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Breast cancer risk in older women: results from the NIH-AARP Diet and Health Study

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Abstract

Background

Divergent risk factors exist for premenopausal and postmenopausal breast cancers, but it is unclear whether differences by age exist among postmenopausal women.

Methods

We examined relationships among 190,872 postmenopausal women, ages 50–71 years recruited during 1995–1996 for the NIH-AARP Diet and Health Study, in whom 7,384 incident invasive breast carcinomas were identified through 2006. Multivariable Cox regression hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated for breast cancer risk factors by age (50–59, 60–69, ≥70 years).

Results

The only factor showing significant statistical heterogeneity by age (p het = 0.001) was menopausal hormone therapy duration, but trends were apparent across all ages and the strongest association prevailed among women 60–69 years. Although other risk factors did not show statistically significant heterogeneity by age, we did observe attenuated relations for parity and late age at first birth among older women [e.g., HR for age at first birth ≥30 vs. 20–24 = 1.62 (95 % CI 1.23–2.14) for women 50–59 years vs. 1.12 (0.96–1.31) for ≥70 years]. In contrast, risk estimates associated with alcohol consumption and BMI tended to be slightly stronger among the oldest subjects [e.g., HR for BMI ≥35 vs. 18.5–24.9 = 1.24 (95 % CI 0.97–1.58) for 50–59 years vs. 1.46 (1.26–1.70) for ≥70 years]. These differences were somewhat more pronounced for estrogen receptor positive and ductal cancers, tumors predominating among older women. Breast cancer family history, physical activity, and previous breast biopsies did not show divergent associations by age.

Conclusion

Although breast cancer risk factor differences among older women were not large, they may merit further consideration with respect to individualized risk prediction.

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References

  1. Benz CC (2008) Impact of aging on the biology of breast cancer. Crit Rev Oncol Hematol 66(1):65–74

    Article  PubMed Central  PubMed  Google Scholar 

  2. Jatoi I, Anderson WF (2010) Qualitative age interactions in breast cancer studies: a mini-review. Futur Oncol 6(11):1781–1788

    Article  Google Scholar 

  3. Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92(7):550–556

    Article  CAS  PubMed  Google Scholar 

  4. Chlebowski RT, Anderson GL, Lane DS et al (2007) Predicting risk of breast cancer in postmenopausal women by hormone receptor status. J Natl Cancer Inst 99(22):1695–1705

    Article  CAS  PubMed  Google Scholar 

  5. Poynter JN, Inoue-Choi M, Ross JA, Jacobs DR Jr, Robien K (2013) Reproductive, lifestyle, and anthropometric risk factors for cancer in elderly women. Cancer Epidemiol Biomark Prev 22(4):681–687

    Article  Google Scholar 

  6. Shantakumar S, Terry MB, Teitelbaum SL et al (2007) Reproductive factors and breast cancer risk among older women. Breast Cancer Res Treat 102(3):365–374

    Article  PubMed  Google Scholar 

  7. Vacek PM, Skelly JM, Geller BM (2011) Breast cancer risk assessment in women aged 70 and older. Breast Cancer Res Treat 130(1):291–299

    Article  PubMed  Google Scholar 

  8. La VC, Negri E, Franceschi S et al (1997) Body mass index and post-menopausal breast cancer: an age-specific analysis. Br J Cancer 75(3):441–444

    Article  Google Scholar 

  9. Schatzkin A, Subar AF, Thompson FE et al (2001) Design and serendipity in establishing a large cohort with wide dietary intake distributions: the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol 154(12):1119–1125

    Article  CAS  PubMed  Google Scholar 

  10. Michaud DS, Midthune D, Hermansen S et al (2005) Comparison of cancer registry case ascertainment with SEER estimates and self-reporting in a subset of the NIH-AARP Diet and Health Study. J Regist Manag 32(2):70–75

    Google Scholar 

  11. SEER (2013) ICD-O-3. Coding materials. http://seer.cancer.gov/icd-o-3/

  12. Hersh AL, Stefanick ML, Stafford RS (2004) National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA 291(1):47–53

    Article  CAS  PubMed  Google Scholar 

  13. Clavel-Chapelon F, Gerber M (2002) Reproductive factors and breast cancer risk. Do they differ according to age at diagnosis? Breast Cancer Res Treat 72(2):107–115

