Environment and Breast Cancer: Science Review

Evidence From Humans
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Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk
van den Brandt, P. A., Spiegelman, D., Yaun, S. S., Adami, H. O., Beeson, L., Folsom, A. R., Fraser, G., Goldbohm, R. A., Graham, S., Kushi, L., Marshall, J. R., Miller, A. B., Rohan, T., Smith-Warner, S. A., Speizer, F. E., Willett, W. C., Wolk, A., Hunter, D. J. American Journal of Epidemiology. 2000. 152:6, 514-27.
Topic area
Body size
Study design
Nested case-control (pooled analysis of 7 cohorts)
Study Participants
Number of Cases
4,385 (invasive only)
Menopausal Status
The menopausal status of women included in this study is listed here.
Post menopausal
Pre menopausal
Number in Cohort
Cohort: 337,819
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
Parent studies: Adventist Health Study, Canadian National Breast Screening Study, Iowa Women's Health Study, Netherlands Cohort Study, New York State Cohort, Nurses' Health Study, Sweden Mammography Cohort Inclusion criteria for studies in pooled analysis: at least 200 incident cases, assessed long-term intake of foods, nutrients and energy intake at baseline, and completed a validation study of the diet assessment methods Exclusion criteria for participants in pooled analysis studies: energy intake is three standard deviations greater than mean energy intake at baseline, reported history of cancer, and missing anthropometry data
Comment about participation selection
Strengths: study assessed over 4,000 incident cases, contained a pooled analysis of seven cohorts studies worldwide, pooled cohort studies included food and nutrient intake data and cohort had a high degree of participation (at least 90%) Limitations: analysis of premenopausal breast cancer was based on only four cohorts and anthropometric data were self-reported
Exposure Investigated
Exposures investigated
BMI, weight and height
How exposure was measured
Questionnaire, self-administered
Exposure assessment comment
Anthropometric data were self-reported
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 at menarche, parity, age at birth of first child, past hormone use, oc use, history of benign breast disease, maternal history of breast cancer, smoking habits, education, fat intake and alcohol consumption
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 modification: HRT use and menopausal status Interaction: HRT use (results not significant) Follow up: 6.1 years (mean for cohorts)
Results Comments
Association between premenopausal breast cancer risk and height, >1.75m vs. <1.60 m, RR=1.42(0.95-2.12) trend p=0.41 Association between postmenopausal breast cancer risk and height, >1.75m vs. <1.60 m, RR=1.28(0.94-1.76) trend p<0.001 Association between breast cancer risk and height, >1.75m vs. <1.60 m, RR=1.22(0.90-1.65) trend p=0.001 Association between premenopausal breast cancer risk and weight, >80 kg vs. <60 m, RR=0.58(0.40-0.83) trend p=0.02 Association between postmenopausal breast cancer risk and weight, >80 kg vs. <60 m, RR=1.25(1.02-1.52) trend p=0.003 Association between premenopausal breast cancer risk and BMI, >33 vs. <21, RR=0.58(0.34-1.00) trend p=0.007 Association between postmenopausal breast cancer risk and BMI, >33 vs. <21, RR=1.27(1.03-1.55) trend p=0.001
Author address
Department of Epidemiology, Maastricht University, The Netherlands. PA.vandenBrandt@epid.uni-maas.nl