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Examining the etiology of early-onset breast cancer in the Canadian Partnership for Tomorrow’s Health (CanPath)

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Abstract

Purpose

Breast cancer incidence among younger women (under age 50) has increased over the past 25 years, yet little is known about the etiology among this age group. The objective of this study was to investigate relationships between modifiable and non-modifiable risk factors and early-onset breast cancer among three prospective Canadian cohorts.

Methods

A matched case–control study was conducted using data from Alberta’s Tomorrow Project, BC Generations Project, and the Ontario Health Study. Participants diagnosed with breast cancer before age 50 were identified through provincial registries and matched to three control participants of similar age and follow-up. Conditional logistic regression was used to examine the association between factors and risk of early-onset breast cancer.

Results

In total, 609 cases and 1,827 controls were included. A body mass index ≥ 30 kg/m2 was associated with a lower risk of early-onset breast cancer (OR 0.65; 95% CI 0.47–0.90), while a waist circumference ≥ 88 cm was associated with an increased risk (OR 1.58; 95% CI 1.18–2.11). A reduced risk was found for women with ≥ 2 pregnancies (OR 0.76; 95% CI 0.59–0.99) and a first-degree family history of breast cancer was associated with an increased risk (OR 1.95; 95% CI 1.47–2.57).

Conclusions

In this study, measures of adiposity, pregnancy history, and familial history of breast cancer are important risk factors for early-onset breast cancer. Evidence was insufficient to conclude if smoking, alcohol intake, fruit and vegetable consumption, and physical activity are meaningful risk factors. The results of this study could inform targeted primary and secondary prevention for early-onset breast cancer.

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Data availability

The data that support the findings of this study are available from Alberta’s Tomorrow Project, BC Generations Project, Ontario Health Study, and Cancer Care Ontario but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Alberta’s Tomorrow Project, BC Generations Project, Ontario Health Study, and Cancer Care Ontario.

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Acknowledgments

We would like to thank and acknowledge the Albert Cancer Registry, Alberta’s Tomorrow Project, BC Generations Project, Ontario Health Study, and Cancer Care Ontario. Alberta’s Tomorrow Project is only possible because of the commitment of its research participants, its staff and its funders: Alberta Health, Alberta Cancer Foundation, Canadian Partnership Against Cancer and Health Canada, and substantial in kind funding from Alberta Health Services. Cancer registry data was obtained through linkage with Surveillance & Reporting, Cancer Research & Analytics, Cancer Care Alberta. The views expressed herein represent the views of the author(s) and not of the data sources or any of its funders. The views expressed herein represent the views of the author(s) and not of the data sources or any of its funders.

Funding

Dr. Darren R. Brenner is supported by the Armstrong Investigatorship in Molecular Epidemiology from the Cumming School of Medicine at the University of Calgary and a Canadian Institutes of Health Research Grant (#397332). Dylan O’Sullivan was supported by an Ontario Graduate Scholarship and a Chen-Aronson Fellowship in Causes of Cancer.

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Author notes

  1. Joy Pader and Robert B. Basmadjian have contributed equally.

Authors and Affiliations

  1. Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada

    Joy Pader, Yibing Ruan, Christine Friedenreich & Darren R. Brenner

  2. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Robert B. Basmadjian, Christine Friedenreich & Darren R. Brenner

  3. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Dylan E. O’Sullivan

  4. Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Dylan E. O’Sullivan, Nicole E. Mealey, Christine Friedenreich & Darren R. Brenner

  5. Department of Epidemiology, Biostatistics and Public Health Practice, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Rachel Murphy

  6. Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Edwin Wang

  7. Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada

    May Lynn Quan

  8. Department of Oncology and Community Health Sciences, University of Calgary, Heritage Medical Research Building, 3300 Hospital Dr NW, Room 382B, Calgary, AB, T2N 4Z6, Canada

    Darren R. Brenner

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  1. Joy Pader
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Contributions

DRB: Conception and design. DRB, RBB, DEO and JP: Development of methodology. DRB, CMF, RM, EW, MLQ, and JP: Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.). JP, RBB, DEO and DRB: Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis). JP, RBB, DEO and DRB, NEM, YR, CMF, RM, EW, and MLQ: Writing, review, and/or revision of the manuscript. JP, RBB: Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases). DRB: Study supervision.

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Correspondence to Darren R. Brenner.

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Pader, J., Basmadjian, R.B., O’Sullivan, D.E. et al. Examining the etiology of early-onset breast cancer in the Canadian Partnership for Tomorrow’s Health (CanPath). Cancer Causes Control 32, 1117–1128 (2021). https://doi.org/10.1007/s10552-021-01460-y

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