Table 3.
Association between cumulative number of times reported severe depressive symptomsa at each cycle and invasive breast cancer risk, NHS (2000–2012) and NHSII (2003–2013)
| All Invasive Cases | ER Positive | ER Negative | Postmenopausal at diagnosis | ||||||
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| Cases/Person-Years | Age- and calendar year Adjusted | Fully Adjustedb | Cases/Person-Years | Fully Adjustedb | Cases/Person-Years | Fully Adjustedb | Cases/Person-Years | Fully Adjustedb | |
| Nurses’ Health Study (N=2,667 cases) |
|||||||||
| 0 | 2,301/760,269 | 1 (ref) | 1 (ref) | 2,028/760,269 | 1 (ref) | 313/760,269 | 1 (ref) | 2,461/751,889 | 1 (ref) |
| 1 | 137/45,587 | 0.93 (0.78–1.10) | 0.91 (0.77–1.09) | 109/45,587 | 0.90 (0.74–1.09) | 21/45,587 | 1.05 (0.67–1.65) | 137/45,587 | 0.92 (0.77–1.09) |
| 2 | 39/14,887 | 0.79 (0.58–1.09) | 0.79 (0.57–1.09) | 31/14,887 | 0.79 (0.55–1.13) | 7/14,887 | 1.02 (0.48–2.20) | 39/14,887 | 0.79 (0.58–1.09) |
| 3+ | 20/8,394 | 0.74 (0.48–1.15) | 0.76 (0.48–1.18) | 18/8,394 | 0.89 (0.55–1.42) | 2/8,394 | 0.51 (0.12–2.06) | 20/8,394 | 0.76 (0.49–1.19) |
| Nurses’ Health Study II (N=1,347 cases) |
|||||||||
| 0 | 1,089/557,035 | 1 (ref) | 1 (ref) | 873/557,035 | 1 (ref) | 178/557,035 | 1 (ref) | 661/556,146 | 1 (ref) |
| 1 | 125/73,582 | 0.87 (0.73–1.05) | 0.88 (0.73–1.06) | 102/73,582 | 0.89 (0.72–1.09) | 18/73,582 | 0.81 (0.49–1.32) | 74/73,496 | 0.83 (0.65–1.06) |
| 2 | 58/28,254 | 1.04 (0.80–1.36) | 1.11 (0.85–1.45) | 53/28,254 | 1.24 (0.94–1.65) | 3/28,254 | 0.39 (0.12–1.22) | 37/28,210 | 1.08 (0.77–1.52) |
| 3+ | 22/12,914 | 0.86 (0.57–1.31) | 0.97 (0.63–1.48) | 15/12,914 | 0.81 (0.48–1.35) | 7/12,914 | 2.18 (1.00–4.71) | 15/12,901 | 1.01 (0.60–1.70) |
| Pooled (N=4,014 cases) |
|||||||||
| 0 | 3,390/1,317,304 | 1 (ref) | 1 (ref) | 2,901/1,317,304 | 1 (ref) | 491/1,317,304 | 1 (ref) | 3,122/1,308,035 | 1 (ref) |
| 1 | 262/119,169 | 0.90 (0.79–1.02) | 0.90 (0.79–1.02) | 211/119,169 | 0.89 (0.77–1.03) | 39/119,169 | 0.93 (0.67–1.30) | 211/119,083 | 0.89 (0.77–1.02) |
| 2 | 97/43,141 | 0.92 (0.71–1.21) | 0.95 (0.68–1.32) | 84/43,141 | 1.01 (0.65–1.56) | 10/43,141 | 0.69 (0.27–1.77) | 76/43,097 | 0.92 (0.68–1.25) |
| 3+ | 42/21,308 | 0.80 (0.59–1.09) | 0.86 (0.63–1.17) | 33/21,308 | 0.85 (0.60–1.20) | 9/21,308 | 1.19 (0.29–4.85) | 35/21,295 | 0.86 (0.61–1.20) |
a
Severe depressive symptoms defined as a score ≤52 on the Mental Health Inventory-5 scale
b
Adjusted for age, calendar year, BMI, count of AD use, age at menarche, current oral contraceptive use (NHSII only), type of PMH use, age at menopause, age at first birth & parity, history of biopsy-confirmed benign breast disease, family history of breast cancer, mammogram in prior 2 years, smoking status, physical activity, alcohol intake, AHEI score