Abstract
To elucidate the magnitude of the effect of menstrual and reproductive factors on breast cancer occurrence among Japanese women, we reviewed eight case‐control studies previously conducted in Japan and used a quantitative method (meta‐analysis) to summarize the data. While individual studies have different methods and populations, the estimated odds ratios (ORs) in the studies were statistically homogeneous for all study variables. It was confirmed that early age at menarche, late age at first birth, and premenopausal status are significantly associated with risk of breast cancer; an estimated combined OR of 0.68 (95% confidence interval (CI): 0.59‐0.77) was obtained for women with onset of menstruation after age 16 compared to those before age 14. Nulliparous women had higher risk than women with first birth before age 25 (OR=1.56 95%, CI: 1.27‐1.91). The OR for women with first birth after age 35 was 2.26 (95% CI: 1.85‐2.77) compared to women at first birth before age 25. Premenopausal women had a higher risk than women with menopause before age 50 (OR=2.21, 95% CI: 1.53‐3.20). We also found a significant protective effect of high parity after controlling for age at first birth and the other menstrual factors. The OR estimate for 3 or more births compared to nulliparity was 0.68 (95% CI: 0.54‐0.86). The meta‐analysis provided quantitative estimates of breast cancer risk among Japanese women with improved precision.
Keywords: Breast cancer, Case‐control study, Japan, Meta‐analysis, Risk factor
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REFERENCES
- 1. ) Kelsey , J. L. , Gammon , M. D. and John E. M.Reproductive factors and breast cancer . Epidemiol. Rev. , 15 , 36 – 47 ( 1993. ). [DOI] [PubMed] [Google Scholar]
- 2. ) Kvale , G. , Heuch , I. and Eide , G. E.A prospective study of reproductive factors and breast cancer. 1. Parity . Am. J. Epidemiol. , 126 , 831 – 841 ( 1987. ). [DOI] [PubMed] [Google Scholar]
- 3. ) Leon , D. A.A prospective study of the independent effects of parity and age at first birth on breast cancer incidence in England and Wales . Int. J. Cancer , 43 , 986 – 991 ( 1989. ). [DOI] [PubMed] [Google Scholar]
- 4. ) Yuan , J. M. , Yu , M. C. , Ross , R. K. , Gao , Y. T. and Henderson , B. E.Risk factors for breast cancer in Chinese women in Shanghai . Cancer Res. , 48 , 1949 – 1953 ( 1988. ). [PubMed] [Google Scholar]
- 5. ) Ewertz , M. , Duffy , S. W. , Adami , H. O. , Kvale , G. , Lund , E. , Meirik , O. , Mellemgaard , A. , Soini , I. and Tulinius , H.Age at first birth, parity and risk of breast cancer: a meta‐analysis of 8 studies from the Nordic countries . Int. J. Cancer , 46 , 597 – 603 ( 1990. ). [DOI] [PubMed] [Google Scholar]
- 6. ) Lund , E.Reproductive histories and premenopausal breast cancer: different estimates using population, neighborhood, or hospital controls . Cancer Res. , 49 , 4015 – 4019 ( 1989. ). [PubMed] [Google Scholar]
- 7. ) Parkin , D. M. , Muir , C. , Whelan , S. L. , Gao , Y. T. , Ferlay , J. and Powell , J.“Cancer Incidence in Five Continents Volume VI,” IARC Scientific Publications No. 120 ( 1992. ). IARC; , Lyon . [Google Scholar]
