BMI and height -> breast cancer?

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Hi All,

CR is accompanied by lower BMI and reduced nutritional factors can potentially

result in lower height.

The below pdf-available paper seems to find that both BMI were the largest

predisposing factors for breast cancer. Caloric intakes were not mentioned.

That BMI and height were the most important factors examined for breast cancer

was

true for white women only. The greatest factor among black women was education,

which was unexpectedly positively related with breast cancer. It may help to

explain this by considering:

Using a 20-year follow-up provided greater confidence in the results.

" Educational attainment was the strongest risk factor observed

in African-American women. Those who were college

educated had a 60 percent higher risk of fatal breast

cancer than did those with less than a high school education,

a finding not observed among White women in our cohort.

Two previous case-control studies reported higher breast

cancer incidence associated with higher education (24,

41), even after controlling for age at first birth and number

of births (24), while two others observed no association (26,

34). Interestingly, spousal education was not related to risk

in our study.

Because our study was of breast cancer mortality, one

may hypothesize that higher education would predict lower

mortality, not greater, if it reflected better access to screening

and health care. Our findings may also be due to unmeasured

confounders among college-educated women (17)

or residual confounding. For example, women in our study

with higher education were taller and experienced menarche

at an earlier age, regardless of race. Thus, higher education

may capture a combination of reproductive and other risk

factors that acts as a stronger predictor of risk than do individual

factors. Nevertheless, this finding varied by race. "

The Table 2 appears to present the most relevant data.

McCullough ML, elson HS, Diver WR, Patel AV, Thun MJ, Calle EE.

Risk Factors for Fatal Breast Cancer in African-American Women and White Women

in a

Large US Prospective Cohort.

Am J Epidemiol. 2005 Aug 24; [Epub ahead of print]

PMID: 16120696

ABSTRACT

African-American women have a higher lifetime risk of fatal breast cancer than

do

White women. Recent studies suggest that breast cancer risk factors may vary by

race. The authors examined risk factors for fatal breast cancer in

postmenopausal

African-American women and White women in a large US prospective cohort. In

1982,

21,143 African-American women and 409,093 White women in the Cancer Prevention

Study

II completed a questionnaire on reproductive, medical, anthropometric, and

demographic factors. During a 20-year follow-up, 257 deaths from breast cancer

occurred among African-American women and 4,265 among Whites. proportional

hazards modeling was used to calculate multivariate-adjusted rate ratios,

stratified

by race. Higher body mass index, taller height, and physical inactivity were

associated with increased breast cancer mortality rates in both groups. A

college

education was associated with higher mortality from breast cancer only in

Africa-American women (hazard ratio = 1.62, 95% confidence interval: 1.13, 2.30;

ptrend = 0.01, vs. less than a high school education). Most other risk factors

were

associated with breast cancer rates similarly in both groups. With few

exceptions,

established breast cancer risk factors were similarly associated with risk of

death

from breast cancer among African-American women and White women.

.... TABLE 2. Hazard ratios and 95% confidence intervals for fatal breast cancer

in

African-American women and White women, Cancer Prevention Study II cohort,

1982–2002

=================

----African-American women (n = 21,143)----White women (n =

409,093)

----No. Rates* Age adjusted Multivariate adjusted ‡----No. Rates*

Age

adjusted Multivariate adjusted ‡

Risk factor----Hazard ratio 95% confidence interval Hazard ratio 95% confidence

interval----Hazard ratio 95% confidence interval Hazard ratio 95% confidence

interval

=================

Height (cm)

<160 56 50 1.00 1.00 1,074 46 1.00 1.00

160–165 73 65 1.30 0.92, 1.84 1.30 0.92, 1.85 1,217 48 1.06 0.98, 1.15 1.09

1.01, 1.19

>165–170 76 78 1.57 1.11, 2.22 1.58 1.11, 2.24 1,145 52 1.13 1.04, 1.23 1.19

1.09, 1.29

>170 42 67 1.27 0.85, 1.90 1.27 0.84, 1.90 771 58 1.24 1.13, 1.36 1.29 1.17,

1.42

ptrend † 0.08 0.09 <0.0001 <0.0001

Body mass index (kg/m2)

