Education level and risk of breast cancer by tumor subtype in the EPIC cohort

被引:0
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作者
Pizzato, Margherita [1 ,2 ]
McCormack, Valerie [3 ]
Dossus, Laure [4 ]
Al-Alem, Umaima [5 ]
Delpierre, Cyrille [6 ]
Lamy, Sebastien [2 ,6 ,7 ]
Macciotta, Alessandra [8 ]
Ricceri, Fulvio [8 ]
Mellemkjaer, Lene [9 ]
Tjonneland, Anne [9 ,10 ]
Dahm, Christina C. [11 ]
Antoniussen, Christian S. [11 ]
Guenel, Pascal [12 ]
Fournier, Agnes [12 ]
Frenoy, Pauline [12 ]
Schulze, Matthias B. [13 ,14 ]
Kaaks, Rudolf [15 ]
Fortner, Renee Turzanski [15 ,16 ]
Ferrari, Pietro [4 ]
Pala, Valeria [17 ]
Panico, Salvatore [18 ]
Tumino, Rosario [19 ]
Masala, Giovanna [20 ]
Olsen, Karina Standahl [21 ]
Gram, Inger Torhild [21 ]
Braaten, Tonje [21 ]
Castro, Carlota [22 ]
Etxezarreta, Pilar Amiano [23 ]
Atxega, Amaia [23 ]
Huerta, Jose Maria [24 ,25 ]
Sanchez, Maria-Jose [25 ,26 ,27 ]
Guevara, Marcela [25 ,28 ,29 ]
Gathani, Toral [30 ,31 ]
Rinaldi, Sabina [4 ]
Vineis, Paolo [32 ]
Vaccarella, Salvatore [2 ]
机构
[1] Univ Milan, Dept Clin Sci & Community Hlth, Via Celoria 22, I-20133 Milan, Italy
[2] Int Agcy Res Canc, Canc Surveillance Branch, Lyon, France
[3] Int Agcy Res Canc, Environm & Lifestyle Epidemiol Branch, Lyon, France
[4] Int Agcy Res Canc, Nutr & Metab Branch, Lyon, France
[5] Univ Illinois, Sch Publ Hlth, Div Epidemiol & Biostat, Chicago, IL USA
[6] Univ Toulouse Paul Sabatier, Ctr Res Epidemiol & Populat Hlth, Inserm, U1295, Toulouse, France
[7] Claudius Regaud Inst, Tarn Canc Registry, Toulouse, France
[8] Univ Turin, Dept Clin & Biol Sci, Turin, Italy
[9] Danish Canc Inst, Diet Canc & Hlth, Copenhagen, Denmark
[10] Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark
[11] Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark
[12] Paris Saclay Univ, Gustave Roussy, Inserm, UVSQ,CESP, Villejuif, France
[13] German Inst Human Nutr Potsdam Rehbrucke, Dept Mol Epidemiol, Nuthetal, Germany
[14] Univ Potsdam, Inst Nutr Sci, Nuthetal, Germany
[15] German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany
[16] Norwegian Inst Publ Hlth, Canc Registry Norway, Dept Res, Oslo, Norway
[17] Fdn IRCCS Ist Nazl Tumori Milano, Epidemiol & Prevent Unit, Milan, Italy
[18] Federico II Univ Naples, Dept Clin Med & Surg, Naples, Italy
[19] AIRE ONLUS, Hyblean Assoc Canc Epidemiol, Ragusa, Italy
[20] Inst Canc Res, Clin Epidemiol Unit, Prevent & Clin Network ISPRO, Florence, Italy
[21] UiT Arctic Univ Norway, Dept Community Med, Tromso, Norway
[22] Catalan Inst Oncol ICO, Unit Nutr & Canc, Barcelona, Spain
[23] BioDonostia Res Inst, Publ Hlth Div Gipuzkoa, Donostia San Sebastian, Spain
[24] Murcia Reg Hlth Council IMIB, Dept Epidemiol, Murcia, Spain
[25] Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain
[26] Escuela Andaluza Salud Publ EASP, Granada, Spain
[27] Inst Invest Biosanitaria Ibs GRANADA, Granada, Spain
[28] Inst Salud Publ & Laboral Navarra, Pamplona, Spain
[29] Navarra Inst Hlth Res IdiSNA, Pamplona, Spain
[30] Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England
[31] Oxford Univ Hosp NHS Fdn Trust, Oxford, England
[32] Imperial Coll London, Sch Publ Hlth, London, England
关键词
breast cancer risk; education level; estrogen receptor; molecular subtypes; ESTROGEN-RECEPTOR STATUS; SOCIOECONOMIC-STATUS; LIFE-STYLE; WOMEN; ASSOCIATION;
D O I
10.1002/ijc.35413
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Breast cancer (BC) is a heterogeneous disease with subtypes based on receptor status (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]), influencing prognosis and treatment. A higher socioeconomic position (SEP) is associated with an increased BC risk, but its relation to BC subtypes is less clear. This study analyzed 311,631 women from the EPIC cohort, focusing on the incidence of in situ and invasive BC (overall and by receptor status and subtype). Educational attainment was used as a proxy for SEP, and hazard ratios (HRs) were calculated using Cox regression models. Mediation analyses were performed to evaluate the extent to which selected risk factors explained the educational gradient. Over 14 years, 14,432 BC cases were identified, including 12,863 invasive cases. Lower education was associated with a reduced risk of both in situ and invasive BCs. The HRs for primary versus tertiary education were 0.61 (95% CI 0.49-0.73) for in situ and 0.81 (95% CI 0.75-0.87) for invasive BC overall, with similar reductions across ER-positive, PR-positive, HER2-positive, Luminal A, BH-, and BH+. No significant association was found between education and ER-negative, and HER2-enriched BCs. Reproductive and lifestyle factors explained 20-40% of the educational differences in BC risk. While many of the risk factors through which education impacts the development of subtype-specific BC were identified, others remain to be fully elucidated. Differences in screening attendance could partially explain the higher ER-positive BC risk among highly educated; this study further contributes to the understanding of the complex nature of BC in terms of its social gradient and aetiology.
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页数:15
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