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Risk factors for inflammatory and non-inflammatory breast cancer in North Africa



Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors.


Between 2009 and 2015, we conducted a case–control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups.


After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types.


We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.

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Inflammatory breast cancer


Estrogen receptor


Body mass index


Odds ratio


Confidence interval


Progesterone receptor


Human epidermal growth factor receptor 2


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We are very grateful to the women who participated in this study. We also thank the following individuals for their important contributions to the study, including identifying, enrolling, and interviewing study subjects, study management, data keying, logistical support, and translation: Tanta Cancer Center/Gharbiah Cancer Society: Dr. Salwas Samir, Dr. Eman Sobhy, Dr. Mohammed El Kholy, Mr. Khalid Dabboos, Ms. Hanaa Elmenshawy; NCI-Cairo: Dr. Gamal Amira, Dr. Heba Mohamed El Leethy, Dr. Usama Farouk El Nagar, Ms. Walaa Emara, Ms. Magda Hassan, Ms. Hanan Mabrouk; Tunisia: Dr. Karima Mrad, Dr. Dalenda Hentati, Dr. Houda Belfekih, Dr. Nesrine Chraiet, Dr. Amira Daldoul, Dr. Mouna Ayadi, Dr. Bassem Alani, Ms. Leila Fadhlaoui, Ms. Neila Ben Hassen; Ibn Rochd Oncology Center: Prof. Nadia Benchakroun, Dr. Hoda Eddakaoui, Dr. Myriam Hatime, Dr. Soufya Majdoul, Dr. Fadwa Qachach, Dr. Basma Billal, Dr. Hajar Kouss, Dr. Noureddine Matar, Dr. Iman Meziane, Dr. Sara Belkheiri, Dr. Karima Bendahhou, Dr. Majdouline Khounigere, Dr. Ibrahim Khalil Ahmadaye; University Hospital Center Mohammed VI, Marrakech: Dr. Mariam Affane, Dr. Sana Zabroug, Dr. Mouna Darfaoui, Mr. Hicham Jabraoui; IMS (data management and keying): Ms. Leslie Carroll, Mr. Bob Banks, Ms. Bette Griffith, Dr. Carol Giffen, Mr. Michael Spriggs; NCI-USA (logistical support): Mr. David Check, Ms. Prisca N. Fall; Westat (translation): Dr. Susan Crystal-Mansour, and Ms. Jerelyn Bouic. The National Institutes of Health National Library of Medicine Interaction Tool used in this work was developed by the Communications Engineering Branch of the National Library of Medicine (Mr. Rodney Long and Mr. Leif Neve). We would also like to thank the Cancer Epidemiology Education in Special Populations (CEESP) Program students who assisted in different parts of the study during their CEESP projects.


This work was supported by the National Cancer Institute at the National Institutes of Health Intramural Research Program (C.S., R.M.P., S.M.G.), the Breast Cancer Research Foundation (S.D.M.), the Metavivor Foundation (S.D.M.), and CEESSP Program (Grant R25 CA112383) (A.S.S.).

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Correspondence to Ruth M. Pfeiffer.

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Sandra Swain reports receiving honoraria from Novartis, personal fees from Cardinal Health, Daiichi-Sankyo, Eli Lilly & Co., Genentech/Roche, Genomic Health, Inivata, Peiris Pharmaceuticals, Tocagen; research support from Genentech; travel and accommodations from Caris Centers of Excellence, Daiichi-Sankyo, Eli Lilly & Co., Genentech/Roche, NanoString Technologies; and remuneration from AstraZeneca for participation on OlympiA IDMC. The other authors declare they have no conflicts of interest.

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Schairer, C., Hablas, A., Eldein, I.A.S. et al. Risk factors for inflammatory and non-inflammatory breast cancer in North Africa. Breast Cancer Res Treat 184, 543–558 (2020).

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  • Inflammatory breast cancer
  • Risk factor
  • Egypt
  • Tunisia
  • Morocco