren, Deirdre K. Tobias, Bernard A. Rosner, Cheng Peng, Alaina M. Bever, Lisa Frueh, Clary B. Clish, Samia Mora, Frank B. Hu, A. Heather Eliassen. Branched-chain amino acids and risk of breast cancer by menopausal status in three large cohorts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 746.

Early age at first birth and multiparity have been associated with a decrease in the risk of breast cancer in women in the general population. We examined whether this relationship is also present in women at high risk of breast cancer due to the presence of a mutation in either of the 2 breast cancer susceptibility genes, BRCA1 or BRCA2. We performed a matched case-control study of 1,260 pairs of women with known BRCA1 or BRCA2 mutations, recruited from North America, Europe and Israel. Women who had been diagnosed with breast cancer were matched with unaffected control subjects for year of birth, country of residence, and mutation (BRCA1 or BRCA2). Study subjects completed a questionnaire detailing their reproductive histories. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived by conditional logistic regression. Among BRCA1 carriers, parity per se was not associated with the risk of breast cancer (OR for parous vs. nulliparous = 0.94; 95% CI = 0.75-1.19; p = 0.62). However, women with a BRCA1 mutation and 4 or more children had a 38% decrease in breast cancer risk compared to nulliparous women (OR = 0.62; 95% CI = 0.41-0.94). In contrast, among BRCA2 carriers, increasing parity was associated with an increased risk of breast cancer; women with 2 or more children were at approximately 1.5 times the risk of breast cancer as nulliparous women (OR = 1.53; 95% CI = 1.01-2.32; p = 0.05). Among women with BRCA2 mutations and who were younger than age 50, the (adjusted) risk of breast cancer increased by 17% with each additional birth (OR = 1.17; 95% CI = 1.01-1.36; p = 0.03). There was no significant increase in the risk of breast cancer among BRCA2 carriers older than 50 (OR for each additional birth = 0.97; 95% CI = 0.58-1.53; p = 0.92). In the 2-year period following a birth, the risk of breast cancer in a BRCA2 carrier was increased by 70% compared to nulliparous controls (OR = 1.70; 95% CI = 0.97-3.0). There was a much smaller increase in breast cancer risk among BRCA2 carriers whose last birth was 5 or more years in the past (OR = 1.24; 95% CI = 0.79-1.95). A modest reduction in risk of breast cancer was observed among BRCA1 carriers with 4 or more births. Among BRCA2 carriers, increasing parity was associated with a significant increase in the risk of breast cancer before age 50 and this increase was greatest in the 2-year period following a pregnancy.

Night-shift work, sleep duration, daytime napping, and breast cancer risk