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. La Vecchia C, Negri E, Bruzzi P et al (1992) The role of age at menarche and at menopause on breast cancer risk: combined evidence from four case–control studies. Ann Oncol 3(8):625–629

    PubMed  Google Scholar 

  15. Horn J, Asvold BO, Opdahl S, Tretli S, Vatten LJ (2013) Reproductive factors and the risk of breast cancer in old age: a Norwegian cohort study. Breast Cancer Res Treat 139(1):237–243

    Article  PubMed  Google Scholar 

  16. Sweeney C, Blair CK, Anderson KE, Lazovich D, Folsom AR (2004) Risk factors for breast cancer in elderly women. Am J Epidemiol 160(9):868–875

    Article  PubMed  Google Scholar 

  17. Faupel-Badger JM, Sherman ME, Garcia-Closas M et al (2010) Prolactin serum levels and breast cancer: relationships with risk factors and tumour characteristics among pre- and post-menopausal women in a population-based case–control study from Poland. Br J Cancer 103(7):1097–1102

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Franceschi S, Favero A, La Vecchia C et al (1996) Body size indices and breast cancer risk before and after menopause. Int J Cancer 67(2):181–186

    Article  CAS  PubMed  Google Scholar 

  19. Lubin F, Ruder AM, Wax Y, Modan B (1985) Overweight and changes in weight throughout adult life in breast cancer etiology. A case–control study. Am J Epidemiol 122(4):579–588

    CAS  PubMed  Google Scholar 

  20. van den Brandt PA, Dirx MJ, Ronckers CM, van den Hoogen P, Goldbohm RA (1997) Height, weight change, and postmenopausal breast cancer risk: the Netherlands Cohort Study. Cancer Causes Control 8(1):39–47

    Article  PubMed  Google Scholar 

  21. Rose DP, Vona-Davis L (2010) Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas 66(1):33–38

    Article  PubMed  Google Scholar 

  22. van den Brandt PA, Spiegelman D, Yaun SS et al (2000) Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 152(6):514–527

    Article  PubMed  Google Scholar 

  23. Siiteri PK (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45(1 Suppl.):277–282

    CAS  PubMed  Google Scholar 

  24. Seitz HK, Pelucchi C, Bagnardi V, La VC (2012) Epidemiology and pathophysiology of alcohol and breast cancer: update 2012. Alcohol Alcohol 47(3):204–212

    Article  PubMed  Google Scholar 

  25. Ahn J, Schatzkin A, Lacey JV Jr et al (2007) Adiposity, adult weight change, and postmenopausal breast cancer risk. Arch Intern Med 167(19):2091–2102

    Article  PubMed  Google Scholar 

  26. Krishnan K, Bassett JK, Macinnis RJ et al (2013) Associations between weight in early adulthood, change in weight, and breast cancer risk in postmenopausal women. Cancer Epidemiol Biomark Prev 22(8):1409–1416

    Article  Google Scholar 

  27. Collaborative Group on Hormonal Factors in Breast Cancer (2012) Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118,964 women with breast cancer from 117 epidemiological studies Lancet Oncol 13(11):1141–1151

  28. Brinton LA, Schairer C, Hoover RN, Fraumeni JF Jr (1988) Menstrual factors and risk of breast cancer. Cancer Invest 6(3):245–254

    Article  CAS  PubMed  Google Scholar 

  29. Press DJ, Sullivan-Halley J, Ursin G et al (2011) Breast cancer risk and ovariectomy, hysterectomy, and tubal sterilization in the women’s contraceptive and reproductive experiences study. Am J Epidemiol 173(1):38–47

    Article  PubMed Central  PubMed  Google Scholar 

  30. Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80–87

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Collaborative Group on Hormonal Factors in Breast Cancer (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease Lancet 358(9291):1389–1399

  32. Colditz GA, Kaphingst KA, Hankinson SE, Rosner B (2012) Family history and risk of breast cancer: nurses’ health study. Breast Cancer Res Treat 133(3):1097–1104

    Article  PubMed Central  PubMed  Google Scholar 

  33. Garcia-Closas M, Brinton LA, Lissowska J et al (2006) Established breast cancer risk factors by clinically important tumour characteristics. Br J Cancer 95(1):123–129

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Yang XR, Chang-Claude J, Goode EL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium studies. J Natl Cancer Inst 103(3):250–263

    Article  PubMed Central  PubMed  Google Scholar 

  35. Li CI, Malone KE, Porter PL, Weiss NS, Tang MT, Daling JR (2003) Reproductive and anthropometric factors in relation to the risk of lobular and ductal breast carcinoma among women 65–79 years of age. Int J Cancer 107(4):647–651

