Environment and Breast Cancer: Science Review

Evidence From Humans
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Markers of insulin resistance and sex steroid hormone activity in relation to breast cancer risk: a prospective analysis of abdominal adiposity, sebum production, and hirsutism (Italy)
Muti, P., Stanulla, M., Micheli, A., Krogh, V., Freudenheim, J. L., Yang, J., Schunemann, H. J., Trevisan, M., Berrino, F. Cancer Causes & Control. 2000. 11:8, 721-30.
Topic area
Body size
Study design
Nested case-control
Funding agency
Other: Italian Association for Cancer Research
Study Participants
Number of Cases
134 (70 pre) (64 post)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number of Controls
Controls: 530
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: Resident of Varese province in Northern Italy; participated in the ORDET study between 6/87 and 6/92; age 35-69 at baseline Ex: women with a history of cancer; bilateral ovariectomy; women who are currently pregnant or breastfeeding; chronic or acute liver disease; women on hormone therapy within three months prior to recruitment
Comment about participation selection
Strengths: nested case-control within a prospective study; anthropometric measurements taken by trained staff; analyzed breast cancer risk by W/H ratio and menopausal status; standardized data collection reduced possible variability in baseline data Limitations: insulin resistance and serum steroids were measured indirectly through abdominal adiposity; sample sizes in the strata were small; few cases;
Exposures investigated
W/H ratio and BMI
How exposure was measured
Questionnaire Anthropometric measurement, researcher-administered
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: BMI and age
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 Follow-up: 5.5 years
Strength of associations reported
W/H ratio associated with breast cancer in pre women, RR=2.2(1.0-4.8)
Association between premenopausal breast cancer risk and WHR, >0.80 vs. <0.75, OR=2.2(1.0-4.8) trend p=0.03
Association between postmenopausal breast cancer risk and WHR, >0.84 vs. <0.79, OR=1.1(0.6-2.2) trend p=0.9
Association between premenopausal breast cancer risk and WHR, >0.80 vs. <0.75, amongst women with a BMI <24, 3.4(1.2-9.5) p=0.016
Author address
Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. muti@buffalo.edu
Controls participation rate
Greater than 70% (92%)