Environment and Breast Cancer: Science Review
About
Serum high-density lipoprotein cholesterol, metabolic profile, and breast cancer risk
Furberg, A. S., Veierod, M. B., Wilsgaard, T., Bernstein, L., Thune, I. Journal of the National Cancer Institute. 2004. 96:15, 1152-60.
Topic area
Body size
Body size
Study design
Prospective cohort
Prospective cohort
Funding agency
Other: Norwegian Cancer Society
Other: Norwegian Cancer Society
Study Participants
Number of Cases
708 (200 pre) (508 post)
708 (200 pre) (508 post)
Menopausal Status
Post menopausal
The menopausal status of women included in this study is listed here.
Pre menopausalPost menopausal
Number in Cohort
Cohort: 38,823
Cohort: 38,823
Cohort participation rate
Retention/participation exceeded 70% for exposed a
Retention/participation exceeded 70% for exposed a
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: women who participated in one of two population based screening surveys by the Norwegian National Health Screening Services in three counties in Norway (Finnmark, Oppland and Sogn og Fjordance) during 1977-1983 and 1985-1987; age 17-59 during survey depending on county
Ex: women with missing BMI information; pregnant women; women with primary amenorrhea; women with prevalent cancers; died within one year after participation of survey
Comment about participation selection
Strengths: extended follow-up of 17.2 years (median); anthropometric data measured by trained staff; analyzed breast cancer risk by BMI and serum high-density lipoprotein cholesterol (HDL-C) levels; study had complete follow-up and histopathologic confirmation of all incident breast cancer cases; excluded women diagnosed within first year of follow-up so that study has a prospective design; one of the first studies to analyze breast cancer risk based on repeated assessments of exposure; blood draws and anthropometric measurements were conducted by the same team of trained nurses in both surveys; used consistent methods in the same laboratory in both surveys to obtain HDL-C levels in fresh sera; high participation rate; population-based approach; large number of fresh serum samples assessed in the surveys; examination of effect modification in analysis Limitations: lack of information on exact age at menopause; defined menopause at age 50 which may have caused participants to be classified improperly; study did not control for changes in the use of HRT during follow-up
Strengths: extended follow-up of 17.2 years (median); anthropometric data measured by trained staff; analyzed breast cancer risk by BMI and serum high-density lipoprotein cholesterol (HDL-C) levels; study had complete follow-up and histopathologic confirmation of all incident breast cancer cases; excluded women diagnosed within first year of follow-up so that study has a prospective design; one of the first studies to analyze breast cancer risk based on repeated assessments of exposure; blood draws and anthropometric measurements were conducted by the same team of trained nurses in both surveys; used consistent methods in the same laboratory in both surveys to obtain HDL-C levels in fresh sera; high participation rate; population-based approach; large number of fresh serum samples assessed in the surveys; examination of effect modification in analysis Limitations: lack of information on exact age at menopause; defined menopause at age 50 which may have caused participants to be classified improperly; study did not control for changes in the use of HRT during follow-up
How exposure was measured
Questionnaire, in person Anthropometric measurement, researcher-administered
Questionnaire, in person Anthropometric measurement, researcher-administered
Breast cancer outcome investigated
Primary breast cancer
Primary breast cancer
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
No
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, county of residence, parity, height, BMI, total serum cholesterol, physical activity and menopausal status
considered adjusting for blood pressure, serum triglycerides, age at first birth, time since last meal, smo
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
No
Description of major analysis
Effect modification: HDL-C levels and menopausal status
Effect modification: HDL-C levels and menopausal status
Strength of associations reported
Association between premenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of less than 25, OR=1.65(0.90-3.02) trend p=.11
Association between premenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of 25 or more, OR=1.26(0.57-2.80) trend p=.46
Association between postmenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of less than 25, OR=1.33(0.86-2.08) trend p=.27
Association between postmenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of 25 or more, OR=0.43(0.28-0.67) trend p<.001
Association between premenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of less than 25, OR=1.65(0.90-3.02) trend p=.11
Association between premenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of 25 or more, OR=1.26(0.57-2.80) trend p=.46
Association between postmenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of less than 25, OR=1.33(0.86-2.08) trend p=.27
Association between postmenopausal breast cancer risk and women with a high concentration of serum high-density lipoprotein cholesterol, >1.64 mmol/L vs. <1.20, who had a BMI of 25 or more, OR=0.43(0.28-0.67) trend p<.001
Author address
Section of Epidemiology and Medical Statistics, Institute of Community Medicine, Faculty of Medicine, University of Tromso, Tromso, Norway. anne-sofie.furberg@ism.uit.no
Section of Epidemiology and Medical Statistics, Institute of Community Medicine, Faculty of Medicine, University of Tromso, Tromso, Norway. anne-sofie.furberg@ism.uit.no