    Article  CAS  PubMed  Google Scholar 

  36. Nyante SJ, Dallal CM, Gierach GL, Park Y, Hollenbeck AR, Brinton LA (2013) Risk factors for specific histopathological types of postmenopausal breast cancer in the NIH-AARP Diet and Health Study. Am J Epidemiol 178(3):359–371

    Article  PubMed  Google Scholar 

  37. Lew JQ, Freedman ND, Leitzmann MF et al (2009) Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women: the NIH-AARP Diet and Health Study. Am J Epidemiol 170(3):308–317

    Article  PubMed Central  PubMed  Google Scholar 

  38. Li CI, Malone KE, Porter PL et al (2008) Relationship between menopausal hormone therapy and risk of ductal, lobular, and ductal–lobular breast carcinomas. Cancer Epidemiol Biomark Prev 17(1):43–50

    Article  Google Scholar 

  39. Phipps AI, Li CI, Kerlikowske K, Barlow WE, Buist DS (2010) Risk factors for ductal, lobular, and mixed ductal-lobular breast cancer in a screening population. Cancer Epidemiol Biomark Prev 19(6):1643–1654

    Article  Google Scholar 

  40. Bouwens CS, van Rensburg SJ, de Kock L, Apffelstaedt JP, Kotze MJ (2012) Influence of genetic factors on the development of breast cancer in the older woman. Curr Aging Sci 5(2):140–147

    Article  PubMed  Google Scholar 

  41. Jemal A, Fedewa SA (2012) Is the prevalence of ER-negative breast cancer in the US higher among Africa-born than US-born black women? Breast Cancer Res Treat 135(3):867–873

    Article  CAS  PubMed  Google Scholar 

  42. Randolph WM, Goodwin JS, Mahnken JD, Freeman JL (2002) Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis. Ann Intern Med 137(10):783–790

    Article  PubMed  Google Scholar 

  43. Yancik R, Ries LG, Yates JW (1989) Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival. Cancer 63(5):976–981

    Article  CAS  PubMed  Google Scholar 

  44. Pfeiffer RM, Park Y, Kreimer AR et al (2013) Risk prediction for breast, endometrial, and ovarian cancer in white women aged 50 y or older: derivation and validation from population-based cohort studies. PLoS Med 10(7):e1001492

    Article  PubMed Central  PubMed  Google Scholar 

  45. Rosner BA, Colditz GA, Hankinson SE, Sullivan-Halley J, Lacey Jr JV, Bernstein L (2013) Validation of Rosner–Colditz breast cancer incidence model using an independent data set, the California Teachers Study. Breast Cancer Res Treat 142(1):187–202

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Acknowledgments

This research was supported in part by the Intramural Research Program of the National Cancer Institute at the National Institutes of Health. Dr. Cher Dallal was supported by the Cancer Prevention Fellowship Program, National Institutes of Health, Bethesda, MD. Cancer incidence data from the collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University (for the Atlanta metropolitan area); the California Department of Health Services, Cancer Surveillance Section; the Michigan Cancer Surveillance Program, Community Health Administration, State of Michigan (for the Detroit metropolitan area); the Florida Cancer Data System (FCDC) under contract with the Florida Department of Health (FDOH); the Louisiana Tumor Registry, Louisiana State University Medical Center in New Orleans; the New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey State Department of Health and Senior Services; the North Carolina Central Cancer Registry; the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania; the Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services; and the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions. The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. We also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support and analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Author notes

  1. Cher M. Dallal

    Present address: Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, USA

Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA

    Louise A. Brinton, Llewellyn Smith, Gretchen L. Gierach, Ruth M. Pfeiffer, Sarah J. Nyante, Yikyung Park & Cher M. Dallal

  2. Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 20892, USA

    Mark E. Sherman

  3. AARP, Washington, DC, USA

    Albert R. Hollenbeck

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  1. Louise A. Brinton
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Correspondence to Louise A. Brinton.

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Brinton, L.A., Smith, L., Gierach, G.L. et al. Breast cancer risk in older women: results from the NIH-AARP Diet and Health Study. Cancer Causes Control 25, 843–857 (2014). https://doi.org/10.1007/s10552-014-0385-3

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  • DOI: https://doi.org/10.1007/s10552-014-0385-3

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