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Breast Cancer Research
Published in: Breast Cancer Research 3/2009

Open Access 01-06-2009 | Research article

Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors

Authors: Marilyn L Kwan, Lawrence H Kushi, Erin Weltzien, Benjamin Maring, Susan E Kutner, Regan S Fulton, Marion M Lee, Christine B Ambrosone, Bette J Caan

Published in: Breast Cancer Research | Issue 3/2009

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Abstract

Introduction

The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.

Methods

Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.

Results

Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).

Conclusions

These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.
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Metadata
Title
Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors
Authors
Marilyn L Kwan
Lawrence H Kushi
Erin Weltzien
Benjamin Maring
Susan E Kutner
Regan S Fulton
Marion M Lee
Christine B Ambrosone
Bette J Caan
Publication date
01-06-2009
Publisher
BioMed Central
Published in
Breast Cancer Research / Issue 3/2009
Electronic ISSN: 1465-542X
DOI
https://doi.org/10.1186/bcr2261

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