Environment and Breast Cancer: Science Review

Evidence From Humans
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Fetal growth and subsequent risk of breast cancer: results from long term follow up of Swedish cohort
McCormack, V. A., dos Santos Silva, I., De Stavola, B. L., Mohsen, R., Leon, D. A., Lithell, H. O. BMJ. 2003. 326:7383, 248.
Topic area
Early life exposures
Study design
Retrospective cohort
Funding agency
Other: UK Medical Research Council, Swedish Counci
Study Participants
Number of Cases
63 premenopausal, 296 postmenopausal
Menopausal Status
The menopausal status of women included in this study is listed here.
Number in Cohort
Cohort:5358 for premenopausal, 5173 for postmenopausal
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
Upsala birth cohort study In: All singleton females delivered at the Uppsala Academic Hospital during 1915-1929 for whom linkage to the 1960 census records was successful and for whom subsequent breast cancer registration could be ascertained through the Swedish Cancer Registry
Comment about participation selection
Long follow-up and high incident breast cancers
Exposures investigated
Birthweight, birth length, gestational age, maternal age
How exposure was measured
Other: Birth records
Statistical Analysis
Breast cancer outcome investigated
Primary incident 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.
BMI, race, alcohol consumption, family history 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
Cox proportional hazard model adjusted for marital status, children in home, age at first marriage, level of education attained, personal car possession, and occupation. Adjustment for birth length and head circumstance was conducted for premenopausal cas
Strength of associations reported
Premenopausal: BW: 3.48 (1.29-9.38); BL: 3.40 (1.45-8.01), GA: 2.06 (1.02-4.16); BW adjusted for BL and HC: 0.73 (0.22-2.44); BL adjusted for BW and HC: 2.30 (0.83-6.39)
Postmenopausal: BW 0.87 (0.56-1.36); BL: 1.29 (0.91-1.84), GA: 0.95 (0.68-1.34)
Maternal age showed no clear pattern with rates of premenopausal breast cancer (results not shown)
Results Comments
Strong evidence of a positive association between measures of birth size and risk of premenopausal breast cancer, in addition, for a given birth size a shorter gestation was associated with a significant increased risk of premenopausal breast cancer. There is no evidence of an association with postmenopausal risk.
Author address
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT. valerie.mccormack@lshtm.ac.uk