- 8. ) Segi , M. , Fukushima , I. , Fujisaku , S. , Kurihara , M. , Saito , S. , Asano , K. and Kamoi , M.An epidemiological study on cancer in Japan. The report of the committee for epidemiological study on cancer, supported by the Ministry of Welfare and Public Health . Gann , 48 ( Suppl ), 1 – 63 ( 1957. ). [Google Scholar]
- 9. ) Wynder , E. L. , Bross , I. J. and Hirayama , T.A study of the epidemiology of cancer of the breast . Cancer , 13 , 559 – 601 ( 1960. ). [DOI] [PubMed] [Google Scholar]
- 10. ) Yuasa , S. and MacMahon , B.Lactation and reproductive histories of breast cancer patients in Tokyo, Japan . Bull. WHO , 42 , 195 – 204 ( 1970. ). [PMC free article] [PubMed] [Google Scholar]
- 11. ) Hirohata , T. , Shigematsu , T. , Nomura , A. M. , Nomura , Y. , Horie , A. and Hirohata , I.Occurrence of breast cancer in relation to diet and reproductive history: a case‐control study in Fukuoka, Japan . Natl. Cancer Inst. Monogr. , 69 , 187 – 190 ( 1985. ). [PubMed] [Google Scholar]
- 12. ) Kato , I , Miura , S. , Kasumi , F. , Iwase , T. , Tashiro , H. , Fujita , Y. , Koyama , H. , Ikeda , T. , Fujiwara , K. , Saotome , K. , Asaishi , K. , Abe , R. , Nihei , M. , Ishida , T. , Yokoe , T. , Yamamoto , H. and Murata , M.A case‐control study of breast cancer among Japanese women: with special reference to family history and reproductive and dietary factors . Breast Cancer Res. Treat. , 24 , 51 – 59 ( 1992. ). [DOI] [PubMed] [Google Scholar]
- 13. ) Wakai , K. , Ohno , Y. , Watanabe , S. , Sakamoto , G. , Kasumi , F. , Suzuki , S. and Kubo‐Fujiwara , N.Risk factors for breast cancer among Japanese women in Tokyo: a case‐control study . J. Epidemiol. , 4 , 61 – 71 ( 1994. ). [Google Scholar]
- 14. ) Hirose , K. , Tajima , K. , Hamajima , N. , Inoue , M. , Takezaki , T. , Kuroishi , T. , Yoshida , M. and Tokudome , S.A large‐scale, hospital‐based case‐control study of risk factors of breast cancer according to menopausal status . Jpn. J. Cancer Res. , 86 , 146 – 154 ( 1995. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. ) Tulinius , H. , Day , N. E. , Johannesson , G. , Bjarnason , O. and Gonzales , M.Reproductive factors and risk for breast cancer in Iceland . Int. J. Cancer , 21 , 724 – 730 ( 1978. ). [DOI] [PubMed] [Google Scholar]
- 16. ) Hsieh , C. C. , Trichopoulos , D. , Katsouyanni , K. and Yuasa , S.Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case‐control study . Int. J. Cancer , 46 , 796 – 800 ( 1990. ). [DOI] [PubMed] [Google Scholar]
- 17. ) Tashiro , H. , Nomura , Y. and Hisamatsu , K.A case‐control study of risk factors of breast cancer detected by mass screening . Gan No Rinsho , 36 , 2127 – 2130 ( 1990. ) ( in Japanese ). [PubMed] [Google Scholar]
- 18. ) Land , C. E. , Hayakawa , N. , Machado , S. G. , Yamada , Y. , Pike , M. C. , Akiba , S. and Tokunaga , M.A case‐control interview study of breast cancer among Japanese A‐bomb survivors. I. Main effects . Cancer Causes Control , 5 , 157 – 165 ( 1994. ). [DOI] [PubMed] [Google Scholar]
- 19. ) Tajima , K. , Hirose , K. , Ogawa , H. , Yoshida , M. and Ohta , M.Hospital epidemiology: a comparative case control study of breast and cervical cancer . Gan No Rinsho , 36 , 351 – 364 ( 1990. ) ( in Japanese ). [PubMed] [Google Scholar]
