Environment and Breast Cancer: Science Review
About
Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC)
Lahmann, P. H., Hoffmann, K., Allen, N., van Gils, C. H., Khaw, K. T., Tehard, B., Berrino, F., Tjonneland, A., Bigaard, J., Olsen, A., Overvad, K., Clavel-Chapelon, F., Nagel, G., Boeing, H., Trichopoulos, D., Economou, G., Bellos, G., Palli, D., Tumino, R., Panico, S., Sacerdote, C., Krogh, V., Peeters, P. H., Bueno-de-Mesquita, H. B., Lund, E., Ardanaz, E., Amiano, P., Pera, G., Quiros, J. R., Martinez, C., Tormo, M. J., Wirfalt, E., Berglund, G., Hallmans, G., Key, T. J., Reeves, G., Bingham, S., Norat, T., Biessy, C., Kaaks, R., Riboli, E. International Journal of Cancer. 2004. 111:5, 762-71.
Topic area
Body size
Body size
Study design
Prospective cohort
Prospective cohort
Funding agency
Other: Europe Against Cancer, programme of the Eur
Other: Europe Against Cancer, programme of the Eur
Study Participants
Number of Cases
1,879 invasive cases (474 premenopausal cases) (1,405 postmenopausal cases)
1,879 invasive cases (474 premenopausal cases) (1,405 postmenopausal cases)
Menopausal Status
Post menopausal
The menopausal status of women included in this study is listed here.
Pre menopausalPost menopausal
Number in Cohort
Cohort: 176,886
Cohort: 176,886
Country where study was conducted
Ten nations in Europe
Ten nations in Europe
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: Lived in a given geographic area in Europe at baseline, participated in the European Prospective Investigation into Cancer and Nutrition (EPIC)
Ex: Women with prevalent cancer anywhere at baseline, women with incomplete responses or missing values, top or bottom 1% of the ratio of energy intake to estimated energy requirement and women with self reported data on body size (Norway, Sweden and 70% of French cohort)
Comment about participation selection
Strength: Large cohort size, analysis from several European cohorts, measurments of body size were taken directly Limitations: Limited follow up period (4.7), no data on family history, body circumferences were measured differently, low participation rate (53% of cohort)
Strength: Large cohort size, analysis from several European cohorts, measurments of body size were taken directly Limitations: Limited follow up period (4.7), no data on family history, body circumferences were measured differently, low participation rate (53% of cohort)
Exposure Investigated
Exposures investigated
Height, Body Weight, BMI, W/H ratio, Waist Circumference, Hip Circumference
Height, Body Weight, BMI, W/H ratio, Waist Circumference, Hip Circumference
How exposure was measured
Questionnaire, self-administered Anthropometric measurement, researcher-administered
Questionnaire, self-administered Anthropometric measurement, researcher-administered
Exposure assessment comment
Original study was based on 336,053 women, after exclusions the study was based on 176,886 women
Original study was based on 336,053 women, after exclusions the study was based on 176,886 women
Statistical Analysis
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: study center, age, education, smoking status, alcohol consumption, parity, age at first pregnancy, age at menarche, current OC use, current HRT use, BMI, waist circumference, hip circumference and W/H ratio
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 modifiers: HRT use, menopausal status Interactions: HRT use with exposures (BMI) Follow up: 4.7 yrs
Effect modifiers: HRT use, menopausal status Interactions: HRT use with exposures (BMI) Follow up: 4.7 yrs
Strength of associations reported
Association between premenopausal breast cancer and height, >167.7 cm vs. <156.0 cm, RR=1.33(0.96-1.84) trend p=0.134
Association between postmenopausal breast cancer and height, >167.7 cm vs. <156.0 cm, RR=1.40(1.16-1.69) trend p<0.001
Association between premenopausal breast cancer and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.70(1.05-2.77) trend p=0.030
Association between postmenopausal breast cancer among non-HRT users and weight, >75.0 kg vs. <56.8 kg, RR=1.65(1.32-2.08) trend p<0.0001
Association between postmenopausal breast cancer among HRT users and weight, >75.0 kg vs. <56.8 kg, RR=0.92(0.66-1.28) trend p=0.529
Association between postmenopausal breast cancer among non-HRT users and BMI, >30.0 vs. <25.0, RR=1.31(1.08-1.59) trend p=0.0012
Association between postmenopausal breast cancer among HRT users and BMI, >30.0 vs. <25.0, RR=0.66(0.45-0.98) trend p=0.064
Association between postmenopausal breast cancer among non-HRT users and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.56(1.12-2.17) trend p=0.002
Association between postmenopausal breast cancer among HRT users and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.02(0.61-1.69) trend p=0.873
Association between premenopausal breast cancer and height, >167.7 cm vs. <156.0 cm, RR=1.33(0.96-1.84) trend p=0.134
Association between postmenopausal breast cancer and height, >167.7 cm vs. <156.0 cm, RR=1.40(1.16-1.69) trend p<0.001
Association between premenopausal breast cancer and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.70(1.05-2.77) trend p=0.030
Association between postmenopausal breast cancer among non-HRT users and weight, >75.0 kg vs. <56.8 kg, RR=1.65(1.32-2.08) trend p<0.0001
Association between postmenopausal breast cancer among HRT users and weight, >75.0 kg vs. <56.8 kg, RR=0.92(0.66-1.28) trend p=0.529
Association between postmenopausal breast cancer among non-HRT users and BMI, >30.0 vs. <25.0, RR=1.31(1.08-1.59) trend p=0.0012
Association between postmenopausal breast cancer among HRT users and BMI, >30.0 vs. <25.0, RR=0.66(0.45-0.98) trend p=0.064
Association between postmenopausal breast cancer among non-HRT users and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.56(1.12-2.17) trend p=0.002
Association between postmenopausal breast cancer among HRT users and hip circumference, >108.0 cm vs. <94.0 cm, RR=1.02(0.61-1.69) trend p=0.873
Results Comments
No significant association between premenopausal breast cancer and WHR. No significant association between postmenopausal breast cancer and WHR stratified by HRT use.
No significant association between premenopausal breast cancer and WHR. No significant association between postmenopausal breast cancer and WHR stratified by HRT use.
Author address
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany. lahmann@mail.dife.de
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany. lahmann@mail.dife.de