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Initiators and promoters for the occurrence of screen-detected breast cancer and the progression to clinically-detected interval breast cancer
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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2017 (English)In: Journal of Epidemiology, ISSN 0917-5040, E-ISSN 1349-9092, Vol. 27, no 3, 98-106 p.Article in journal (Refereed) Published
Abstract [en]

Background: The risk factors responsible for breast cancer have been well documented, but the roles of risk factors as initiators, causing the occurrence of screen-detected breast cancer, or promoters, responsible for the progression of the screen-detected to the clinically-detected breast cancer, have been scarcely evaluated.

Methods: We used data from women in a cohort in Kopparberg (Dalarna), Sweden between 1977 and 2010. Conventional risk factors, breast density, and tumor-specific biomarkers are superimposed to the temporal course of the natural history of the disease.

Results: The results show that older age at first full-term pregnancy, dense breast, and a family history of breast cancer increased the risk of entering the preclinical screen-detectable phase of breast cancer by 23%, 41%, and 89%, respectively. Overweight/obesity (body mass index >= 25 kg/m(2)) was a significant initiator (adjusted relative risk [aRR] 1.15; 95% confidence interval [CI], 0.99-1.33), but was inversely associated with the role of promoter (aRR 0.65; 95% CI, 0.51-0.82). Dense breast (aRR 1.46; 95% CI, 1.12 -1.91), triple-negative (aRR 2.07; 95% CI, 1.37-3.15), and Ki-67 positivity (aRR 1.66; 95% CI, 1.19-2.30) were statistically significant promoters. When the molecular biomarkers were considered collectively as one classification, the basal-like subtype was the most influential subtype on promoters (aRR 4.24; 95% CI, 2.56-7.02) compared with the Luminal A subtype.

Discussion: We ascertained state-dependent covariates of initiators and promoters to classify the risk of the two-step progression of breast cancer. The results of the current study are useful for individually-tailored screening and personalized clinical surveillance of patients with breast cancer that was detected at an early stage.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2017. Vol. 27, no 3, 98-106 p.
Keyword [en]
Breast cancer, Risk factor, Personalized, Multi-state
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-133521DOI: 10.1016/j.je.2016.10.003ISI: 000397215900003PubMedID: 28142043OAI: oai:DiVA.org:umu-133521DiVA: diva2:1096964
Available from: 2017-05-20 Created: 2017-05-20 Last updated: 2017-05-20Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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