Environment and Breast Cancer: Science Review

Evidence From Humans
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Risk of breast cancer in relation to anthropometry, blood pressure, blood lipids and glucose metabolism: a prospective study within the Malmo Preventive Project
Manjer, J., Kaaks, R., Riboli, E., Berglund, G. European Journal of Cancer Prevention. 2001. 10:1, 33-42.
Topic area
Body size
Study design
Prospective cohort
Funding agency
Other: Ernhold Lundstrom Foundation
Study Participants
Number of Cases
269 (invasive only) (112 premenopausal) (157 postmenopausal)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Cohort: 9738
Cohort participation rate
Retention/participation exceeded 70% for exposed a
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: Malmo residents; born between 1926 and 1949; attended a health examination initiated by the Malmo Preventive Project between 1977 and 1992 Ex: women with unclear menopausal status; diagnosed with a prior cancer
Comment about participation selection
Strengths: anthropometric data measured by trained staff members; blood pressure and blood glucose were taken; average follow-up was 13.1 years; fasting plasma insulin was measured; analyzed pre and post menopausal breast cancer risk by blood pressure measurements, pulse rate and selected metabolic factors Limitations: BMI breast cancer risk results were inconsistent with previous studies; a large number of women were excluded due to unknown menopausal status; possible selection bias due to a possible under diagnosis of breast tumors in obese women (obese women had more advanced cancers at diagnosis); possible exposure misclassification caused by random measurement errors; insufficient number of cases when stratified by anthropometric quartiles combined with menopausal status
Exposures investigated
Height, weight, and BMI
How exposure was measured
Questionnaire, self-administered Anthropometric measurement, researcher-administered by trained staff at baseline examination
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, age at menarche, nulliparity, current oral contraceptive use, current HRT use, smoking habits, alcohol consumption, height and weight
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: 13.1 years
Strength of associations reported
Association between peri/postmenopausal breast cancer risk and height, >168 cm vs. <160 cm, RR=1.78(1.14-2.77) trend p=0.008
Author address
Department of Community Medicine, Malmo University Hospital, Lund University, Malmo, Sweden. jonas.manjer@smi.mas.lu.se