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Int J Cancer. 2019 Feb 25. doi: 10.1002/ijc.32231. [Epub ahead of print]

The preventable burden of breast cancers for premenopausal and postmenopausal women in Australia: A pooled cohort study.

Author information

1
Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
2
Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
3
Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia.
4
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
5
Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.
6
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
7
ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.
8
Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia.
9
Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
10
Adelaide Medical School, University of Adelaide, Adelaide, Australia.
11
Centre for Vision Research, Westmead Institute for Medical research, University of Sydney, Sydney, Australia.
12
Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
13
Breast Cancer Network Australia, Melbourne, Australia.
14
ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia.
15
School of Life and Environmental Sciences Charles Perkins Centre, University of Sydney, Sydney, Australia.

Abstract

Estimates of the future breast cancer burden preventable through modifications to current behaviours are lacking. We assessed the effect of individual and joint behaviour modifications on breast cancer burden for premenopausal and postmenopausal Australian women, and whether effects differed between population subgroups. We linked pooled data from six Australian cohort studies (n = 214,536) to national cancer and death registries, and estimated the strength of the associations between behaviours causally related to cancer incidence and death using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We combined these estimates to calculate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), and compared PAFs for population subgroups. During the first 10 years follow-up, there were 640 incident breast cancers for premenopausal women, 2,632 for postmenopausal women, and 8,761 deaths from any cause. Of future breast cancers for premenopausal women, any regular alcohol consumption explains 12.6% (CI = 4.3-20.2%), current use of oral contraceptives for ≥5 years 7.1% (CI = 0.3-13.5%), and these factors combined 18.8% (CI = 9.1-27.4%). Of future breast cancers for postmenopausal women, overweight or obesity (BMI ≥25 kg/m2 ) explains 12.8% (CI = 7.8-17.5%), current use of menopausal hormone therapy (MHT) 6.9% (CI = 4.8-8.9%), any regular alcohol consumption 6.6% (CI = 1.5-11.4%), and these factors combined 24.2% (CI = 17.6-30.3%). The MHT-related postmenopausal breast cancer burden varied by body fatness, alcohol consumption and socio-economic status, the body fatness-related postmenopausal breast cancer burden by alcohol consumption and educational attainment, and the alcohol-related postmenopausal breast cancer burden by breast feeding history. Our results provide evidence to support targeted and population-level cancer control activities.

KEYWORDS:

breast cancer; cohort; population attributable fraction; preventable burden; risk factors

PMID:
30802946
DOI:
10.1002/ijc.32231

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