Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors

Marilyn L. Kwan, Lawrence H. Kushi, Erin Weltzien, Benjamin Maring, Susan E. Kutner, Regan S. Fulton, Marion M. Lee, Christine B. Ambrosone, Bette J. Caan

Research output: Contribution to journalArticle

210 Citations (Scopus)

Abstract

Introduction: The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.Methods: Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.Results: Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).Conclusions: These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.

Original languageEnglish (US)
Article numberR31
JournalBreast Cancer Research
Volume11
Issue number3
DOIs
StatePublished - May 22 2009
Externally publishedYes

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Survivors
Epidemiology
Cohort Studies
Odds Ratio
Prospective Studies
Confidence Intervals
Breast Neoplasms
Neoplasms
Hormone Replacement Therapy
Life Style
Health Maintenance Organizations
Progesterone Receptors
Oral Contraceptives
Parity
Breast Feeding
Hispanic Americans
Alcohol Drinking
Estrogen Receptors
African Americans
Obesity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Kwan, M. L., Kushi, L. H., Weltzien, E., Maring, B., Kutner, S. E., Fulton, R. S., ... Caan, B. J. (2009). Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Research, 11(3), [R31]. https://doi.org/10.1186/bcr2261

Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. / Kwan, Marilyn L.; Kushi, Lawrence H.; Weltzien, Erin; Maring, Benjamin; Kutner, Susan E.; Fulton, Regan S.; Lee, Marion M.; Ambrosone, Christine B.; Caan, Bette J.

In: Breast Cancer Research, Vol. 11, No. 3, R31, 22.05.2009.

Research output: Contribution to journalArticle

Kwan, ML, Kushi, LH, Weltzien, E, Maring, B, Kutner, SE, Fulton, RS, Lee, MM, Ambrosone, CB & Caan, BJ 2009, 'Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors', Breast Cancer Research, vol. 11, no. 3, R31. https://doi.org/10.1186/bcr2261
Kwan, Marilyn L. ; Kushi, Lawrence H. ; Weltzien, Erin ; Maring, Benjamin ; Kutner, Susan E. ; Fulton, Regan S. ; Lee, Marion M. ; Ambrosone, Christine B. ; Caan, Bette J. / Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. In: Breast Cancer Research. 2009 ; Vol. 11, No. 3.
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abstract = "Introduction: The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.Methods: Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95{\%} confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.Results: Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95{\%} CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95{\%} CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95{\%} CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95{\%} CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95{\%} CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95{\%} CI = 1.03 to 3.24) or obese (OR = 1.97, 95{\%} CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95{\%} CI = 1.16 to 4.13) or Asian (OR = 2.02, 95{\%} CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95{\%} CI = 0.26 to 0.79).Conclusions: These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.",
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T1 - Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors

AU - Kwan, Marilyn L.

AU - Kushi, Lawrence H.

AU - Weltzien, Erin

AU - Maring, Benjamin

AU - Kutner, Susan E.

AU - Fulton, Regan S.

AU - Lee, Marion M.

AU - Ambrosone, Christine B.

AU - Caan, Bette J.

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N2 - Introduction: The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.Methods: Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.Results: Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).Conclusions: These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.

AB - Introduction: The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.Methods: Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.Results: Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).Conclusions: These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.

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