- 20. ) Yoo , K. Y. , Tajima , K. , Kuroishi , T. , Hirose , K. , Yoshida , M. , Miura , S. and Murai , H.Independent protective effect of lactation against breast cancer: a case‐control study in Japan . Am. J. Epidemiol. , 135 , 726 – 733 ( 1992. ). [DOI] [PubMed] [Google Scholar]
- 21. ) Yoo , K. Y. , Tajima , K. , Miura , S. , Yoshida , M. , Murai , H. , Kuroishi , T. , Lee , Y. , Risch , H. and Dubrow , R.A hospital‐based case‐control study of breast‐cancer risk factors by estrogen and progesterone receptor status . Cancer Causes Control , 4 , 39 – 44 ( 1993. ). [DOI] [PubMed] [Google Scholar]
- 22. ) Horwitz , R. I. and Feinstein , A. R.Methodologic standards and contradictory results in case‐control research . Am. J. Med. , 66 , 556 – 565 ( 1979. ). [DOI] [PubMed] [Google Scholar]
- 23. ) Longnecker , M. P. , Orza , M. J. , Adams , M. E. , Vioque , J. and Chalmers , T. C.A meta‐analysis of alcoholic beverage consumption in relation to risk of colorectal cancer . Cancer Causes Control , 1 , 59 – 68 ( 1990. ). [DOI] [PubMed] [Google Scholar]
- 24. ) Greenland , S.Quantitative methods in the review of epidemiologic literature . Epidemiol. Rev. , 9 , 1 – 31 ( 1987. ). [DOI] [PubMed] [Google Scholar]
- 25. ) Greenland , S. and Longnecker , M. P.Methods for trend estimation from summarized dose‐response data, with applications to meta‐analysis . Am. J. Epidemiol. , 135 , 1301 – 1309 ( 1992. ). [DOI] [PubMed] [Google Scholar]
- 26. ) Health and Welfare Statistics Association . “Marriage and Fertility in Present Day in Japan” ( 1992. ). Kosaido; , Tokyo . [Google Scholar]
- 27. ) Fleiss , J. L.“Statistical Methods for Rates and Proportions,” pp. 160 – 187 ( 1981. ). John Wiley & Sons; , New York . [Google Scholar]
- 28. ) SAS Institute. “SAS User's Guide, Version 6.03” ( 1988. ). SAS Institute Inc. , Gary . [Google Scholar]
- 29. ) MacMahon , B. , Cole , P. , Lin , T. M. , Lowe , C. R. , Mirra , A. P. , Ravnihar , B. , Salber , E. J. , Valaoras , V. G. and Yuasa , S.Age at first birth and breast cancer risk . Bull. WHO , 43 , 209 – 221 ( 1970. ). [PMC free article] [PubMed] [Google Scholar]
- 30. ) DerSimonian , R. and Laird , N.Meta‐analysis in clinical trials . Controlled Clin. Trials , 7 , 177 – 188 ( 1986. ). [DOI] [PubMed] [Google Scholar]
- 31. ) Pike , M. C. , Krailo , M. D. , Henderson , B. E. , Casagrande , J. T. and Hoel , D. G.‘Hormonal’ risk factors, ‘breast tissue age’ and the age‐incidence of breast cancer . Nature , 303 , 767 – 770 ( 1983. ). [DOI] [PubMed] [Google Scholar]
- 32. ) Dickersin , K. and Berlin , J. A.Meta‐analysis: state‐of‐the‐science . Epidemiol. Rev. , 14 , 154 – 177 ( 1992. ). [DOI] [PubMed] [Google Scholar]
- 33. ) Olkin , I.Statistical and theoretical considerations in meta‐analysis. J . Clin. Epidemiol. , 48 , 133 – 146 ( 1995. ). [DOI] [PubMed] [Google Scholar]
- 34. ) Anello , C. and Fleiss , J. L.Exploratory or analytic meta‐analysis: should we distinguish between them ? J. Clin. Epidemiol. , 48 , 109 – 116 ( 1995. ). [DOI] [PubMed] [Google Scholar]
