Environment and Breast Cancer: Science Review

Evidence From Humans
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Anthropometric predictors of breast cancer incidence and survival in a multi-ethnic cohort of female residents of Hawaii, United States
Galanis, D. J., Kolonel, L. N., Lee, J., Le Marchand, L. Cancer Causes & Control. 1998. 9:2, 217-24.
Topic area
Body size
Study design
Prospective cohort
Funding agency
Not reported
Study Participants
Number of Cases
378 (women diagnosed with incident breast cancer) (86 pre) (292 post) 34 (breast cancer deaths)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: residents of Hawaii; women who participated in a random survey/ demographic and health-related study administered by the Hawaii State Department of Health from 1975-1980; age 18 or older during survey Ex: military personnel or dependents (not considered permanent residents); women with incomplete information for name or age; diagnosed with cancer before survey; women that answered duplicate state administered surveys over the five year period; women who were not of Hawaiian, Caucasian, Japanese, Filipino or Chinese descent; women with missing information on study covariates; in situ breast cancers
Comment about participation selection
Strengths: lengthy follow-up (14.9 years); analyzed breast cancer incidence by BMI stratified by menopausal status and age; prospective study design and sample characteristics; anthropometric data was self-reported before breast cancer diagnosis; study was population based to the state of Hawaii Limitations: anthropometric data were self-reported; low participation rate due to a large number of exclusions (69.6%); did not obtain information on menopausal status, therefore age 50 was used as a proxy cut-point; few premenopausal cases (86); did not obtain information on potentially confounding variables such as age at menarche, age at first birth, parity, use of oral contraceptives, use of replacement estrogens, and family history of breast cancer
Exposure Investigated
Exposures investigated
BMI and Height
How exposure was measured
Questionnaire, self-administered
Exposure assessment comment
Anthropometric data were self-reported
Statistical Analysis
Breast cancer outcome investigated
Primary breast cancer
Mortality from breast cancer
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, Confounders: age, education, ethnicity, alcohol consumption, and stage of breast cancer
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Description of major analysis
Effect modifiers: menopausal status and age Follow-up:14.9 years
Strength of associations reported
Incidence of breast cancer associated with BMI, (>26 vs <19.6), RR=1.8(1.3-2.6) p=0.0001
Incidence of breast cancer associated with height, ( >160.1 vs <154.9), RR=1.5(1.1-2.1) p=0.008 in post women and RR=1.4(1.1-1.9) p=0.02 in all women
Incidence of breast cancer associated with BMI among post women age 65 years or more, ( >24 vs <21.1), RR=1.6(1.1-2.5) p=0.008
Results Comments
Non significant positive association between BMI and breast cancer survival. No relationship between height and breast cancer survival.
Author address
Injury Prevention and Control Program, Hawaii Department of Health, Honolulu 96813, USA.