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The Contribution of Risk Factors to the Higher Incidence of Invasive and In Situ Breast Cancers in Women With Higher Levels of Education in the European Prospective Investigation Into Cancer and Nutrition

Menvielle, Gwenn; Kunst, Anton E.; van Gils, Carla H.; Peeters, Petra H.; Boshuizen, Hendriek; Overvad, Kim; Olsen, Anja; Tjonneland, Anne; Hermann, Silke and Kaaks, Rudolf, et al. (2011) In American Journal of Epidemiology 173(1). p.26-37
Abstract
The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association... (More)
The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women. (Less)
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publication status
published
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keywords
breast neoplasms, education, incidence, reproductive history, risk, factors
in
American Journal of Epidemiology
volume
173
issue
1
pages
26 - 37
publisher
Oxford University Press
external identifiers
  • wos:000285412200003
  • scopus:78650501938
ISSN
0002-9262
DOI
10.1093/aje/kwq319
language
English
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yes
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0b034d22-c7f8-4e71-83a6-62728107ca47 (old id 1791120)
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2011-03-02 14:25:07
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@article{0b034d22-c7f8-4e71-83a6-62728107ca47,
  abstract     = {The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.},
  author       = {Menvielle, Gwenn and Kunst, Anton E. and van Gils, Carla H. and Peeters, Petra H. and Boshuizen, Hendriek and Overvad, Kim and Olsen, Anja and Tjonneland, Anne and Hermann, Silke and Kaaks, Rudolf and Bergmann, Manuela M. and Illner, Anne-Kathrin and Lagiou, Pagona and Trichopoulos, Dimitrios and Trichopoulou, Antonia and Palli, Domenico and Berrino, Franco and Mattiello, Amelia and Tumino, Rosario and Sacerdote, Carlotta and May, Anne and Monninkhof, Evelyn and Braaten, Tonje and Lund, Eiliv and Ramon Quiros, Jose and Duell, Eric J. and Sanchez, Maria-Jose and Navarro, Carmen and Ardanaz, Eva and Borgquist, Signe and Manjer, Jonas and Khaw, Kay Tee and Allen, Naomi E. and Reeves, Gillian K. and Chajes, Veronique and Rinaldi, Sabina and Slimani, Nadia and Gallo, Valentina and Vineis, Paolo and Riboli, Elio and Bueno-de-Mesquita, H. Bas},
  issn         = {0002-9262},
  keyword      = {breast neoplasms,education,incidence,reproductive history,risk,factors},
  language     = {eng},
  number       = {1},
  pages        = {26--37},
  publisher    = {Oxford University Press},
  series       = {American Journal of Epidemiology},
  title        = {The Contribution of Risk Factors to the Higher Incidence of Invasive and In Situ Breast Cancers in Women With Higher Levels of Education in the European Prospective Investigation Into Cancer and Nutrition},
  url          = {http://dx.doi.org/10.1093/aje/kwq319},
  volume       = {173},
  year         = {2011},
}