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A Multicenter Matched Case Control Study of Breast Cancer Risk Factors among Women in Karachi, Pakistan

  • Shamsi, Uzma (Epidemiology and Biostatistics, Department of Community Health Sciences, Aga Khan University Hospital) ;
  • Khan, Shaista (Department of Surgery, Aga Khan University Hospital) ;
  • Usman, Sheheryar (Department of Medicine, P.A.F Hospital) ;
  • Soomro, Saleem (Department of Surgery, Jinnah Postgraduate Medical Center) ;
  • Azam, Iqbal (Epidemiology and Biostatistics, Department of Community Health Sciences, Aga Khan University Hospital)
  • Published : 2013.01.31

Abstract

Background: Breast cancer (BC), the most common female cancer in Pakistan, is associated with a very high mortality. However, the roles of individual risk factors for BC among Pakistani women are still controversial. To assess potential risk factors for BC, a matched case-control study was conducted in two tertiary care hospitals of Karachi, Pakistan. Materials and Methods: The study population included 297 pathologically confirmed incident cases of BC patients diagnosed between January 2009 and December 2010. 586 controls without any history of BC were matched on hospital and ${\pm}5$ years of ages. Results: Positive family history of BC (MOR=1.72; 95%CI: 1.10, 2.80 for first degree vs. none), single marital status (MOR=1.55; 95%CI: 1.10, 2.39 for single/divorced/widowed women vs. married women), older age at menopause (MOR=3.92; 95%CI: 2.52, 6.18 for menopausal women aged below 45 years, MOR=6.42; 95%CI: 3.47, 11.98 for menopausal women above 45 years of age compared with premenopausal women) conferred an increased risk of BC for women. Increasing parity decreased the risk of BC (MOR=0.90; 95%CI: 0.85, 0.97 for each live birth). Intake of Vitamin D supplements (MOR=0.30; 95%CI: 0.12, 0.81 for ${\leq}3$ years and MOR=0.27; 95%CI: 0.13, 0.56 for >3 years) was protective compared to non-users of Vitamin D. Conclusions: This study confirmed only few of the recognized risk factors in Pakistani women. The protective effect of Vitamin D is important from public health perspective and needs to be further explored through a randomized controlled trial.

