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Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort

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Abstract

Purpose

Breast cancer (BC) characteristics are known to influence patients survival. Social differences have been reported by previous studies for those characteristics but questions persist because of inconsistent conclusions. We aimed to investigate the impact of education on BC stage, grade, and hormone receptor (HR) status, while adjusting for potential confounders including a broad set of health behaviors, anthropometric measures, and reproductive factors.

Methods

In the French E3N cohort, 5236 women developed a primary invasive BC for which there was available information on stage, grade, and HR status. No multivariate analyses was performed for BC stage based on the lack of association in bivariate analyses. Odds ratios and confidence intervals were estimated using multinomial logistic regression models for BC grade or binomial logistic regression models for HR status of BC.

Results

Women with a lower education were diagnosed with higher grade BC compared to women with a higher education (1.32 [1.12; 1.57]). This association was slightly attenuated after adjustment for covariates independently and more strongly affected in the fully adjusted model (1.20 [0.99; 1.45]). A significant association was observed between lower education and HR- status of BC (1.20 [1.02; 1.42]) attenuated after adjustment for age at first childbirth (1.12 [0.95; 1.33]).

Conclusion

In this cohort, education was associated with BC grade and HR status but not stage at diagnosis. The link between education and BC grade was not entirely explained by the different adjustments. A specific mechanism could be at play and deserves further investigations.

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Data availability

The dataset generated and/or analyzed during the current study is not publicly available and permission to use the data is restricted to the team in charge of the cohort, which can be extended to collaborators with a specific research agreement.

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Acknowledgments

This work was supported by La Ligue nationale contre le cancer [Equipe Labellisée LIGUE 2017/CD]). The E3N cohort is being carried out with the financial support of the “Mutuelle Générale de l’Education Nationale” (MGEN); European Community; French League against Cancer (LNCC); Gustave Roussy Institute (IGR); French Institute of Health and Medical Research (INSERM).

Funding

This work was supported by the French National Institute of Cancer [SHSESP 2017-130 to CD]. The funder had no role in the study design, analysis and interpretation of data and in writing the manuscript.

Author information

Author notes

  1. Raphaële Castagné and Cyrille Delpierre are jointly supervised this work.

Authors and Affiliations

  1. CERPOP, UMR 1295, INSERM, Université de Toulouse III Paul Sabatier, 31000, Toulouse, France

    Eloïse Berger, Raphaële Castagné & Cyrille Delpierre

  2. Paris-Saclay University, UVSQ, INSERM, Gustave Roussy, “Exposome, Heredity, Cancer and Health” Team, CESP U1018, 94805, Villejuif, France

    Amandine Gelot, Agnès Fournier, Marie-Christine Boutron-Ruault & Gianluca Severi

  3. Nutrition and Metabolism Branch, International Agency for Research On Cancer, Lyon, France

    Laure Dossus

  4. Department of Statistics, Computer Science and Applications “G. Parenti” (DISIA), University of Florence, Florence, Italy

    Gianluca Severi

Authors
  1. Eloïse Berger
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Contributions

CD, RC, GS designed research; AG, AF, LD, MCB, GS collected and controlled the data; AG contributed to data acquisition and preparation. EB performed the statistical analysis and wrote the first draft of manuscript. CD, RC, EB, and GS discussed the results. All authors critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eloïse Berger.

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Competing interest

The authors declare no competing financial interests.

Ethical approval

The E3N study was approved by the French Commission for Data Protection and Privacy (NCT03285230, CNIL/Commission national informatique et libertés-no. 327346 V 13). All methods were carried out in accordance with relevant guidelines and regulations.

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All participants signed an informed consent form at study entry.

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Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization. The work reported in this paper was performed during Agnès Fournier’s term as a Visiting Scientist at the International Agency for Research on Cancer.

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Berger, E., Gelot, A., Fournier, A. et al. Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort. Cancer Causes Control (2024). https://doi.org/10.1007/s10552-024-01873-5

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