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Risk factors for uncommon histologic subtypes of breast cancer using centralized pathology review in the Breast Cancer Family Registry

  • Epidemiology
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Abstract

Epidemiologic studies of histologic types of breast cancer including mucinous, medullary, and tubular carcinomas have primarily relied on International Classification of Diseases-Oncology (ICD-O) codes assigned by local pathologists to define histology. Using data from the Breast Cancer Family Registry (BCFR), we compared histologic agreement between centralized BCFR pathology review and ICD-O codes available from local tumor registries among 3,260 breast cancer cases. Agreement was low to moderate for less common histologies; for example, only 55 and 26 % of cases classified as mucinous and medullary, respectively, by centralized review were similarly classified using ICD-O coding. We then evaluated risk factors for each histologic subtype by comparing each histologic case group defined by centralized review with a common set of 2,997 population-based controls using polytomous logistic regression. Parity [odds ratio (OR) = 0.4, 95 % confidence interval (95 % CI): 0.2–0.9, for parous vs. nulliparous], age at menarche (OR = 0.5, 95 % CI: 0.3–0.9, for age ≥13 vs. ≤11), and use of oral contraceptives (OCs) (OR = 0.5, 95 % CI: 0.2–0.8, OC use >5 years vs. never) were associated with mucinous carcinoma (N = 92 cases). Body mass index (BMI) (OR = 1.05, 95 % CI: 1.0–1.1, per unit of BMI) and high parity (OR = 2.6, 95 % CI: 1.1–6.0 for ≥3 live births vs. nulliparous) were associated with medullary carcinoma (N = 90 cases). We did not find any associations between breast cancer risk factors and tubular carcinoma (N = 86 cases). Relative risk estimates from analyses using ICD-O classifications of histology, rather than centralized review, resulted in attenuated, and/or more imprecise, associations. These findings suggest risk factor heterogeneity across breast cancer tumor histologies, and demonstrate the value of centralized pathology review for classifying rarer tumor types.

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Abbreviations

BCFR:

Breast Cancer Family Registry

BMI:

Body mass index

CI:

Confidence interval

ER:

Estrogen receptor

HRT:

Hormone replacement therapy

ICD-O:

International Classification of Diseases-Oncology codes

OC:

Oral contraceptives

OR:

Odds ratio

PR:

Progesterone receptor

SEER:

Surveillance, Epidemiology and End Results

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Acknowledgments

This study was supported through the National Cancer Institute, National Institutes of Health under RFA-CA-06-503, Cancer Care Ontario (U01 CA69467), Cancer Prevention Institute of California (U01 CA694117), University of Melbourne (U01 CA69638) and through cooperative agreements with members of the Breast Cancer Family Registry (BCFR) and Principal Investigators. The Australian Breast Cancer Family Study was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council and the Victorian Health Promotion Foundation. The recruitment of controls by the Northern California Cancer Center was supported in part by National Institutes of Health Grant U01CA 71966. The recruitment of controls in Ontario was supported by the Canadian Breast Cancer Research Initiative. This study was also supported by a Ruth L. Kirschstein National Research Service Award T32 Training Grant. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the BCFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR. We acknowledge the important contribution of Dr. A.S. Whittemore to the development of the three studies.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St., 7th Floor, New York, NY, 10032, USA

    Meghan E. Work, Yuyan Liao, Fang Fang Zhang & Mary Beth Terry

  2. Department of Molecular Genetics, Cancer Care Ontario, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Irene L. Andrulis

  3. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Julia A. Knight

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Julia A. Knight

  5. Department of Laboratory Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Frances O’Malley & Anna Marie Mulligan

  6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Frances O’Malley & Anna Marie Mulligan

  7. Cancer Prevention Institute of California, Fremont, CA, USA

    Esther M. John & Dee W. West

  8. Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA

    Esther M. John, Dee W. West & Teri A. Longacre

  9. Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, VIC, Australia

    John L. Hopper, Roger L. Milne & Graham G. Giles

  10. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia

    Graham G. Giles

  11. Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia

    Melissa C. Southey

  12. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA

    Hanina Hibshoosh & Mary Beth Terry

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  1. Meghan E. Work
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Correspondence to Mary Beth Terry.

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Work, M.E., Andrulis, I.L., John, E.M. et al. Risk factors for uncommon histologic subtypes of breast cancer using centralized pathology review in the Breast Cancer Family Registry. Breast Cancer Res Treat 134, 1209–1220 (2012). https://doi.org/10.1007/s10549-012-2056-y

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  • DOI: https://doi.org/10.1007/s10549-012-2056-y

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