早期社会经济环境与乳腺钼靶密度
Early life socioeconomic environment and mammographic breast density.
作者信息
Tehranifar Parisa, Cohn Barbara A, Flom Julie D, Protacio Angeline, Cirillo Piera, Lumey L H, Michels Karin B, Terry Mary Beth
机构信息
Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
出版信息
BMC Cancer. 2017 Jan 10;17(1):41. doi: 10.1186/s12885-016-3010-x.
BACKGROUND
Early life social environment may influence breast cancer through shaping risk factors operating in early life, adolescence and adulthood, or may be associated with breast cancer risk independent of known risk factors. We investigated the associations between early life socioeconomic status (SES) and mammographic density, a strong risk factor for breast cancer, and the extent to which these associations were independent of risk factors across the lifecourse.
METHODS
We used data from an adult follow-up study of two U.S. birth cohorts of women (average age = 43 years) with prospectively collected data starting during the pregnancy of the mother and continuing through early childhood of the offspring. We collected data on factors in later life periods through computer-assisted interviews with the offspring as adults, and obtained routine clinical mammograms for measurement of percent density and dense and nondense breast areas using a computer assisted method. We used generalized estimating equation models for multivariable analysis to account for correlated data for sibling sets within the study sample (n = 700 composed of 441 individuals and 127 sibling sets).
RESULTS
Highest vs. lowest family income level around the time of birth was associated with smaller dense breast area after adjustment for early life factors (e.g., birthweight, maternal smoking during pregnancy) and risk factors in later life periods, including adult body mass index (BMI) and adult SES (β = -8.2 cm, 95% confidence interval [CI]: -13.3, -3.2). Highest vs. lowest parental educational attainment was associated with higher percent density in models that adjusted for age at mammogram and adult BMI (e.g., β = 4.8, 95% CI = 0.6, 9.1 for maternal education of college or higher degree vs. less than high school), but the association was attenuated and no longer statistically significant after further adjustment for early life factors. There were no associations between early life SES indicators and non-dense area after adjustment for adult BMI. Neither adult education nor adult income was statistically significantly associated with any measure of mammographic density after adjusting for age and adult BMI.
CONCLUSIONS
We did not observe consistent associations between different measures of early life SES and mammographic density in adulthood.
背景
早年的社会环境可能通过塑造在早年、青春期和成年期起作用的风险因素来影响乳腺癌，或者可能独立于已知风险因素与乳腺癌风险相关。我们研究了早年社会经济地位（SES）与乳房X线密度（一种强有力的乳腺癌风险因素）之间的关联，以及这些关联在多大程度上独立于整个生命过程中的风险因素。
方法
我们使用了来自两项美国女性出生队列成人随访研究的数据（平均年龄 = 43岁），前瞻性收集的数据始于母亲孕期并持续至后代幼儿期。我们通过对成年后的后代进行计算机辅助访谈收集了后期生活阶段的因素数据，并使用计算机辅助方法获得常规临床乳房X线照片，以测量密度百分比以及致密和非致密乳腺区域。我们使用广义估计方程模型进行多变量分析，以处理研究样本中同胞组的相关数据（n = 700，由441名个体和127个同胞组组成）。
结果
出生时家庭收入水平最高与最低相比，在调整了早年因素（如出生体重、母亲孕期吸烟）和后期生活阶段的风险因素（包括成年人体重指数（BMI）和成年SES）后，与较小的致密乳腺区域相关（β = -8.2 cm，95%置信区间[CI]：-13.3，-3.2）。在调整了乳房X线照片拍摄年龄和成年BMI的模型中，父母教育程度最高与最低相比，与更高的密度百分比相关（例如，母亲为大学或更高学历与高中以下学历相比，β = 4.8，95% CI = 0.6，9.1），但在进一步调整早年因素后，该关联减弱且不再具有统计学意义。在调整了成年BMI后，早年SES指标与非致密区域之间没有关联。在调整了年龄和成年BMI后，成年教育程度和成年收入与任何乳房X线密度测量指标均无统计学显著关联。
结论
我们未观察到成年期不同早年SES测量指标与乳房X线密度之间存在一致的关联。
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