Keywords

References

  1. Aghassi-Ippen M, Green MS, Shohat T (2002). Familial risk factors for breast cancer among Arab women in Israel. Eur J Cancer Prev, 11, 327-31. https://doi.org/10.1097/00008469-200208000-00003
  2. Bhurgri Y, Bhurgri A, Hassan SH, et al (2000). Cancer incidence in Karachi, Pakistan: first results from Karachi cancer registry. Int J Cancer, 85, 325-9. https://doi.org/10.1002/(SICI)1097-0215(20000201)85:3<325::AID-IJC5>3.0.CO;2-J
  3. Bhurgri Y, Kayani N, Faridi N, et al (2007). Patho-epidemiology of breast cancer in Karachi '1995-1997'. Asian Pac J Cancer Prev, 8, 215-20.
  4. Braverman AS (2007). Evidence that high calcium and vitamin D intake decrease the risk of breast cancer in premenopausal women: implications for breast cancer prevention and screening. South Med J, 100, 1061-2.
  5. Butt Z, Haider SF, Arif S, et al (2012). Breast cancer risk factors: A comparison between pre-menopausal and postmenopausal women. JPMA, 62, 120-4.
  6. Chen P, Hu P, Xie D, et al (2009). Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat, 121, 469-77.
  7. De Brabander B, Gerits P (1999). Chronic and acute stress as predictors of relapse in primary breast cancer patients. Patient Educ Counsel, 37, 265-72. https://doi.org/10.1016/S0738-3991(99)00030-0
  8. Ebrahimi M, Vahdaninia M, Montazeri A (2002). Risk factors for breast cancer in Iran: a case-control study. Breast Cancer Res, 4, 10. https://doi.org/10.1186/bcr465
  9. Egan KM, Stampfer MJ, Rosner BA, et al (1998). Risk factors for cancer in women with a breast cancer family history. Cancer Epidemiol Biomarkers Prev, 7, 359-64.
  10. Ewertz M, Duffy SW (1988). Risk of breast cancer in relation to reproductive factors in Denmark. Br J Cancer, 58, 99-104. https://doi.org/10.1038/bjc.1988.172
  11. Faheem M, Khurram M, Jafri IA, et al (2007). Risk factors for breast cancer in patients treated at NORI Hospital, Islamabad. J Pak Med Assoc, 57, 242-5.
  12. Fox B (1996). The role of psychological factors in cancer incidence and prognosis. Oncology, 9, 245-56.
  13. Gajalakshmi CK, Shanta V (1991). Risk factors for female breast cancer. A hospital-based case-control study in Madras, India. Acta Oncol, 30, 569-74. https://doi.org/10.3109/02841869109092419
  14. Gilani GM, Kamal S (2004). Risk factors for breast cancer in Pakistani women aged less than 45 years. Ann Hum Biol, 31, 398-407. https://doi.org/10.1080/0301446042000226763
  15. Ginsberg A, Price S, Ingram D, Nottage E (1996). Life events and the risk of breast cancer: a case-control study. Eur J Cancer, 32, 2049-52. https://doi.org/10.1016/S0959-8049(96)00275-4
  16. Jacobs J (2000). Early and chronic stress and their relation to breast cancer. Psychol Med, 30, 669-78. https://doi.org/10.1017/S0033291799002020
  17. Jasmin C, Le MG, Marty P, Herzberg R (1990). Evidence for a link between certain psychological factors and the risk of breast cancer in a case-control study. Psycho-Oncologic Group (P.O.G.). Ann Oncol, 1, 22-9.
  18. Kruk J (2007). Association of lifestyle and other risk factors with breast cancer according to menopausal status: a case-control study in the region of Western Pomerania (Poland)." Asian Pac J Cancer Prev, 8, 513-24.
  19. Lee E, Ma H, McKean-Cowdin R, et al (2008). Effect of reproductive factors and oral contraceptives on breast cancer risk in BRCA1/2 mutation carriers and noncarriers: results from a population-based study. Cancer Epidemiol Biomarkers Prev, 17, 3170-8. https://doi.org/10.1158/1055-9965.EPI-08-0396
  20. Lipkin M, Newmark HL (1999). Vitamin D, calcium and prevention of breast cancer: a review. J Am Coll Nutr, 18, 392-7. https://doi.org/10.1080/07315724.1999.10718903
  21. Malik IA (2002). Clinico-pathological features of breast cancer in Pakistan. J Pak Med Assoc, 52, 100-4.
  22. Malik IA, Mubarik A, Luqman M, et al (1992). Epidemiological and morphological study of breast cancer in Pakistan. J Environ Pathol Toxicol Oncol, 11, 353.
  23. McPherson KSC, Dixon JM (2000). ABC of breast diseases. Breast cancer-epidemiology, risk factors, and genetics. BMJ, 321, 624-8. https://doi.org/10.1136/bmj.321.7261.624
  24. Norsa'adah B, Rusli BN, Imran AK, Naing I, Winn T (2005). Risk factors of breast cancer in women in Kelantan, Malaysia. Singapore Med J, 46, 698-705.
  25. Pakseresht S, Ingle GK, Bahadur AK, et al (2009). Risk factors with breast cancer among women in Delhi. Indian J Cancer, 46, 132-8. https://doi.org/10.4103/0019-509X.49151
  26. Parsa P, Parsa B (2009). Effects of reproductive factors on risk of breast cancer: a literature review. Asian Pac J Cancer Prev, 10, 545-50.
  27. 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 Biomarkers Prev, 19, 1643-54. https://doi.org/10.1158/1055-9965.EPI-10-0188
  28. Rao DN, Ganesh B, Desai PB (1994). Role of reproductive factors in breast cancer in a low-risk area: a case-control study. Br J Cancer, 70, 129-32. https://doi.org/10.1038/bjc.1994.261
  29. Sezer H, Yilmaz M, Gurler H, Koyuncu A (2011). Breast cancer risk factors in turkey: a hospital-based case-control study. Asian Pac J Cancer Prev, 12, 2317-22.
  30. Sohail S, Alam SN (2007). Breast cancer in pakistan - awareness and early detection. J Coll Physicians Surg Pak, 17, 711-2.
  31. Usmani K, Khanum A, Afzal H, Ahmad N (1996). Breast carcinoma in Pakistani women. J Pak Med Assoc, 15, 251-3.
  32. Welsh J (2007). Vitamin D and prevention of breast cancer. Acta Pharmacol Sin, 28, 1373-82. https://doi.org/10.1111/j.1745-7254.2007.00700.x
  33. Yuan JM, Yu MC, Ross RK, Gao YT, Henderson BE (1988). Risk factors for breast cancer in Chinese women in Shanghai. Cancer Res, 48, 1949-53.

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