A Multilevel Model of Postmenopausal Breast Cancer Incidence

Abstract

Background: Breast cancer has a complex etiology that includes genetic, biologic, behavioral, environmental, and social factors. Etiologic factors are frequently studied in isolation with adjustment for confounding, mediating, and moderating effects of other factors. A complex systems model approach may present a more comprehensive picture of the multifactorial etiology of breast cancer.Methods: We took a transdisciplinary approach with experts from relevant fields to develop a conceptual model of the etiology of postmenopausal breast cancer. The model incorporated evidence of both the strength of association and the quality of the evidence. We operationalized this conceptual model through a mathematical simulation model with a subset of variables, namely, age, race/ethnicity, age at menarche, age at first birth, age at menopause, obesity, alcohol consumption, income, tobacco use, use of hormone therapy (HT), and BRCA1/2 genotype.Results: In simulating incidence for California in 2000, the separate impact of individual variables was modest, but reduction in HT, increase in the age at menarche, and to a lesser extent reduction in excess BMI >30 kg/m 2 were more substantial.

The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions

“…Yet, despite conceptual acknowledgment of the importance of neighborhoods for cancer, neighborhood social and built environment factors have not often been considered in cancer research. Although documented associations between neighborhood social and built environments and health behaviors (eg, physical activity and diet) are of relevance to cancer etiology and outcomes, other aspects of carcinogenesis and cancer survivorship warrant a dedicated review and discussion of the ways in which they are affected by neighborhood environments . In light of the public health importance of malignancies and the interventions possible through modification of neighborhood social and built environments, it is opportune to review the extent to which these factors are being addressed in cancer research.…”

Environmental Determinants of Breast Cancer

“…The multitude of environmental factors to consider let alone the ever-expanding understanding of genetic variants, gene-environment interactions, and tumor characteristics makes it difficult to grasp the full picture of how the external environment plays a causal role in breast cancer incidence and mortality. Even attempts to model the complex factors involved in breast cancer etiology have to, by necessity, leave out the full scope of factors known or suspected to be involved in the origins of this cancer (53). In addition, for epidemiologic studies, there are multiple methodologic challenges to the investigation of environmental factors and breast cancer (51).…”

“…There is not one cause of breast cancer but many (53). There is not one type of breast cancer but several (69).…”

Transdisciplinary approaches enhance the production of translational knowledge

“…36–38 Furthermore, establishing transdisciplinary teams can promote communication between diverse subject matter experts to advance the development of new complex systems models. 39 These models can allow researchers to think about the relationships between putative causal factors from multiple fields in novel ways. Such methods create a unique opportunity to develop the multilevel hypotheses that are needed to address complex health problems.…”