<25 84 64 1.00 1.00 2,244 45 1.00 1.00

25–<30 86 58 0.94 0.69, 1.27 0.98 0.72, 1.32 1,345 57 1.28 1.19, 1.37 1.31

1.22,

1.40

30–<35 55 79 1.23 0.87, 1.72 1.32 0.93, 1.88 432 63 1.46 1.32, 1.62 1.54

1.38,

1.71

=/>35 21 70 1.12 0.69, 1.80 1.28 0.78, 2.09 140 73 1.66 1.40, 1.97 1.74 1.46,

2.07

ptrend † 0.34 0.14 <0.0001 <0.0001

Exercise

None or slight 78 79 1.00 1.00 1,048 56 1.00 1.00

Moderate 140 58 0.73 0.56, 0.97 0.72 0.54, 0.95 2,900 49 0.88 0.82, 0.95

0.93

0.87, 1.00

Heavy 19 52 0.67 0.41, 1.11 0.70 0.42, 1.16 236 49 0.84 0.73, 0.97 0.91

0.79,

1.04

ptrend † 0.03 0.03 0.0004 0.05

Education

Less than high school 64 55 1.00 1.00 661 48 1.00 1.00

High school 46 61 1.28 0.87, 1.87 1.28 0.87, 1.89 1,322 51 1.00 0.91, 1.10

1.00

0.91, 1.10

Some college 55 68 1.38 0.96, 2.00 1.41 0.97, 2.05 1,247 49 0.99 0.90, 1.09

0.98

0.89, 1.08

College graduate 77 80 1.63 1.16, 2.28 1.62 1.13, 2.30 957 51 1.01 0.91,

1.11

0.96 0.87, 1.07

ptrend † 0.005 0.01 0.96 0.35

Parity

Nulliparous 66 89 1.00 1.00 627 62 1.00 1.00

Parous 173 60 0.66 0.50, 0.88 0.69 0.51, 0.92 3,466 49 0.78 0.71, 0.85 0.78

0.71, 0.85

No.of livebirths ¶

1 33 56 1.00 1.00 561 56 1.00 1.00

2 45 64 1.17 0.75, 1.84 1.18 0.75, 1.86 1,125 50 0.88 0.79, 0.97 0.90 0.82,

1.00

3 44 90 1.47 0.93, 2.32 1.52 0.96, 2.41 856 47 0.82 0.74, 0.92 0.86 0.77,

0.96

=/>4 49 47 0.77 0.49, 1.20 0.83 0.52, 1.32 908 46 0.79 0.71, 0.88 0.83 0.74,

0.93

ptrend † 0.19 0.44 <0.0001 <0.001

Age (years) at first livebirth

<20 45 51 1.00 1.00 324 44 1.00 1.00

20–24 53 56 1.04 0.70, 1.56 0.94 0.62, 1.42 1,422 47 1.09 0.96, 1.23 1.09

0.97,

1.24

25–29 35 72 1.37 0.88, 2.14 1.10 0.68, 1.80 1,059 49 1.13 0.99, 1.28 1.11

0.98,

1.27

=/>30 22 70 1.44 0.86, 2.41 1.13 0.65, 1.98 585 59 1.46 1.27, 1.67 1.37 1.18,

1.59

ptrend † 0.09 0.64 <0.0001 <0.0001

Age (years) at menarche ¶

<12 45 71 1.00 1.00 734 57 1.00 1.00

12 49 56 0.77 0.52, 1.16 0.79 0.52, 1.18 1,030 51 0.91 0.83, 1.00 0.92 0.84,

1.01

13 64 68 0.96 0.66, 1.41 0.97 0.66, 1.43 1,166 50 0.88 0.80, 0.97 0.90 0.82,

0.99

>13 76 69 0.96 0.66, 1.40 1.00 0.69, 1.45 1,169 47 0.84 0.77, 0.92 0.86

0.78,

0.95

ptrend † 0.74 0.61 0.0003 0.002

Age (years) at menopause

<45 51 55 1.00 1.00 822 48 1.00 1.00

45–49 55 75 1.41 0.96, 2.09 1.47 0.99, 2.17 935 51 1.05 0.95, 1.15 1.05

0.96,

1.16

50–54 54 67 1.22 0.82, 1.81 1.27 0.85, 1.89 1,431 55 1.14 1.05, 1.25 1.14

1.04,

1.25

=/>55 21 65 1.29 0.76, 2.17 1.34 0.79, 2.27 431 51 1.26 1.12, 1.42 1.26 1.12,

1.42

ptrend † 0.65 0.50 0.05 0.02

Estrogen replacement therapy use

Never 121 64 1.00 1.00 2,035 53 1.00 1.00

Ever 62 65 1.04 0.77, 1.42 0.98 0.72, 1.35 1,675 47 0.90 0.84, 0.96 0.90

0.85,

0.97

History of breast cyst

No 229 63 1.00 1.00 3,416 48 1.00 1.00

Yes 28 86 1.39 0.93, 2.06 1.38 0.92, 2.06 849 64 1.32 1.22, 1.42 1.34 1.24,

1.45

Family history of breast cancer

No 240 63 1.00 1.00 3,786 49 1.00 1.00

Yes 17 94 1.47 0.90, 2.41 1.44 0.88, 2.36 479 71 1.44 1.31, 1.59 1.41 1.29,

1.56

================

* Standardized rates of breast cancer per 100,000 person-years.

‡ Multivariate models are adjusted for all the other variables in the table, in

addition to alcohol.

† Trend tests do not include missing or unknown categories.

¶ Among parous women only.

Al Pater, PhD; email: old542000@...

__________________________________

- PC Magazine Editors' Choice 2005

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