Faustin Ntirenganya, Jean Damascene Twagirumukiza, Georges Bucyibaruta, Belson Rugwizangoga, Stephen Rulisa
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引用次数: 10
Abstract
Background: Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women.
Objectives: The purpose was to identify modifiable BC risk factors and assess associations between common breast cancer risks factors and molecular subtypes in premenopausal women in Rwanda.
Methods: This was a case-control study. Premenopausal women with histological confirmation of BC and frequency-matched for age controls were recruited. A preestablished questionnaire was administered to both cases and controls for sociodemographics, BC probable risk factors, and clinical and pathological characteristics. BC was classified into luminal A, luminal B, HER2-type, basal-like (triple negative), and unclassified molecular subtypes by immunohistochemistry (IHC). Odds ratio (OR) and 95% confidence interval (CI) were estimated using multivariate logistic regression analysis.
Results: 340 participants were recruited into the study (170 cases vs. 170 controls). The median age was 39 years. The majority of cases presented at advanced stages of the disease (51.2% in stages III and IV) and had invasive ductal carcinoma (98.2%). 60.6% had subtypes of poor prognosis (HER2 enriched 14.7%, triple negative 12.9%, and unclassified 32.9%). Alcohol intake (AOR = 3.73, 95%CI 2.19 - 6.32, p < 0.001), obesity/overweight in adolescence or early adulthood (AOR = 10.86, 95%CI 4.82 - 24.4, p < 0.001), history of primary infertility (AOR = 33.8, 95%CI 3.5 - 321.5, p = 0.002), nulliparity (AOR = 3.75, 95%CI 1.61 - 8.75, p = 0.002), and a history of benign breast disease (AOR = 6.06, 95%CI 1.19 - 30.73, p = 0.03) were associated with the occurrence of premenopausal breast cancer. There was no significant difference between risk factor stratification per molecular subtype.
Conclusion: Several reproductive, environmental, and lifestyle risk factors have been identified to be associated with premenopausal BC. Among them, alcohol intake and obesity/overweight during adolescence/early adulthood can be modified. Interventions targeting alcohol consumption and obesity/overweight in adolescents and young adults may decrease the incidence of premenopausal breast cancer.
背景:乳腺癌(BC)是女性中最常见的癌症,也是世界范围内女性癌症相关死亡和发病的主要原因。在卢旺达,不列颠哥伦比亚省的发病率正在增加,绝经前妇女的死亡率高得令人无法接受。目的:目的是确定可改变的乳腺癌危险因素,并评估卢旺达绝经前妇女常见乳腺癌危险因素与分子亚型之间的关系。方法:采用病例-对照研究。招募组织学证实BC且频率与年龄对照相匹配的绝经前妇女。对病例和对照组进行预先设置的问卷调查,以了解社会人口统计学、BC可能的危险因素以及临床和病理特征。免疫组化(IHC)将BC分为管腔A型、管腔B型、her2型、基底样(三阴性)和未分类的分子亚型。比值比(OR)和95%置信区间(CI)采用多变量logistic回归分析估计。结果:340名参与者被纳入研究(170例对照170例)。平均年龄为39岁。大多数病例出现在疾病晚期(51.2%为III期和IV期),并伴有浸润性导管癌(98.2%)。60.6%预后不良(HER2富集14.7%,三阴12.9%,未分类32.9%)。饮酒(AOR = 3.73, 95% ci 2.19 - 6.32, p < 0.001),肥胖/超重在青春期或成年早期(优势比= 10.86,95% ci 4.82 - 24.4, p < 0.001),与原发不孕症的历史(优势比= 33.8,95% ci 3.5 - 321.5, p = 0.002),未产妇(优势比= 3.75,95% ci 1.61 - 8.75, p = 0.002),和良性乳房疾病的历史(优势比= 6.06,95% ci 1.19 - 30.73, p = 0.03)与绝经前乳腺癌的发生有关。不同分子亚型的危险因素分层无显著差异。结论:一些生殖、环境和生活方式的危险因素已被确定与绝经前BC相关。其中,酒精摄入和青春期/成年早期的肥胖/超重是可以改变的。针对青少年和年轻人饮酒和肥胖/超重的干预措施可能会降低绝经前乳腺癌的发病率。
期刊介绍:
International Journal of Breast Cancer is a peer-reviewed, Open Access journal that provides a forum for scientists, clinicians, and health care professionals working in breast cancer research and management. The journal publishes original research articles, review articles, and clinical studies related to molecular pathology, genomics, genetic predisposition, screening and diagnosis, disease markers, drug sensitivity and resistance, as well as novel therapies, with a specific focus on molecular targeted agents and immune therapies.