Reproductive risk factor associations with lobular and ductal carcinoma in the Carolina Breast Cancer Study
Menée aux Etats-Unis à partir de données portant sur 2 856 patientes atteintes d'un carcinome canalaire, sur 326 patientes atteintes d'un carcinome lobulaire et sur 473 patientes atteintes d'un carcinome mixte canalaire/lobulaire entre 1993 et 2013, cette étude évalue l'association entre divers facteurs reproductifs (âge à la première naissance, durée de l'allaitement, utilisation d'une contraception orale, etc.) et le risque de développer un cancer du sein par sous-type moléculaire
Background : Invasive lobular breast tumors display unique reproductive risk factor profiles. Lobular tumors are predominantly Luminal A subtype, and it is unclear whether reported risk factor associations are independent of molecular subtype. Methods : Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between risk factors and histologic subtype [ductal (n = 2,856), lobular (n = 326), and mixed ductal–lobular (n = 473)] in the Carolina Breast Cancer Study (1993–2013). Three-marker immunohistochemical clinical subtypes were defined as Luminal A (ER+ or PR+/HER2-), Luminal B (ER+ or PR+/HER2+), Triple Negative (ER−/PR−/HER2-), and HER2+ (ER−/PR−/HER2+). Results : In case–case analyses compared to ductal, lobular tumors were significantly associated with lactation duration > 12 months [OR 1.86, 95% CI (1.33–2.60)], age at first birth ≥ 26 years [OR: 1.35, 95% CI: (1.03–1.78)], and current oral contraceptive use [OR: 1.86, 95% CI: (1.08–3.20)]. Differences in risk factor associations between ductal and lobular tumors persisted after restricting to Luminal A subtype. Conclusions : Lobular tumors were associated with older age at first birth, increased lactation duration, and current oral contraceptive use. Etiologic heterogeneity by histology persisted after restricting to Luminal A subtype, suggesting both tumor histology and intrinsic subtype play integral parts in breast cancer risk.